Empowering young people to protect themselves from HIV

1. Empowering young people to protect themselves from HIV Business Case

2. Process till date • Working Group formed • Discusses process • Consultation designed • Country level survey commissioned on priorities • BC Drafts developed by UNFPA, UNESCO, UNICEF, WHO and ILO • Draft compiled for consultation • Desk study completed of 65 documents: • 26 NSPs from 7 regions • 8 key meeting / consultation reports • 22 Technical and Research papers • 9 other resources

3. Business case – how organized ? • Rationale – why it is important • Goal statement and focus • What is working well (to be scaled up) • What is not working well (why) • What needs to be done (strategies) • Key stakeholders and resources • Role of UNAIDS , including leveraging assets, structures of UNAIDS • Engaging external partners and stakeholders • Accountability and measuring progress • Moving forward (priority countries, epidemics)

4. Business case – 4 Sections • Rationale – why it is important • Goal statement and focus • What is working well (to be scaled up) • What is not working well (why) • What needs to be done (strategies) • Key stakeholders and resources • Role of UNAIDS , including leveraging assets, structures of UNAIDS • Engaging external partners and stakeholders • Accountability and measuring progress • Moving forward (priority countries, epidemics)

5. Process for this session • Introduction the Business Case (10 mts) • Presentation of section 1 (10 mts) • Buzz Group for Section 1 (10 mts) • Presentation & Buzz group –Section 2 (20 mts) • Presentation & Buzz group –Section 3 (10 mts) • Presentation & Buzz group –Section 4 (10 mts) • Buzz group report back – 3 mts per group / 10 groups (30 mts) • Plenary conclusion (10 mts)

6. Presentation structure • Each of the 4 sections have sub-sections • Each section is presented as: • What is in the Business case (now) • What are the gaps (vis a vis format & requirements) • What are the other resources available (from desk study) to fill these gaps

7. Rationale, GOAL & FOCUS Section 1

8. Section 1: Rationale, goal & focus • Rationale – why it is important • Summary of the context and the priority areas’ importance to the AIDS response, • Differences among regions and epidemic contexts • Goal statement and focus • High-level goal statement for 2015 and a longer-term (post 2015) vision statement. • Quantification of success (e.g. number of people affected, impact over time). • Effects on other priority areas, the overall AIDS response, and on the MDGs • Three strategic and measurable and time-bound intermediate objectives • Geographic, epidemiological, and other factors that affect the focus or implementation of the strategy.

9. Rationale • Young – defined as 10-24 • 33 million living with HIV, 62 % in SS Africa • 45 % of new infections amongst 15-24 age • Young disproportionately more affected, particularly girls/women • 2/3rd of infection in complex emergency countries • MARPS who are young have specific and special needs (particularly hyper and generalized epidemics) • Low awareness (only 40 %) aware of HIV and its transmission (Target 95 %) • SRH needs of young not addressed • High levels of stigma, particularly for young people who are HIV+ • Migration phenomenon – particularly important for young people • Loss of parents • Sexual exploitation, gender based violence

10. Gaps • Regional differences • particularly Asia and Pacific, Latin American, Caribbean, West and Central Africa and Middle East and North Africa • Diversity of epidemic scenarios and vulnerabilities • Hyper, generalised, concentrated and low and its effects. • Tighter and clearer arguments and justifications for WHY young people as a priority area – • Estimation of young people to be reached, Epidemiology, risks, vulnerabilities, challenges in reaching them effectively and the benefit for AIDS response for addressing young people • Focus and special groups • Age disparate & inter-generational sex • How the definition of 10-24 reached

11. Additional resources • UNFPA & UNAIDS – Disproportionate argument strengthening • Social drivers and structural factors (Addressing social drivers of HIV/AIDS) • Macro and micro trend variation on sexual behaviour and other determinants (Education & Vulnerability - role of schools) • Age disparate & inter-generational sex • Odds of HIV infection is 40-70 % higher when partner > 5 years older • Impact of abstinence approach • HIV risk and education • Increases by 8 % for those without sec education • How young have different needs • 4.3 million young PLHIVs do not know their status – testing • Female Sex workers typically start young; age at initiation dropping significantly in many countries and majority of sex workers < 25

12. Additional resources • 70 % of injecting drug users < 25 years of age (half started between 16-19) • Young MARPs disproportionately affected: • Myanmar - the highest HIV rates among female sex workers and injecting drug users occurred at ages 20 to 24 (41 percent and 49 percent, respectively), • Bangkok - HIV incidence among young MSM (ages 15-22) has nearly doubled in recent years (4.1 % in 2003 to 7.7 % in 2007) • Barriers to access and unmet needs • Different needs of Young PLHIVs and within them – children, adolescents • Need for contextual analysis of young • Focus, estimates and needs

13. Goal statements • Young people to be more engaged, and UNAIDS Programme (at country, regional and Global) to be more accountable and coordinated to meet existing national and global coverage and outcome targets for HIV prevention, treatment and care and support for young people, and aggressively collect age and sex disaggregated data by 2015. • To increase young people’s access to and utilization of HIV prevention, treatment, and care services to reach the goal of universal access by 2015. • UNGASS Target is 1) By 2010 at least 95% of young men and women aged 15 to 24 have access to the information, education, and services necessary to develop the life skills required to reduce their vulnerability to HIV infection. (2) By 2010 reduce HIV prevalence among young men and women aged 15-24 globally by 25%.

14. Gaps • Only goal statements attempted. • Even these are not clear, direct and focused. • Targets (quantity) need to be clearly thought through (Impact, outcomes, outputs) • and it should be time bound • Connection to MDGs – needs more elaboration

15. Additional resources • Promoting realistic options for young adults leads to safer sexual behaviour • Understanding and addressing the social drivers of HIV • Community driven empowerment and behaviour change in men • Movement for social transformation • Rights based approach • Reduction of stigma • Sustained and informed leadership which mobilises and retains focus • Reduce school drop out rates • Social marketing to address the less educated / literate • Socio economic status and empowerment

16. Process for this session • Introduction the Business Case (10 mts) • Presentation of section 1 (10 mts) • Buzz Group for Section 1 (10 mts) • Presentation & Buzz group –Section 2 (20 mts) • Presentation & Buzz group –Section 3 (10 mts) • Presentation & Buzz group –Section 4 (10 mts) • Buzz group report back – 3 mts per group / 10 groups (30 mts) • Plenary conclusion (10 mts)

17. BUZZ GROUP 1 • Pls form groups of 4-5 people • Discuss the Section 1 presentation • Document separately • Gaps • Suggestions and • Queries • in three different sheets / cards • Total time – 10 mts

18. What works well, what doesn’t and what needs to be done Section 3

19. Section 2 • What is working well (and scaled up) • What is not working well (and why) • What needs to be done • Summary / overview. • Geographic and other focus

20. What is working well • Surveys in 35 countries indicate sexual behaviors improving (condom use with non-regular partner, partner reduction, age at first sex) • Where improvements made, factors unclear • Evidence that school AIDS Programmes work • Needs to implemented in quality and scale • Focus on education, training, counseling • Work place programmes targeting the young have an impact, particularly peer education • Analysis of the costs and benefits of 41 programmes targeting young people in developing countries - investments in youth yield the highest economic returns. • Promotion of a ‘basic minimum package' of topics and learning objectives • Mode of transmission studies to inform strategies • Active youth organizations and networks to develop leaders • Comprehensive programmes addressing – biomedical, behavioural and structural aspects

21. What is working - gaps • Specific examples and a summary of evidence informed interventions • Joint programming at country level (need examples of success). • Interventions need to scale up and what should be the reach

22. What is working well-Resources • Using opinion leaders • Youth friendly services • One stop services • Addressing other needs as the PLHIV progresses through different stages of life • Supportive policies and standards • Involvement of YPLHIV, Support groups • Listening to young people voices • Innovative intervention through mass media challenging societal norms that create vulnerability eg Fataki campaign • Campaign against homophobia, working with social networks

23. What is not working well • Although rates are falling, younger people still account for highest new infections • 21 countries reporting comprehensive coverage – Only 9-50 % of children reached • Women/girls consistently having lesser outcomes and greater negative impact • Differentiated and prioritized interventions; which are evidence based • Single and isolated interventions (lack of comprehensiveness) don’t work • Higher knowledge not always translating into less risky behaviour (Kenya, Namibia) • Out of school – very few have strategies in place and implemented • Legal and policy constraints – largely unaddressed • Where well developed policies exists for MARPs – very little for young people within them • Weak co-ordination at country level • The ‘hows’ of dealing with adolescent mind • Effective participation of young people (voice and response) • Sex and age disaggregated data

24. What is not working well - Gaps • Country examples • ‘what if’ analyses (if these were not removed)

25. What is not working - Resources • Simplistic understanding (e.g. poverty) of deeper linkages • Abstinence programs not very effective in comparison to comprehensive program • lack of planning, standards and consistent resources • Lack of linkages • Inappropriate package of services

26. What needs to be done • Define and scale up access to appropriate HIV prevention, treatment, care and support • Reinforce the requirement for strategic information on young people • Innovative approaches to support existing HIV prevention programmes for young people: • Interventions focusing on structural change (including “large-scale” and “upstream” aspects of this) • New technologies (eg from microbicides to information and communication technologies (ICTs)) • Existing interventions adapted for young people (eg male circumcision and voluntary counselling and testing)

27. What needs to be done • Invest in meaningful activism and participation and capacity building of young people • Developing and evaluating structural interventions that go beyond young people themselves, such as: • interventions for communities as a whole • interventions to change social norms that impact transmission/acquisition • focusing on adults, especially adult men in generalized epidemics (where the virus is coming from) • interventions to mitigate the consequences of increased vulnerability

28. What needs to be done - gaps • Geographical and epidemic contexts and the changes required in strategies • Costing

29. What needs to be done- resources • Need for addressing social determinants • Specific strategies and processes by every country, keeping in mind context • Address state, service provision, communities, families and individuals. • Community Mobilisation • Increase access to SRH services • Adequate technical and financial resources to address structural driver • Strengthen country capacity for Strategic information • Generate demand and provide youth friendly community services • Mental health and psychological services • Respectful SRH services, focussing on retention of client • Collect disaggregated data • Policies and standards which are youth friendly • Detailed evidence gathering in-country on context and local epidemic and tailored programs. • Costing and economic analysis

30. Process for this session • Introduction the Business Case (10 mts) • Presentation of section 1 (10 mts) • Buzz Group for Section 1 (10 mts) • Presentation & Buzz group –Section 2 (20 mts) • Presentation & Buzz group –Section 3 (10 mts) • Presentation & Buzz group –Section 4 (10 mts) • Buzz group report back – 3 mts per group / 10 groups (30 mts) • Plenary conclusion (10 mts)

31. BUZZ GROUP 2 • Pls form groups of 4-5 people • Discuss the Section 2 presentation • Document Gaps, suggestions and queries in three different sheets / cards • Total time – 10 mts

32. Roles and partnerships Section 3

33. Section 3 – Roles and partnerships • Key stakeholders and resources • Role of UNAIDS , including leveraging assets, structures of UNAIDS • Engaging external partners and stakeholders

34. Roles • Young people addressed transversally in division of labour • Structures: • IATT on Young people, convened by UNFPA; • IATT on Education, convened by UNESCO; • IATT on Children Affected by AIDS and on PMTCT, both convened by UNICEF • AIDS Security and Conflict Initiative (ASCI) • Governments • Research and institutions • Young people

35. Roles • Role of UNAIDS: • Promotion of systems wide response to HIV and long term investment • Intersectoral nature of the response which enables the provision of response across communities and an individual’s lifecycle. • Policy direction and impetus (encouragement!) for changing social norms related to sensitive issues. • Technical guidance for intervention development/implementation based on intervention research and operations research • Provision of strategic information, sharing knowledge and state of the art innovations.

36. Roles • Normative guidance, building support, convening stakeholders. • Target setting and support for monitoring • Capacity building of regional institutions to provide technical support at country level • Coherent and coordinated response through the Unified Budget and Work-plan and the division of labour. • Strong partnership framework both with UN agencies, civil society and people living with HIV • Strengthen existing coordination mechanisms at Global level-the Interagency Task Team (IATT) on young people, IATT on Education and IATT on Children) as well as those at country level

37. Roles gaps • Roles undefined: • Civil society and international NGOs • Youth organizations • the Interagency Youth Working Group (IYWG) • Bilateral agencies and donors • Other development partners, including Global fund • Roles not linked to objectives • Huge expectations from UNAIDS (Unrealistic?) • Human, technical and financial capacity at country, regional and global level to support implementation • Is this based on core strengths of UNAIDS and its partners • New opportunities to add value

38. Roles gaps • What UNAIDS structures, systems, plans and policies already exist that can guide / inform action in this Priority Area? • What UNAIDS Secretariat and Cosponsors need to change in order to make the largest possible contribution to the priority area • How the Joint Programme should work in new ways across the cross-cutting strategies • Requirements at country level (focus on required country team contribution and consider differences between types of country/region if relevant) • Current and proposed mechanisms at the country levels (improvement based on experiences)

39. Process for this session • Introduction the Business Case (10 mts) • Presentation of section 1 (10 mts) • Buzz Group for Section 1 (10 mts) • Presentation & Buzz group –Section 2 (20 mts) • Presentation & Buzz group –Section 3 (10 mts) • Presentation & Buzz group –Section 4 (10 mts) • Buzz group report back – 3 mts per group / 10 groups (30 mts) • Plenary conclusion (10 mts)

40. BUZZ GROUP 3 • Pls form groups of 4-5 people • Discuss the Section 3 presentation • Document gaps, suggestions and queries in three different sheets / cards • Total time – 5 mts

41. Ensuring accountability & measuring progress Section 4

42. Section 4: Ensuring accountability & measuring progress • How to ensure accountability for agreed products and milestones • How to measure the Secretariat’s and Cosponsors’ progress, including metrics and milestones. The current monitoring and evaluation approach should change only if it is insufficient or not working

43. Ensuring accountability & measuring progress • To begin with, hold ourselves accountable for operationalizing the plan ( ) • Hold policy makers to account for facilitating and providing the political leadership to operationalize their policies as well as involving young people not only as beneficiaries of the services, but as actors. • Develop a system of performance evaluation, including establishing realistic benchmarks and indicators for evaluation

44. Ensuring accountability & measuring progress • Improve Programme monitoring to ensure increased quality in data and evidence to further guide programmes. • UNGASS data needs to be age and sex disaggregated that enables and analysis of most-at-risk young people and provides detailed trend analysis for young people • Resources allocated to prevention need to be flexible to ensure that programmes can be adjusted based on evidence and trends • Long term investments are needed to enable effective behavior change programming to ensure impact at a generational level.

45. Ensuring accountability & measuring progress - Gaps • Not specific, does not address the questions • How to address accountability and what should be the metrics to measure progress? • What are the current mechanisms (other UNGASS mentioned) will be used? • For each of the milestones and strategies identified above, who is accountable? • How measure UNAIDS and its cosponsors accountability towards each of the agreed strategies? • A table linking the organizations with each of the agreed strategies and the indicator to measure each of them will be clear and will be useful.

46. Process for this session • Introduction the Business Case (10 mts) • Presentation of section 1 (10 mts) • Buzz Group for Section 1 (10 mts) • Presentation & Buzz group –Section 2 (20 mts) • Presentation & Buzz group –Section 3 (10 mts) • Presentation & Buzz group –Section 4 (10 mts) • Buzz group report back – 3 mts per group / 10 groups (30 mts) • Plenary conclusion (10 mts)

47. BUZZ GROUP 4 • Pls form groups of 4-5 people • Discuss the Section 4 presentation • Document Gaps, suggestions and queries in three different sheets / cards • Total time – 5 mts

48. Process for this session • Introduction the Business Case (10 mts) • Presentation of section 1 (10 mts) • Buzz Group for Section 1 (10 mts) • Presentation & Buzz group –Section 2 (20 mts) • Presentation & Buzz group –Section 3 (10 mts) • Presentation & Buzz group –Section 4 (10 mts) • Buzz group report back – 3 mts per group / 10 groups (30 mts) • Plenary conclusion (10 mts)

49. Documents Reviewed

50. National Strategic Plans • Five Regions, 26 Countries • Asia-Pacific- Malaysia, Pakistan, PNG, Thailand, Sri Lanka • Caribbean- Guyana, Jamaica • Eastern Europe and Central Asia- Macedonia, Moldova, Serbia • East and Southern Africa- Botswana, Kenya, Swaziland, Uganda, Zimbabwe • West and Central Africa- Cameroon, Central African Republic, Ghana, Ivory Coast • Middle East and North Africa-Algeria, Morocco, Tunisia • Latin America- Belize, Costa Rica, Peru, Bolivia