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UNDP Youth Policies and Strategies in the Context of the MDGs

UNDP Youth Policies and Strategies in the Context of the MDGs. George Ionita gionita@unicef.org Regional HIV Advisor UNICEF MENA. Harvard Study: Young People’s Sexual Reproductive Health and Rights. Unicef-UNFPA-UNAIDS-IFRC-WHO Started in 2003 Almost completed

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UNDP Youth Policies and Strategies in the Context of the MDGs

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  1. UNDP Youth Policies and Strategies in the Context of the MDGs George Ionita gionita@unicef.org Regional HIV Advisor UNICEF MENA

  2. Harvard Study: Young People’s Sexual Reproductive Health and Rights • Unicef-UNFPA-UNAIDS-IFRC-WHO • Started in 2003 • Almost completed • 20-21 June 2005, Cairo, League of Arab States

  3. Harvard Study: Methodology • Desk-based review of published & unpublished literature • Telephone interviews (N = 33) with key experts across region and internationally • Face to Face interviews by research assistants in Egypt Lebanon, Jordan, and Tunisia (N = 29) • Collection of data in above countries • Email survey to UNFPA, UNICEF, IFRC country offices

  4. The “youth bulge” • Unique demographic moment: unprecedented numbers of young people 10 to 24 Arab region (roughly 1/3 of population) • What are some of the implications of the “youth bulge” for young men and women and families? • How have young people themselves experienced these changes? • Problem: very little research on Arab youth (other than from sectoral perspective)

  5. Considerable Unmet Need in the Region • Rapid social change: • urbanization; • rising unemployment; • breakdown of social networks; • exposure to global media; • migration; • rising educational levels; • widening generation gaps; • changing gender roles etc. • Rising age of marriage • Few policies/services dedicated to age group • Youth centres tend to exclude girls for various reasons

  6. Need for Positive Youth Development Approach • Need to integrate various interventions for youth within broad approach • Need for positive approach (not seeing youth as deviant or politically dangerous): Youth are part of the Solution, not a Problem • Importance of understanding perspective of young people • Arab Human Development Report: high desire for emigration among young people – need to address their concerns

  7. Social Context Protective factors: • Strong family solidarity but in flux • Intra-regional shared heritage • Rising levels of education • Increasing age at marriage • Greater communication/access to electronic media • Religious values that in some instances positively promote youth development and SRH

  8. Economic Context • Sharp class differences in vulnerability and outcomes (e.g. education; high risk behaviour in terms of HIV/AIDS) • Rising unemployment among youth • Higher costs of living/housing • Higher material aspirations (media etc.) • Above - Reasons for deferral of marriage (little research except for Egypt)

  9. Political Context • Conflict creates vulnerability: • Palestine (first intifada led to earlier marriage), • Sudan (HIV/AIDS driven by civil war) and • Iraq (violence against young women increased) • Reluctance to address sensitive issues/ risk behaviors by both government and NGOs • Political participation of youth limited, particularly young women

  10. Marriage Patterns: • Rising age at marriage for both males and females • Early marriage still a problem in pockets of all societies • High incidence of consanguineous marriages • Higher numbers of unmarried women in 30s • Resurgence of forms of non-conventional marriage

  11. Maternal Mortality • Maternal deaths concentrated in • Djibouti, Egypt, Morocco, Sudan, Yemen, • Risks among young high, but number of deaths may not be known (few studies on age group) • Early marriage a factor • Anaemia in pregnancy high across region • No data on relationship between induced abortion and maternal mortality

  12. Unwanted Pregnancy and Abortion • Young girls who marry early face strong pressure to bear children • Unsafe induced abortion known to occur with often severe health consequences but little data on age group • Survey of suicides in Algeria (1980s) showed 30% were unmarried and pregnant

  13. Female Genital Mutilation (FGM) and Violence • FGM in four countries: • Djibouti, Egypt, Sudan, Yemen and • Also reported in Iraq, Oman, Saudi Arabia, • Sexual violence, abuse and incest reported, but little reliable data • “Honour killings” reported across region, but much more data in some countries

  14. Reproductive Morbidity • Giza study: • Prevalence of reproductive tract infections • 45% among 14-19 year olds, • 55% among 20-24 year olds • Genital prolapse was 24% for 14-19 year olds in Giza study • Vasico-vaginal fistulae and prolapse in Yemen and Sudan (early marriage and poor nutrition) • Poverty, lack of access to water, and inadequate IUD screening

  15. Sexually Transmitted Infections • WHO: 600,000 new infections per year but underreporting (esp. women and youth) • Most reported: • trichomoniasis, gonorrhoea and syphillis • Around 74,000 STIs in 5 countries reported 2002 • Study in Morocco: 40% of reported STIs among young adults 15 – 29 years

  16. HIV Epidemic Levels in the MENA/EM Region Type 1: Consistently low rates but no consistent testing of high risk groups:  Egypt, Syria, Jordan, possibly Saudi Arabia and Iraq Type 2: Accumulating levels of infection; some rapid increase in identified high risk groups:  Algeria, Iran, Libya, Morocco, Tunisia, Lebanon, Oman, Bahrain, Kuwait, Yemen and possibly UAE and Qatar Type 3: High levels of HIV in general population, although solid epidemiological data are lacking:  Djibouti, Sudan and possibly Somalia

  17. HIV/AIDS and Youth • Very little data on AIDS related knowledge and behaviour • Wide reports of premarital sexual activity at least in urban areas but little research • Main modes of transmission: Heterosexual and IDU • Most women develop AIDS at younger age (25 – 29) than men (35 – 39) • Globally: Married young women more at risk for HIV than sexually active un-married young women

  18. HIV/AIDS: WHAT DOES IT MEAN? Human Immune Deficiency Virus Acquired Immune Deficiency Syndrome

  19. People Living with HIV: • 1980s: 100,000 • 2004: 39,400,000 (36-44 million) Damascus, May 3-5-2005, Joint WHO-UNESCO-UNICEF Workshop on School Health, Peer ED

  20. Orphans: • 1990: 1,000,000 • 2003: 11,000,000 • 2010: 25,000,000

  21. Regional HIV/AIDS statistics and features, end of 2004 % of HIV-positive adults who are women Main mode(s) of transmission for those living with HIV/AIDS ** Adults & children newly infected with HIV Epidemic started Adults & children living with HIV/AIDS Adult prevalence rate * 25.4 million 440 000 1.4 million 1.0 million 1.7 million 7.1 million 540 000 610 000 35 000 1.1 million 39.4 million late ’70s early ’80s late ’80s late ’80s late ’80s late ’70s early ’80s late ’70s early ’80s early ’90s late ’70s early ’80s late ’70s early ’80s late ’70s early ’80s 3.1 million 53 000 210 000 44 000 240 000 890 000 92000 21 000 5000 290 000 4.9 million 7.4% 2.3% 0.8% 0.6% 0.6% 0.6% 0.3% 0.3% 0.2% 0.1% 1.1% 57% 49% 34% 25% 36% 30% 48% 25% 21% 22% 47% Hetero Hetero, IDU Hetero, IDU IDU, Hetero, MSM MSM, IDU, Hetero Hetero, MSM IDU MSM, IDU MSM, IDU, Hetero MSM Sub-Saharan Africa Caribbean Eastern Europe&Central Asia North America Latin America South and South-East Asia North Africa & Middle East Western and Central Europe Australia & New Zealand East Asia & Pacific TOTAL * The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2004, using 2004 population numbers ** Hetero: heterosexual transmission – IDU: transmission through injecting drug use – MSM: sexual transmission among men who have sex with men

  22. + 1 300% + 20% + 20% + 160% + 300% + 60% + 40% HIV prevalence in adults, end 2001 + 30% 15 – 39% 5 – 15% 1 – 5% 0.5 – 1.0% + 20% 0.1 – 0.5% 0.0 – 0.1% not available The global view of HIV, end 2001 Recent trends in HIV infection, 1996–2001 Source:UNAIDS/WHO July 2002 outside region

  23. HIV in High Risk Groups-ad hoc surveys, reports-#1 0.59% in MSM;12% in FSW; 12% in STD patients (1998) 12% in IDUs (in-treatment) up to 69%(in one prison) (2001) 0.3% in 291 IDUs (2000) 0.22% in 458 FSW (registered)(2001) 0 in 945 prisoners 2.3% in 217 FSW (2001) 0.86% in 815 MSM (2001) Qatar Bahrain 5% in 2240 STD patients (1999) 571 new HIV infections, 98% IDUs, (2000) 3% in 139 FSW; 2% of sex workers in Oran and 9% in Tamanrasset , 1.7%STD clinic in Oran (2000) 5% in 135 arrested IDUs (1999); 8.3% in 60 IDUs (2000) North: 10% in tea sellers, 4% in sex workers, 4% among refugees South: 17% in VCCT centers 7% in FSW (2001); 1.8% in 248 STD patients (2000) *FSW = Female Sex Workers *IDU = Injecting Drug Users *MSM = *STD = Sexually Transmitted Disease 28% in bar girls, >50% in street FSWs (1996-98) 0.14% in 2102 IDUs (1997)

  24. HIV in General Population 0.06% in blood donors, 0.6% TB patients (2000) .0015% in blood donors 1.5% ANC (2000) 0 in 108 ANC ; 0.03% in blood donors (2000) Tunisia Syria 0 ANC (1999);0.03% blood donors (1999); 0.36% in 281 TB patients (2000) Jordan Morocco Kuwait 1.7% in 275,307 screened (2000) Algeria 0.2% in 627 ANC (1998) Bahrain Libya Egypt Qatar 0 in 2,464 blood donors Oman 0.4% in 1.984 ANC; 0.9% at ANC sites in south (Tamanrasset) Yemen 4.8% TB patients (2000) Sudan Djibouti 0.7% in 11,070 low risk persons (1998); 0.04% up to 0.28% in blood donors(1998-2000); sex ratio:4:1(M:F) in 1995 to 2:1 in 2001 2.5% general population (2000) *ANC = Ante Natal Clinics 2.9% general population (2002)

  25. Do Services Meet Needs?: HEALTH • Respondents report service providers often judgemental, young people not welcomed • Few scaled up programs: • Egypt Ministry of Health HIV Hot-Line • Oman Ministry of Health HIV Hotline + Outreach to High Risk Groups • Morocco NGO services

  26. Do Services Meet Needs?: EDUCATION • Lack of life skills and sexuality education programs • Gender disparities in access/outcomes • Generational differences in education • Rural migrants to university often at risk • E.g. Tunisia “Double Protection” Project in Tunisian university dormitories

  27. Quantitative Research • Exists DHS, PAPFAM and Gulf Family Health among others • BUT lack of consistent data across region makes comparisons difficult • Lack of dis-aggregation or secondary analysis of surveys for relevance to youth • Certain questions never asked • Limited info on unmarried • Need more youth development surveys (PAPFAM Youth Module good opportunity but optional and new)

  28. Till Recently little population based data on youth because: 1) Preoccupation fertility/family planning (so only ever married women) 2) It is sensitive to interview unmarried 3) Adolescent policy received little attention

  29. Qualitative Research Gaps • Perceptions of young people (of services, social norms etc.) • Perceptions of adults re youth Reproductive Sexual Health (service providers, parents etc.) • High quality and in-depth research (many KAP) • Key linkages between development/social trends and RSH (much anecdotal)

  30. CONCLUSIONS • Lack of access to public Sexual Reproductive Health • Information, • Education, • Counseling and • Services for young people – married and unmarried • Knowledge gaps huge • e.g. Need for understanding of this stage of life-cycle in cultural context • Most programs small-scale and not sufficiently evaluated • How to build on protective factors?

  31. Moscow Ballet, Jerash Art Festival 2004 Photo by Dr. George Ionita

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