Web-Conference: Strengthening HIV Prevention through Sexuality Education 29 April, 2010

1. Preventing HIV Infections in Adolescents & Young People: Progress and Key Challenges Dr. Susan Kasedde Senior Specialist, HIV Prevention UNICEF, NY Web-Conference: Strengthening HIV Prevention through Sexuality Education 29 April, 2010

2. Presentation Outline • Why it is important to focus on young people • Progress and challenges for prevention in young people • Strategic opportunities

3. Why Young People? • An opportunity to slow the epidemic down because young people contribute significantly each year to new infections globally. • Most infections globally are transmitted sexually and sexual behaviour is initiated and modeled early. Young people are important allies for changing social norms. • Where declines in ante-natal prevalence have been observed in high prevalence settings (Botswana, Malawi, Tanzania, Zambia, Zimbabwe), population based surveys have confirmed sexual behaviour changes among young people. • With the roll out of paediatric treatment and improved care, growing number of adolescents living with HIV are maturing sexually. Important partners for prevention. Critical to improve their guidance, care and support for prevention.

4. In the last three years, young people have accounted for more than one third of all new infections Source: UNAIDS, 2006, 2008, 2009

5. Gender disparities in prevalence reflect inequalities in social and economic opportunities and access to services Distribution of HIV infections between young males and females, aged 15 – 24 yrs in countries with highest gender disparity Source: UNAIDS, Dec 2008 with additional analysis by UNICEF

6. Prevention efforts in concentrated settings must have strong focus on most-at-risk Adolescents Source: UNAIDS 2008 • Young people constitute a significant proportion of most-at-risk populations with behaviours initiated primarily during adolescence. • A national survey in Ukraine found up to 98% of IDU started before age 18 (UNICEF, 2008). • Between 72 – 96% of IDU started before age 25 in 12 cities across the world (WHO, 1998).

7. Strengthening communities and families is essential for prevention Source: UNICEF, Stocktaking Report, Dec 2009

8. Strengthening communities and families is essential for prevention Four countries with very high HIV prevalence also have especially high proportions of adolescents living without the day to day care and protection from both parents. Adult prevalence 23.2% 15.3% 15.3% 26.1% Source: UNICEF, Stocktaking Report, Dec 2009

9. Progress towards increased condom use during high risk sex is uneven • Condoms are an essential tool for HIV prevention with the opportunity for expansion of access available through well established facility-based and outreach SRH services as well as private sector outlets. • Yet, data availability on condom use in young people remains a problem in many countries - reflective of continued reluctance in many countries, to programme specifically on condoms for sexually active young people. • In 2001, States committed to ensuring expanded access to essential commodities for HIV prevention including male and female condoms. Source: UNICEF Stocktaking Report, Dec 2009

10. Changing Global Financial Landscape Source: UNAIDS, 2006, 2008, 2009

11. Improvements in comprehensive correct knowledge among young women and men aged 15-24 but most countries far from 2010 target Developing countries with 10 or more percentage point increase in the percentage of young women and men aged 15-24 with comprehensive correct knowledge of HIV Young women aged 15-24 Global 2010 target (95%) Young men aged 15-24 Global 2010 target (95%) Source: UNICEF global databases, 2010 (MICS, DHS and other national surveys, 2003-2008)

12. Critical to reach young people before they are sexually active with opportunities to build skills and age-appropriate information to raise risk perception and knowledge on HIV and prevention • Early age at first sex, unprotected vaginal or anal sex, age disparate sex and sex with multiple and concurrent partners are the behaviours driving sexual transmission of HIV. • High levels of school attendance among adolescents provides a window of opportunity to reach young people to focus on these behaviours and build competence to reduce their risk for infection before they become sexually active. Table Showing Access to Primary School at the Grade 5 Level (age 10/11) Source: UNFPA, State of the World Population Report, 2009

13. Conclusions and Recommendations • Strengthen basic understanding of national and sub-national epidemic and its drivers. • Critical to define expected results from an appropriate combination prevention approach including support and partnership with PLHA • Establish a clear coordination mechanism for their achievement. • Define clear accountabilities of all partners. • Address quality of services and balance interventions to create demand as well as improve delivery. • Direct services including information and support to those most at risk. • Invest in systems to build more efficient service delivery, tracking and design.

14. Thank You!