Abstract
BackgroundArmed 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.MethodsWe 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.DiscussionThe 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.
Highlights
Armed conflict erupted in eastern Ukraine in 2014 and still continues
Vasylyeva et al recently demonstrated that HIV viral lineages have moved from Donetsk and Luhansk in eastern Ukraine to other parts of Ukraine, corresponding to the movement of people displaced during the armed conflict [7]
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 Hepatitis C virus (HCV) rates among female sex workers (FSWs) and their clients
Summary
Study setting The study will take place in Dnipro, an industrial city in eastern Ukraine, with a population of approximately 1 million [34]. The qualitative component of the study, including the in-depth interviews, participant diaries, and archival review will explore the influence of conflict at the individual level and how this changes over time. Archival review Data from the qualitative strand will be triangulated with primary archival data, such as newspapers, parliamentary debate transcripts, and municipal records from the State Statistics Service of Ukraine, the Ministry of Health of Ukraine, and country-level behavioural surveys This data will establish the social, geopolitical, and economic milieu in which the experience of individual FSW/client is embedded as conflict continues to evolve. The model structure will capture the influences identified through the cross-sectional surveys, in-depth interviews, and participant diaries and will reflect the empirical understanding of how conflict may be changing sex work and associated HIV and HCV risk in Dnipro. Incoming data will be integrated throughout the study to inform changes in the questionnaires and interview guides
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