How Can You Touch This Child? What Kind of Woman Are You? Provider Perspectives on Stigma, Victimization and Violence Among Native and Ethnic Minority Street-Connected Youth in Tbilisi, Georgia

Background and purpose: Street-connected youth, defined as young people aged 10-19 years old who spend most of their time living and/or working on the street, are highly vulnerable to HIV/AIDS. In the Republic of Georgia, the site of the present study, the government has identified street-connected youth as a key population in the National HIV/AIDS Strategic Plan. Studies estimate that 2,500 street-connected youth live in Georgia, with approximately 1,000 residing in the capitol city of Tbilisi. In recent years, social service organizations have developed to meet the complex needs of street-connected youth, many of whom are vulnerable to social, economic and sexual exploitation and abuse. Despite this growth, little research has examined how social service providers understand the social contexts in which street-connected youth live, and how these contexts affect their risk for HIV/AIDS. The present paper interviewed key informants who provide services to street-connected youth in order to understand provider perspectives on street-connected youth’s vulnerability to HIV and the extent to which providers are engaged with the country’s HIV/AIDS strategic plan.

Methods: Trained interviewers conducted individual semi-structured interviews with 22 key informants (68% female; 32% male) from governmental institutions and social service organizations (n=6 social workers, n=5 psychologists, n=5 peer educators, n=4 managers and n=2 mobile health officers). Informants were asked to discuss their perspectives in three areas: (1) the social network characteristics of street-connected youth, (2) youth’s involvement in substance use and sexual behaviors related to HIV/AIDS, and (3) the social contexts of youth engagement and service delivery. Interviews were conducted in Georgian and a written transcript was produced for each interview. Three independent coders conducted a content analysis of the data in Dedoose using a theoretically-grounded codebook and open coding. Forwards-backwards translation methods were used to translate informant quotes into English to ensure linguistic and cultural equivalence.

Results: Providers perceived that street-connected youth were socially and economically vulnerable, and engaged in high rates of alcohol use, drug use, and condomless sex. Sexual behavior was described as occurring in the context of sex work and in romantic relationships with other street-connected youth. Few providers, however, described offering HIV-prevention programming. Rather, providers discussed offering case-to-case services enacted when a child was found to be sexually active, pregnant, or HIV-positive. Analyses indicated that stigma against HIV/AIDS and street-connected youth shaped HIV-related service delivery, with some providers believing that HIV/AIDS was not their business and that prevention programming could encourage risky behaviors. In addition, some providers reported that they encouraged “high risk” youth to seek services elsewhere.

Conclusions and implications: Findings point to a gap between perceived needs and provider responses with respect to preventing HIV/AIDS among street-connected youth. The lack of integrted, multilevel prevention programs for street-connected youth is a serious gap in Georgia’s efforts to meet the national HIV/AIDS strategic goals. As this work proceeds, there is a clear need to address provider stigma and to develop proactive prevention programming that can serve all street-connected youth, especially those engaged in sex work that may eleveate their exposure to HIV-infection.