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 youth were embedded in ethnically homogenous networks that reflected ethnic segregation in Georgian society. Providers discussed how the presence of family members in the networks of street-connected youth conferred exposure to HIV-infection. Providers perceived that the highest risks were for native Georgian youth who had run away from home and were involved in commercial sex work. In contrast, youth from other ethnic groups were often in social networks that contained family members who protected them from sex work. However, Kurdish-Azeri youth—also embedded in networks with family—were reported as engaging in commercial sex work. The presence of sex work in social networks was directly connected to economic stress, with more marginalized networks being more vulnerable to commercial sex work. In addition, Kurdish-Azeri youth were identified as experiencing additional vulnerability, as official resources are not available to this ethnic group.
Implications and conclusion: Study findings highlight the different role of family members and economic marginalization in shaping street-connected youth’s vulnerability to HIV. Network-based approaches need to consider the whole network and the resources and constraints within the network. Additional resources are needed to support Kurdish-Azeri youth, who experience additional stigma and are often excluded from accessing social and health services.