Most-at-risk adolescents in CEE/CIS: Lessons learnt from programming

1. Most-at-risk adolescents in CEE/CIS: Lessons learnt from programming Anja Teltschik, UNICEF Consultant 3 September 2009

2. Where we started: • No political and donor priority • Lack of strategic information • Low service scale, scope & quality • Reluctance of civil society to address MARA issues MARA largely left out out of the AIDS response

3. What strategic information revealed: • A substantial percentage of IDUs, FSWs and MSM initiates risk behaviour < 18 • Dysfunctional families • Street settings increase risk & vulnerability • MARA are diverse and intermix • Distinct differences between MARA & MARP

5. I. Political buy-in: advocacy for MARA

6. Accepting a new concept takes time • Sound data are critical • Use HIV/AIDS coordination mechanisms & strategic planning to insert MARA In the context of: Double standards & competing priorities = UNICEF has to keep MARA on the agenda

7. II. Political & legislative barriers

8. A legal ‘vacuum’ affecting research + services for MARA Major stumbling blocks • ‘Parental consent’ issues • Illegality of risk behaviour • NGOs limited in their service provision to minors • Child rescue policy – doing more harm than good? Changes take time – find practical solutions

9. III. Creating an evidence base: data collection

10. Methodological issues • Sampling • Recruitment • Language and understanding of questionnaires Ethical issues • Documenting the process: tracking referrals and cases of abuse

11. IV. A possible conceptual framework for the CEE/CIS

12. Majority of adolescents – not at risk   Parents & families Make systems friendly to MARA EVA   Sexual & socialnetworks Pull MARA out of risk MARA   Do it with and not for MARA… In the context of child & human rights…

13. Child protection & social services Health system HIV planning and M&E MARA Child-care system Financial system Education Donors / UN HIV-NGOs Justice system Youth organisations Humanitarian programmes

14. V. Planning & designing interventions

15. Key issues • Deciding whom to partner with? • Deciding what may work with MARA? • Building response capacity (including M&E) • Linking MARA programming to the national AIDS response

16. VI. Implementation issues

17. Civil society partners • Daily battle with the system – demotivating • Winning the trust of MARA • Reaching the most hidden – is it possible? • Education, information & condoms and syringes are not enough • Working with families

18. Health care services “We are open to all – what do you want?” • MARA – ‘the additional burden’ • Youth-friendly services – not automatically MARA-friendly • Avoiding additional stigma + ensuring confidentiality

19. Getting different sectors to cooperate & be accountable • Building referral systems / agreeing on procedures / protocols • Motivating MARA to take up referrals • Individual case management – new approach • Linkages to child protection = key challenge

20. Understanding and working with the police and the judicial environment • Dealing with corruption • Working in a criminal milieu • Dealing with police harassment (MARA / outreach workers)

21.  Special needs of MARA living with HIV/AIDS • Existing services & networks – no focus on HIV+ MARA • Barriers to treatment access and eligibility • Adherence issues • Additional stigma and discrimination

22. THANK YOU!