In February 2001, Médecins du Monde Sweden carried out an assessment mission to St Petersburg in Russia. Here is the full report with details and recommendations.

ASSESSMENT MISSION TO ST PETERSBURG

Time frame: February 7th -12th 2001

Locations: Central St Petersburg, Northern, Southern and Western peripheries.

Author: Hugh Griffiths.

Street children are constituted in groups of between 10 and 40. They congregate in places known as "tousovkas" . The tousovka is often situated at metro and railway stations. These places provide shelter and warmth in the evenings in a city where the temperature often drops to -25 degrees during winter. The tousovkas also provide the street children with a means of financial and material support. Children can beg for cigarettes and money; a significant number of the girls appeared to be involved in prostitution, as well as many of the boys. Theft is a popular form of income generation, stealing from the many people who use the stations. Theft becomes a more pronounced activity during peak rush hours when the metro is crowded making pick-pocketing and escape easier

Tousovkas also provide children with the space to inhale solvent based glue and in some cases, inject drugs. However, most importantly, the tousovkas provide street children with a structure around which to base short to medium term survival in a hostile environment. There is greater security in numbers and the street children alternatively protect, intimidate and fight each other in a manner not dissimilar to that described by the author Charles Dickens in his novel "Oliver Twist" which revolved around a child group in early Victorian London. In a manner similar to that of Oliver Twist, there is generally a leader within the group, an older child or adolescent who acts as the interface between those adults who abuse the children, using them as child prostitutes, to carry drugs, steal from citizens etc.

Anecdotal evidence would suggests that certain police are involved in the activities of the adults and their proxies thestreet children, since the illegal trade could not flourish without certain law enforcement officers turning a blind eye.

Nevertheless, it should be acknowledged that while tousovkas can be violent, dangerous spaces, which shorten the childrens chances of long term survival, the children often view tousovkas as their "home" a place which provides them forms of economic opportunity and social support where they gain comfort from the company of their persons in a similar predicament to themselves.

1.2 Impressions from the street

Médecins du Monde Sweden met with four groups of children from four different Tousovkas. From one group of approximately 15 children, at least 66% of them were under influence of solvent based glue druing the observation period. Of the 3 girls within the group, two of them had used heroin intravenously within the past 6 hours. They were 14 and 15 respectively. The third girl, aged 16 was the leader and acted as the interface with the adults. All three were involved in prostitution and the two younger girls exhibited symptoms consistent with severe traumatisation (hyper-arousal coupled with periods of detachment).

Of the other Tousovkas visited, solvent abuse appeared the most widely available intoxicant, with two 13 and 14 year old girls experiencing difficulties in standing due to inhalation. Physical symptoms of alcohol inebriation were present in six of the children interviewed. Alcohol appears to be a popular, easily available intoxicant. The termperature on this night was -15 degrees with children drinking and inhaling both in the metro station and in the streets outside. The visually observable maladies of the children ranged from racking lice, scabies and general intoxication. The final street observation took place at Moscow Railway station. There, a generally older group of children and adolescents were encountered. Ages ranged from 12 to 16. There were a total of 5 boy and 2 girls. All were involved in prostitution, although they claimed to have stable relationships involving only 1 partner. All were under the influence of solvent based glue and alcohol. 5 out of the 7 admitted to taking heroin intravenously on a regular basis.

1.3 Street Children Data: General Characteristics

From the limited statistics available(1), it is clear that the vast majority of children living all or part of their lives on the street come from dysfunctional family backgrounds. The number of children with a "functional family" from those surveyed was 11.6%. 39.8% had only 1 parent. 30.3% came originally from families with three or more children. Those whose parents were socially and economic marginalised numbered some 21.1% in 1998, with the number rising to 24.6% in 1999. The data gathered tends to reflect the more general observation that there are more male street children than female, 59% and 41% respectively. Over the period 1998-2000, there has been a rise in the number of children whose parents have alcohol and heroin addiction problems.

Age of Children surveyed in 1999

Age	% of total
Age unknown	3.0
Less than 5 years old	2.0
Less than 8 years old	2.3
8 years old	3.4
9 years old	3.0
10 years old	5.6
11 years old	6.0
12 years old	9.6
13 years old	10.3
14 years old	12.2
15 years old	10.3
16 years old	11.4
17 years old	8.3
18 and over	35.1

1. Statistics are from data compiled by Médecins du Monde France Medical Centre for street children from questionaires during medical examinations. Years 1998, 1999, 2000.

1.4 Street Children Data -- Drug/Alcohol Abuse

A specific survey carried out over a period of two years showed a significant increase in the level of alcohol and drug abuse amongst street children. The most dangerous increase, which is reflected across the board in St.Petersburg amongst children, adolescents and adults is the increase in heroin use. This is particularly dangerous for street children given the HIV epidemic currently sweeping the city. The use of heroin also dramatically reduces the ability of the body to cope with the number of other diseases that children are exposed to, living and sleeping on the street.

The survey authors also note that increases in 1999 are due to an intensification of the outreach/street work of Medecins Du Monde France doctors, social workers and psychologists which has led to a greater number of street children with dangerous habits using the MDM France Medical Centre and thus participating in the survey.

However, even with this factor taken into account, it is nevertheless clear that substantial increases, particularly with regard to heroin have taken place. Initial findings from the 2000 statistics reinforce this trend.

Drug Type	1998	1999
	% of children using	% of children using
Tobacco	55.6	73.1
Alcohol	28.6	60.8
Solvent (glue)	14.9	15.5
Heroin	8.5	22.2

2. Médecins du Monde France Medical Centre for Street Children survey 1998-1999

1.5 Street Child Data - Sexual Behaviour

In addition to the data on drug and alcohol abuse, Medecins Du Monde have also undertaken a survey regarding the sexual behaviour and practices of the children who use the facilities of the MDM Medical Centre. The survey was limited to small number of persons who came regularly to the Medical Centre and with whom the doctors, social workers and psychologists had built a strong relationship. It was felt that these children trusted their interviewers enough to give accurate and honest information.

It should be noted that the legal age of consent in Russia is 16 and that the sexual experiences of those under that age would be registered in legal terms as a form of sexual abuse. It should also be noted that those under the age of 14 had some difficulty in differentiating between when they consented and when sexual acts were committed against their will. Other young children were unwilling to admit to abuse, clearly intimidated by those they perceived to be threatening them.

Sexual Experience (Consenting)

Age	11-12 years	13-15	16-18	18 and +
No answer	14.3%	-	5.4%	-
Already experienced	14.3%	43.9%	81.8%	88.5%
Never experienced	71.4%	56.1%	12.8%	11.5%

Age	11-12 years	13-15	16-18	18 and +
No answer	7.1%	9.1%	5.5%	-
Yes	7.1%	13.6%	34.5%	23.1%
No	85.8%	77.3%	60%	76.9%

Given the relatively high levels of sexual activity/abuse surrounding the street children, an AIDS awareness study was undertaken by Medecins Du Monde France with 162 children questioned.

To the question : "Do you know what AIDS is ?"

	Boys	Girls
No answer	5.3%	1.5%
Yes	70.2%	69.1%
No	24.5%	29.4%

However, when questioned on the ways in which AIDS can be contacted, a majority displayed a deadly ignorance, especially in regard to the intravenous methods which currently pose the greatest risk in terms of the St.Petersburg infection transmission routes.

To the questions : "How can you catch AIDS ?" The following answers were checked off by the respondents.

I do not know	22%
Through sex	75%
Using a syringe	25%
Kissing	5%
By blood	18%
Toilets	2%
At birth	2%

In addition to these surveys, MDM France have also produced a detailed questionaire which all children who attend their medical centre are requested to complete. Questions include "How often do you change your underwear ?" "What was your first sexual experience?", "What kinds of contraception do you use?", "How many partners?"

Some questions especially those aimed at assessing the level of sexual abuse are less direct -- "Did some adults or teenagers ever try to play games with you- like doctors and nurses."

Each questionaire is attached to the file of the child, lodged under an identity code to protect the identity. MDM France have, in this manner amassed data on the 1000 children attending their medical centre. This covers behavioural activities ranging across a spectrum covering drug abuse, eating habits, vaccinations/immunisations, sexual activity and family background. A disease profile is included, covering blood testing for infectious diseases as well as standard data such as height, wieght etc.

Notable trends identified by MDM France physicians include the observation that prior to 1995, using heroin was extremely rare. Now it is increasingly figuring in the medical records of street children. Another alarming statistic is the level of syphilis, currently running at 14-15% of tested girls. Hepatitis B and C are on the increase in tandem with HIV as intravenous drug use increases.

There is a profound ignorance amongst the children regarding medical matters, including sex education amongst the street children. Many do not know what the word "infection" means, something that has to be explained in great detail when they have tested positive for Hepatitis B, C, HIV or syphilis. A good number have no idea what the term "psychology" means or indeed what a "penis" is. Their vocabulary is often limited to street words which makes the job of medical prevention, treatment and cure all the more difficult.

1.6 Street Child Data -Infectious Diseases

Initial data from 2000 shows a sharp increase in the rates of Hepatitis B and C, as well as HIV increases. These figures will be released on March 1st 2000 and will be used for the purposes of this report. Médecins du Monde France physicians confirm that there is currently an Hepatitis B and C epidemic. HIV figures from the harm reduction program (mainly adults) coupled with the increases recorded in 2000 strongly indicate the onset of an HIV epidemic in St.Petersburg.

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