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5. Krasnoselskih T. V. Prevalence of STD among the drug users in St Petersburg / Krasnoselskih T. V., Abdalla N., Verevochkin S. V. // Russian Journal of HIV/AIDS and Related Conditions. — Vol. 8, N 1. — P. 27 - 29. [in Russian]
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7. Grinenko G. Sexual transmitted disease at women reproductive age: risk factors, clinical — epidemiological data / Grinenko G., Savicheva A. // Z. Akus. Zen. Bolezn. — 2003, — Vol. LII, N 2. — P. 145 - 150. [in Russian]
8. Global prevalence and incidence estimates of selected curable STDs / Gerbase A. C., Rowley J. T., Heymann D. H. L. [et al.] // Sexually Transmitted Infections. — 1998. — Vol. 74, N 1. — P. 12- 16.
9. WHO. Global prevalence and incidence of selected curable Sexually transmitted infections. Overview and estimates. — Geneva: WHO, 2001.
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UNICEF ACTIVITY FOR CLINICS FRIENDLY TO TEENAGERS AND YOUNG PEOPLE IN RUSSIA
^ А. Vartanova ([email protected])
The program "Health and young people's development" UNISEF, Russia.
The question about the necessity of special services for teenagers despite the fact that there are clinics for both adults and children is frequently asked. However, statistics shows that while the mean age of the sexual debut has decreased, the number of sexually transmitted infections (STIs) increased, as has early pregnancies, drug addiction, drug abuse, cigarette smoking, alcoholism, neglect, involvement of teenagers in the sex industry and the AIDS epidemic. In regular clinics teenagers are not very welcome because they are considered unreliable, insolvent, peculiar and overly sensitive. Teenagers tend to ignore such clinics because they are annoyed by the cool reception and bad publicity.
During the past 10 - 15 years, people throughout the world considered the importance of the specific needs of young people in the health field. Since teenagers are less subject to children and adult diseases, they are more vulnerable to other health problems that are connected with growing up as well as behaving in a risky or ignorant way. This is one major reason why teenagers in particular need information on such issues as reproductive and mental health protection, preventive measures for AIDS, STI and unwanted pregnancy, opportunity for free STI treatment, free access to contraception, help from
psychologists and lawyers and prevention in risky behavior in general.
Reorganization of the medical health service for teenagers and measures for reproductive health protection should be considered as two of the main priorities of the Russian government. Administration at different levels attempts to integrate public health activity, education and social protection in order to develop a system that informs and services young people concerning the reproductive health field. At the same time, neither public health service nor education service are prepared to effectively solve specific health problems of this growing generation of young people.
There are numerous methods to help teenagers. One such method, which is used successfully in many countries, including the Russian Federation, involves the creation of special medical and social services or clinics for teenagers. There are three reasons to create such departments: teenager's health degradation, inadequacy of current basic medical help and the social importance of health in this age group.
So why do we need friendly clinics for teenagers? This is the institution where teenagers and young people can get professional medical, psychological and social help regarding health protection for young
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people and prophylaxis of socially dangerous diseases. Such clinics differ from others mainly because of the way they work: (1) accessibility, kindness, confidentiality, good and unprejudiced attitude to the clients, (2) complexity of the given services (3) participation of the teenagers themselves in the activities of the clinic and (4) the staff is specially trained for working with young people. Help is provided through understanding the teenager's problems and joint efforts for finding ways to change unwanted behavior. Moreover, this clinic is a progressive model based on modern technologies and is this open to the experiences of other organizations.
We should stress the meaning of two particular qualities the clinic: the first quality is the complexity of the clinic's services. It is complex in the sense that the aim of the clinic is not only treatment but also preventive strategies. The second quality of the model is to attract teenagers to the various aspects of the clinic's work.
Every teenager or young person who wants and requires consultation, information, diagnosis, treatment and rehabilitation, regarding reproductive health matters are potential patients at such a clinic. Teenager's relatives and parents can find all the necessary information about their children's health condition and prevention policies, as well as support with conflict resolution and mental problems. Experts from other institutions, working with teenagers and young people, could acquire experience of preventive work, get the information.
A clinic friendly to teenagers could have different forms of organization. For instance, the clinic could consist of only one consulting room, or could include a diagnostic department, a hospital and even groups of different structures (e.g., together with medical departments there could be psychological centers, centers for early development, a placement service, an organization working with invalids). Such clinics could be a completely separate department or could be a part of the structure of the public health, social and education services. However, regardless of organization form, this service should include the following four principles of working: voluntariness, availability, kindness and confidence.
Developing a clinic especially conducive to the problems of teenagers began in 1999 and is one of the main program components of UNICEF activity in Russia. The program is devoted to helping young people gain assess to a variety of services (treatment and diagnostic assessment, provide preventive care, information and education) in the area of reproductive health protection and preventive measures for high risk groups.
It is important to note that when these clinics designed for young people were started a great deal of information was accumulated that helped in adapt-
ing the program's conceptual style to Russian conditions as based on the recommendations of the World Health Organization (WHO), UNICEF and UNFPA. In March 1993, in St. Petersburg, the first Russian center for reproductive health protection, "Uventa", was founded. In October 1993, another consultative and diagnostic center for children and teenagers was created in Novosibirsk. Finally, since 1994, a regional youth center specialized in social, medical and an educational issue has started in Khabarovsk.
UNICEF program for the teenage clinic system in Russia from the beginning was conducted with two interrelated directions. On the one hand, it was necessary to help with the development of real clinics working in the country regions. These clinics required expert support regarding working, intense education and raising the expert's level of skill, organization of probation periods and training tours, help with equipping new-founded clinics with minimal medical facilities and help with developing approaches for preventive work organization.
These problems could be solved only because of the close relationship and collaborative efforts of a wide circle of national, municipal and social organizations with expert knowledge of teenage sexual behavior and sexual health in general. At the same time, the deciding role in the formation and realization of the program in the developing clinics primarily belongs to the ST. Petersburg organizations, which includes the "Uventa", chair of juvenile medicine of the St. Petersburg Medical Academy of Postgraduate Education and the regional public-service organization "The look into the future".
In summary, the following strategy was used during the period the program: interdepartmental approach, coalition of partners, integration of informational, methodological and regular unit resources, use of possible structures in an innovation approach and, finally, support of young people and teenagers.
Below is a brief summary of the effectiveness of the program, which has been operating since 1999:
• about 70 medico-social services/centers/consulting rooms for teenagers are operating in 20 regions of the Russian Federation. The results of the independent assessment, conducted in 2006, showed that the local clinics were flexible and could easily adapt. In addition, the clinics were found to be economically feasible;
• based on the juvenile medicine at the St. Petersburg Medical Academy of Postgraduate Education and the St. Petersburg municipal consulting and diagnostic center "Uventa", a teaching and educational center was established teaching experts from the city and other country regions how to provide medical and social help to teenagers and young people;
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• training material was published for the leaders of the clinics, which was based on the results of analysis and a summary of the practical experience of the Russian organizations that help teenagers and young people;
• in cooperation with WHO the methods of estimating the quality of the clinics' work in the sphere of reproductive health was approved;
• a textbook for doctors and public health organizations ("Clinics friendly to teenagers") was published. This book contains criteria and standards of the medico-social services for teenagers, as well as methods for estimating the quality of help based on the clinics' standards;
Municipal Consultative
The particular importance of the teenagers' reproductive health protection is explained by the crisis in the demographic situation in the country, which does not only have social causes but is also a result of the low reproductive abilities of the young generation.
Of the girls, 75 - 86 % have chronic somatic diseases, 10 - 15 % have gynecological disorders that limit their fertility [1, 2, 3]. The rate of gynecological disorders has trebled during the last five years. The prevalence of gynecological diseases increases with age by more than 2.5 times — from 116.2 at the age of 14 to 297.0 at the age of 17 per 1 000 examined girls.
The reproductive health among young males does not offer a better picture. The rate of andrological diseases in St. Petersburg varies between 13 - 56 0%, and 2.2 o% of the youths need andrological operative treatment. The necessity of surgical treatment is at its highest at the age of 14 - 16 years. About 60 %% of the diseases in boys and youths in the ages between 14 and 17 may become a real threat to their future fertility [4].
The early sexual activity of teenagers has become one of the most important social problems in Russia. Often they are not prepared for sexual life, physiologically or psychologically, they do not have sufficient knowledge about sexually transmitted infections, the possible negative consequences of an early sexual debut or pregnancy interruption.
A questionnaire aimed at schoolgirls from classes 9 - 11 (more than ten thousand) in St. Petersburg revealed that 52 o% of the 16 year old respondents had sexual experience; 68 % of the girls had their first sexual
• the experience of the Russian Federation in the development of services for teenagers has been recognized by WHO experts. Further, the full-scale introduction of the clinic's model for teenagers into everyday practice of the medico-social institutes that work with teenagers and young people has been useful in several ways (e.g., in developing the expansion of methodical and normative documentation regarding the organization of the clinics, increased the number of working persons and has helped them adapt to the conditions, important in health expert development and has introduced the mechanism of service quality monitoring.
contact either under the influence of alcohol or narcotic drugs, or had actually been raped.
Extramarital births make up 60.7 - 68.7 %%. During a period of so-called postponed parenthood, which according to our data is 8 years, every fifth woman has one or more abortions in her anamneses, every third woman uses urgent contraception, and every sixth of their sexual partners has had an STI in the past.
The number of abortions in Russia is about 40 per 1000 adolescents at the age of 15 - 19 years, which is one of the highest rates in the world [5].
Among numerous factors forming reproductive potential, one of the most important is information about a healthy life-style and safe sexual connections. Unfortunately, the main information source for adolescents is either an incompetent person of the same age, a sexual partner, or their own unfavorable experiences. Popular literature and advertisements are on second place; third and fourth place is shared by the information received in the family and from friends. Only in 16 %%, the information source was given by physicians. Specialists from whom schoolchildren expect to get knowledge are physicians and specially trained teachers. Only an insignificant number of adolescents answered that they would like to get this knowledge from their parents.
There is a shortage of physicians, teachers, and social worker specialists who are prepared and able to provide sexual education to adolescents — in 60 % of the cases they are trained by non-specialists.
The existing system of children health care does not appear to be ready to solve the newly arisen specific
MEDICAL AND SOCIAL AID IN THE REPRODUCTIVE HEALTH PROTECTION OF ADOLESCENTS
P. N. Krotin ([email protected])
and Diagnostic Center for Children — "Juventa" (reproductive health), St. Petersburg, Russia.
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