title: Sex, drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine.
abstract: METHODS
  One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010-2011.
  
  
  OBJECTIVE
  Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion.
  
  
  METHODS
  Retrospective cohort study involving record reviews.
  
  
  RESULTS
  Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert.
  
  
  CONCLUSIONS
  In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.
authors.affiliation: International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: O
authors.initials: O
authors.lastname: Denisiuk
authors.affiliation: International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: P
authors.initials: P
authors.lastname: Smyrnov
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: World Health Organization India Country Office, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Achanta
authors.affiliation: International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: K
authors.initials: K
authors.lastname: Boyko
authors.affiliation: Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operational Research Unit (LUXOR), MSF-Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Khogali
authors.affiliation: World Health Organization India Country Office, New Delhi, India.
authors.forename: B
authors.initials: B
authors.lastname: Naik
authors.affiliation: Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operational Research Unit (LUXOR), MSF-Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
keywords: HIV prevention; HIV seroconversion; HIV testing; injection drug users; most-at-risk populations