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WORK WITH YOUTH: PROTECTION OF REPRODUCTIVE HEALTH
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COOPERATION OF SPECIALISTS FOR PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS AND HIV/AIDS AND UNWANTED PREGNANCY AMONG YOUTHS IN ST. PETERSBURG (EXPERIENCE OF THE RUSSIAN-SWEDISH PROJECT)
А. Simakhodskiy 1, P. Krotin 2, N. Vorobyova 3 (natsan@mail.rcom.ru), T. Kozhukhovskaya 2
1 The department of medical help to mothers and children organization of the Public Health Committee of St. Petersburg Government, St. Petersburg, Russia;
2 Municipal Consulting and Diagnostic Centre "Juventa", St. Petersburg, Russia;
3 Maternity welfare clinic of the Krasnogvardeyskyi region, St. Petersburg, Russia.
The peculiarity of modern Russian teenagers is that the period of their maturation coincides with the ongoing transition of Russian society which complicates the establishment of the teenager's personality. It is important to remember, that in childhood and adolescence the basics of a healthy lifestyle lay the foundation for ideas about family, marriage and parenthood. It is very important to take into account the opinion and active participation of teenagers regarding medical and consulting help. To help teenagers is possible only through the inter-departmental interaction of adults, i.e. specialists in the field of public health services, education, social services, public organizations and mass media with the support of political departments at the city and national level. In this regard the international experience, adapted to Russian conditions, is highly relevant as it can widen our insight and enrich our knowledge through the acquisition of new methods.
The Russian-Swedish collaboration for the reproductive health protection of young people covers a 10-year period involving 3 main projects: project №13 (1997 - 2002), 13-plus (2000 - 2004) and "Teenager is our future" (2004 - 2007). The initiator of this collaborative effort was taken by Russian authorities. The Public Health Committee and Country Education Committee comprehend the importance of such work, especially because demographic conditions have significantly worsened over the years, seriously threatening an increase of HIV in drug abusers but even in ordinary young people. The Swedish partner is the East European Committee and Department of Public Medicine in Stockholm.
As a result of the Russian-Swedish 10-year joint effort, 13 Youth Clinics (YCs) were inaugurated in 11 regions in Russia. A unified learning model on questions of prophylaxis was developed for YCs and teachers working within similar areas. The originality of the YC is in its comprehensive approach to the problems of young people and how to solve these problems using a specially trained
team of professionals: gynecologists (for girls), urologists-andrologists (for boys), obstetricians, psychologists (psychotherapists) and experts in social work and health management. These experts were trained in St. Petersburg (special postgraduate courses at the Medical Academy of Postgraduate Studes (MAPE), at the Russian-Swedish seminars in the Municipal Consulting and Diagnostic Centre "Juventa") and in Stockholm.
As a result of the collaboration in the Russian-Swedish project "Optimization of sexually transmitted infections diagnostic and treatment", YC experts acquired the necessary skills and knowledge to perform bed-side microscopy of genital smears.
It is important that consultation and treatment at the YCs is free for patients under 18-19 years of age. Confidentiality must be maintained for all patients and qualified services dealing with STIs, unwanted pregnancy, etc., should be available and guaranteed for all patients requiring these services.
One orientation of the YCs concerns organization of the work with specialists (e. g., teachers, school's medical staff, public and youth medical organizations, which provide young persons with a positive attitude to a healthy lifestyle.
For the purpose of supplying teenagers with reliable protection from STIs, sale of high-quality condoms at a reduced price was arranged by the Municipal Consulting and Diagnostic Centre "Uventa", which is comparable with the conception of demographic development in St. Petersburg until 2015: "...providing free contraceptives for socially unprotected groups".
Regional YCs, because of their substantial help and guidance with children and teenagers, have a significant place in the medico-social system in St. Petersburg. They are the real centers of prevention and, with the absence of an integrated sexual education program, assist teachers in their work.
The new Youth Clinics foundation was included in the Conception of the public health development until the year 2010.
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VOL LVI SUPPLEMENT may/2007
ISSN 1684-0461 ■
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WORK WITH YOUTH: PROTECTION OF REPRODUCTIVE HEALTH
The main orientation of the project is to train educational specialists and YC staff for the purpose of creating an integrated approach to questions related to youth reproductive health protection. About 1600 educational specialists and YC staff participated in a 2-day conference with the theme "The teenager is our future". At this conference youth reproductive health issues were discussed, but more importantly, ways of solving these issues were proposed. YC staff and educational specialists, who come under the training within the domain of the project, share their experience on 5-day extension courses organized by the Academy of Pedagogical Postgraduate Education. Special attention is focused on legal and legislative matters regarding preventive work in schools in collaboration with district YCs. Within the project, few guidelines were established. The Swedish guideline "The red thread", which was translated into Russian for specialists working with young people, is of particular interest.
Special attention concentrated on the development of modern sources of information in order to raise the level of knowledge of young people concerning personal relations and prevention of risk-taking behaviors. From the Municipal Consulting and Diagnostic Centre "Juventa" a website for teenagers (www.teeninfo.ru) was designed where specially trained experts reply to users' questions on line. In addition, the web site offered other information, such as addresses of the YCs. Because of the project resources, members of mass media (e. g., journalists and radio and TV commentators) were also given special training, which helped to cover these problems in the mass media in a more correct manner, as well as being influential in the publication of a special magazine for teenagers called Flash. Such knowledge will also help to continue such work in the media in the future.
Understanding the teenager's need to rely on people to solve many important problems, support was provided to the volunteers' from youth organizations. It is important to note that this way of working failed to receive proper development because in Sweden there is little experience of volunteers from youth organizations that work with questions on healthy lifestyle. The present movement is more of a Russian model. As a result, within the project there exists a close link between YCs/schools and youth organizations.
We considerer that the success of the Russian-Swedish project on improving the reproductive and sexual health of young people is primarily the result of an integrated effort of different professionals, including medical staff and teachers, experts in social work, young people themselves and public and mass media organizations that deal with questions of risky behavior prevention among young persons. Well-defined practicable goals and objectives, a highly qualified team from Russia and Sweden, use of Swedish experience but taking into account Russian peculiarities are key factors that helped in decreasing the number of unwanted pregnancies, STIs and new registered cases of HIV/AIDS in teenagers in St. Petersburg.
Nevertheless, the number of cases of HIV/AIDS is still alarming and most experts predict a new wave of the infection. Now that Swedish financing has terminated, it is very important to maintain the results thus far attained and to develop inter-departmental interaction with the support of legislative authorities and executive powers of the State government.
"Cooperation agreement", signed by the governor of St. Petersburg and region of Stockholm in 2006 ", is a guarantee of future development and expansion of communication and joint financing between our countries in the sphere of public health, social development, education and culture, as well as youth politics.
■ SyPRA.ll AKiHIEPCTBA" XEHCKHXTi BOJTE3 HEii VOL LVI SUPPLEMENT may/2007 ISSN 1684-0461
