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Community based research on most at-risk youths to HIV/AIDS/STI

Community based research on most at-risk youths to HIV/AIDS/STI

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MAPPING AND COMMUNITYBASED RESEARCH STUDY ONMOST AT-RISK ADOLESCENTSTO HIV/AIDS/STI
December, 2007
 
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The assessment is conducted by the team of researchers from the Institute of Ethnology andAnthropoogy, the University ‘Sts. Cyril and Methodious” Skopje.
Chief Researcher:
 Ass. Prof. Ljupco S. Risteski, PhD, the Institute of Ethnology and Anthropology
Assistant Researchers:
Davorin Trpeski, MA, Grad. Ethnologist, the Institute of Ethnology and AnthropologyMarija Toseva, Grad. Social Worker, NGO HOPS, SkopjeVanja Dimitrievski, Grad. Ethnologist, the Institute of Ethnology and Anthropology
Field Research Mentors:
 Zoran Jordanov, NGO EGAL, SkopjeSvetlana Vojnovska, Grad. Social Worker, the Institute of Social Work and Social Policy, SkopjeVlatko Dekov, Grad. Social Worker, NGO HOPS, Skopje
Field Researchers:
 Zoran Jordanov, EGAL, SkopjeKaterina Partinova, NGO HOPS, SkopjeMila Carovska, NGO HOPS, SkopjeFroska Nanova, NGO Izbor, StrumicaBiljana Miceva, NGO Izbor, StrumicaStevo Dimusevski, NGO HOPS, SkopjeNikola Nedeski, Grad. Social Worker, NGO HOPS, SkopjeKiril Penov, medical doctor, NGO HOPS, SkopjeAleksandar Sitnikovski, Grad. Social Worker, NGO HOPS, SkopjeRobert Jovanovski, NGO HOPS, KumanovoSonja Aleksievska, Grad. Psychologist, NGO HOPS, KumanovoPetar Petreski, NGO HELP, Gostivar Ivan Stojanoski, Grad. Social Worker, NGO HELP, Gostivar 
Project Administrator:
 Elizabeta Pavkovik, Grad. Ethnologist, the Institute of Ethnology and Anthropology, Skopje
International consultant engaged for design of the research study, review of the draft report andwriting up of the executive summary and recommendations
:Joanna Busza, Lecturer, Centre for Population Studies, London School of Hygiene and TropicalMedicine, London, UK
Research Supervisory Committee:
D-r Gordana Kuzmanovska, Epidemiologist, Republic Institute for Health ProtectionD-r Sandra Kuzmanovska, Ministry of Health, Manager of the project supported by the Global Fund for HIV/AIDS, Tuberculosis and MalariaProf. Vesna Dimitrievska, PhD, Sociologist, Institute for SociologySlavica Sekutkovska, President, Association of Social Workers of the City of SkopjeKaterina Miovska, President, NGO HERA –Health Education and Research AssociationNora Stojanovik, Macedonian Harm Reduction NetworkMiodraga Stefanovska, NGO Macedonian Interethnic AssociationD-r Silvana Onceva, Local Auditor of the project supported by the Global Fund for HIV/AIDS,Tuberculosis and Malaria
D-r Igor Veljkovik, Project ofcer, UNICEF Ofce, SkopjeThis assessment was commissioned by the United Nations Children’s Fund (UNICEF) Skopje ofce, withnancial support from the SIDA (Swedish International Development Agency) and the DCI (Development
Cooperation of Ireland). The statements in this publication are the views of the author(s) and do not nec-
essarily reect the policies or the views of UNICEF. The publication is not edited to UNICEF standards.
 
INTRODUCTION
In recent years, concern has grown within the FYR of Macedonia
1
that while the country’s HIV epidemic re-
mains concentrated within specic marginalised populations engaging in at-risk behaviours such as injectingdrug use, the exchange or sale of sex, and unprotected male-to-male anal intercourse, adolescents (dened by
WHO as aged 10-18) and young people (10-24) may be particularly neglected and under-served by targetedprevention and treatment services. In order to identify potential gaps in service provision for the youngestmembers of at-risk groups and characterise their needs, UNICEF commissioned formative research into the
situation of most-at-risk-adolescents in Macedonia, dened as young people under the age of 18 who have
engaged in at least one of the following activities known to increase risk of HIV acquisition and transmission:injecting drug use (IDU), sex work (SW), and unprotected same-sex behaviour among males (MSM).
Review of previous studies demonstrated that signicant information existed on structural factors that could putyoung people at risk (denial of health insurance and specic harm reduction services to those under 18), as well
as on some of the norms and attitudes that affect their choices. Most previous research, however, started fromthe perspective of health service provision, and focused on knowledge or use of services and did not includeinformation based on MARA’s own perceptions that might broaden understanding of their local environmentand social networks, how and why they make certain decisions, and what their needs are from their own point of view. This study was thus designed as a community-based qualitative exploration of risk-taking among MARAand their attitudes and behaviours related to prevention of HIV and other adverse health outcomes.The study was coordinated by the Institute of Ethnology and Anthropology of the Universi-ty “Ss. Cyril and Methodius” from Skopje, in collaboration with a range of national public healthand research institutions and non-governmental organisations (NGO) with extensive commu-nity-based experience of working with drug users, sex workers, and men who have sex with men.
STUDY OBJECTIVES
The primary aims of the mapping and the community based research study for MARA to HIV/AIDS/STIs inMacedonia were as follows:1. To produce knowledge on the existence of MARA and describe their locations, behaviours, socialcontext and the problems they face.
To locate different MARA sub-groups and collect information on their experiences atindividual level, at commuity level and structural level with information from the community itself.2. To identify case studies illustrating how legal frameworks, social programmes, publicauthorities, and available harm reduction initiatives facilitate or pose barriers to optimal use of appropriate services for MARA.
To analyse the information gathered from MARA that reect all the factors inuencing their 
individual risky behaviour and health-seeking or preventive measures.
METHODS
As the main priority of the study was to provide good quality formative research on MARA that
could document and describe how they t within larger categories of adolescents and specic high-
risk groups, qualitative methods were selected to help explore MARA’s lifestyles, relationships, andconcerns. The emphasis was on eliciting participants’ own perspectives and world-views.
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The country was admitted to the United Nations under designation of “the Former Yugoslav Republic of Macedonia”.For simplicity, herein after, the country is referred to as “Macedonia”.

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