ORIGINAL RESEARCH ARTICLE Multicity HIV seroprevalence in street youth, Ukraine C L Robbins PhD* † , L Zapata PhD † , D M Kissin MD MPH † , N Shevchenko MD ‡ , R Yorick MD MPH § , H Skipalska ‡ , E Finnerty**, T Ornstein**, P A Marchbanks PhD † , D J Jamieson MD MPH † and S D Hillis PhD † *Epidemic Intelligence Service; † Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; ‡ HealthRight International, Kyiv, Ukraine; § HealthRight International, St Petersburg, Russia; **HealthRight International, New York, NY, USA Summary: We conducted the first systematic, community-based, multicity assessment outside the USA of HIV seroprevalence, risk factors and linkage into clinical services among 929 street youth. After city-wide mapping, we used time-location sampling and randomly selected 74 venues in Odesa, Kyiv and Donetsk, Ukraine. Rapid HIV testing with post-test counselling was offered to all eligible youths aged 15–24 years. Overall, 18.4% (95% confidence interval 16.2–20.2) were HIV positive and 85% had previously unknown status. Rates were identical by sex. Subgroups with highest rates included orphans (26%), youths with histories of exchanging sex (35%), sexually transmitted infections (STIs) (37%), injection drug use (IDU) (42%) and needle sharing (49%). Independent predictors, similar across age groups and city, included being orphaned, time on the street, history of anal sex, STIs, exchanging sex, any drug use, IDU and needle sharing. Two-thirds (68%) of HIV-positive youths were linked to services. This high-risk population has many immediate needs. Keywords: HIV, Europe, epidemiology, high-risk screening INTRODUCTION Recent reports suggest that half of all new cases of HIV in the world occur in youths aged 15–24 year, 1–3 and HIV is the second leading cause of death among youths aged 20–24 years. 4 Multiple international donor organizations acknowledge young people are at increased risk of HIV/AIDS. 2 Although youths constitute 29% of the total population in developing countries, 5 and are at high risk, many young people lack access to HIV prevention, testing and treatment services. 1,2 Youths who are minors (aged ,18 years) face additional chal- lenges as they may lack legal authority to access HIV testing without parental consent and yet be unable to obtain such consent. This gap in access constitutes a breach of the widely endorsed universal access framework, which advocates that equal access to comprehensive HIV prevention, treatment, care and support should be available to all who need it. 1,6 Certain subpopulations of young people, such as street youth, are at even greater risk of HIV/AIDS. 3,6 Street youth, or young people aged 15 –24 years living part-time or full-time on the street, often have social risk factors such as abuse, neglect, abandonment and deficient familial support, which may lead to sexual and drug-use risk-taking behaviours. 7–11 Risk of HIV infection among street youth is further increased if they inject drugs or exchange sex for money or goods. 3,7 Moreover, the very characteristics that increase vulnerability of street youth (e.g. living outside of parental care) also create barriers to HIV prevention, testing and care. 1,2,8 – 11 Although it is generally accepted that street youth possess an elevated risk of HIV, studies addressing HIV seroprevalence have primarily been based on convenience samples of shelter populations in single cites in the USA or Canada, which have found rates ranging from 0.3% to 11.5%. 12–16 The three studies that attempt to avoid the biases of convenience sampling were conducted in single cities in Canada, the USA and Eastern Europe, and tended to report higher seroprevalences ranging from 2.8% to 37%. 9,17,18 High HIV seroprevalences among street youth in single cities may reflect isolated geographic out- breaks; in contrast, a systematic, multicity, community-based study would shed light on whether high HIV rates among street youth are a generalized phenomenon. To date, the only multicity report was based on a convenience sample from a USA population of youths accessing shelters or medical clinics nearly two decades ago, and reported a seroprevalence of 2.3%. 19 Thus, previous estimates of HIV seroprevalence among street youth may have been biased by sampling approaches. Valid estimates of the size of the street youth population do not exist, but up to 100,000,000 worldwide have been cited. 20 The size of the street youth population in Ukraine, estimated at 40,000 – 300,000, 3 rivals estimates for other populations most at risk for HIV infection, such as sex workers (110,000) and injection drug users (325,000). 21 Although there is a size- able street youth population, little is known about the HIV ser- oprevalence or risk factors of those in Ukraine, which has one of the fastest growing HIV epidemics in the world. 2,8,9 As of 2007, 440,000 children and adults 15 years living in Ukraine were estimated to have HIV/AIDS. 11 Although in Ukraine, many Correspondence to: C L Robbins, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway NE, Mailstop K-22, Atlanta, GA 30341-3724, USA Email: clrobbins@cdc.gov DOI: 10.1258/ijsa.2010.010097. International Journal of STD & AIDS 2010; 21: 489–496