Assessing the influence of conflict on the dynamics of sex work and the HIV and HCV epidemics in Ukraine: protocol for an observational, ethnographic, and mathematical modeling study

Abstract

Background Armed conflict erupted in eastern Ukraine in 2014 and still continues. This conflict has resulted in an intensification of poverty, displacement and migration, and has weakened the local health system. Ukraine has some of the highest rates of HIV and Hepatitis C (HCV) in Europe. Whether and how the current conflict, and its consequences, will lead to changes in the HIV and HCV epidemic in Ukraine is unclear. Our study aims to characterize how the armed conflict in eastern Ukraine and its consequences influence the pattern, practice, and experience of sex work and how this affects HIV and HCV rates among female sex workers (FSWs) and their clients. Methods We are implementing a 5-year mixed methods study in Dnipro, eastern Ukraine. Serial mapping and size estimation of FSWs and clients will be conducted followed by bio-behavioral cross-sectional surveys among FSWs and their clients. The qualitative component of the study will include in-depth interviews with FSWs and other key stakeholders and participant diaries will be implemented with FSWs. We will also conduct an archival review over the course of the project. Finally, we will use these data to develop and structure a mathematical model with which to estimate the potential influence of changes due to conflict on the trajectory of HIV and HCV epidemics among FSW and clients. Discussion The limited data that exists on the effect of conflict on disease transmission provides mixed results. Our study will provide rigorous, timely and context-specific data on HIV and HCV transmission in the setting of conflict. This information can be used to inform the design and delivery of HIV and HCV prevention and care services.

Exploring the dynamics of workplace typologies for sex workers in Eastern Ukraine

“…The study took place in Dnipro, Dnipropetrovsk oblast, Ukraine, an industrial city of 1-million people located approximately 200 km from the conflict zone in the Donbas region of Ukraine. Dnipro has become a key destination for internally displaced persons, and a transit city for frontline forces (Becker et al, 2019;UNHCR, 2017). There are approximately 1087 (range 817-1357) sex workers in Dnipro (McClarty et al, 2018).…”

“…Sampling followed a two-stage sampling design: in the first stage, a representative sample of hotspots was randomly selected after stratifying the hotspots by administrative division and type of hotspot; in the second stage, sex workers at each hotspot were randomly sampled. The sample size for each selected hotspot was proportional to the size of the sex worker population estimated in the hotspot from the mapping (Becker et al, 2019).…”

“…The survey consisted of questions around socio-demographic characteristics, numbers and types of sexual partners, HIV and HCV risk behaviours and experiences, programme/healthcare access, and questions specific to the influence of conflict on sex workers' lives and livelihoods. Those who provided consent received HIV and HCV rapid testing conducted by a certified medical worker; pre-and post-test counselling were also provided (Becker et al, 2019). Participants were compensated with a 250 UAH ($9.20 USD) honorarium.…”

“…Our variables of interest included those describing the organisation and practice of sex work, and experiences of violence and feeling of safety while doing sex work (grounded in our project's conceptual framework, see Becker et al, 2019). Variables of interest included are: main workplace for meeting clients in the past 30 days, self-reported 'prestige' of primary workplace (derived from the question: 'How would you rate the prestige of this place' and referring to their main workplace), number of regular client (frequent and familiar clients with consistent and repeated encounters which become expected) and occasional client (unfamiliar or sporadic clients from which patronage is not expected) visits in a 30-day period, number of military clients in a 30-day period, hourly wage (derived from the question: 'How much do you get paid for yourself per hour?…”

“…The HIV prevalence among female sex workers in Ukraine is approximately five times that of the adult general population (UNAIDS, 2018). This paper exists within a larger project which aims to assess the influence of conflict on the dynamics of sex work and the HIV and HCV epidemics in Dnipro, Ukraine (Becker et al, 2019).…”