Most at risk young people in concentrated epidemic scenarios - Asia and Pacific

1. Most at risk young people in concentrated epidemic scenarios - Asia and Pacific Advancing UNAIDS support to empowering young people to protect themselves from HIV New York 26 – 27 October 2009 R. Gray Sattler, Regional Adviser HIV East Asia and Pacific

2. How has universal access increased for most-at-risk young people in concentrated epidemic scenarios in Asia and the Pacific? Not sure that it has, has it?

3. We have a broad consensus on HIV in Asia • Varied epidemics: shared characteristics • Unprotected paid sex • Sharing contaminated needles and syringes among drug users • Unprotected sex between men • Concentrated epidemics require targeted interventions • With drug users • With men who have sex with men • With sex workers and their clients • Not mutually exclusive - quite the opposite. Sources: Commission on Asia Report, James Chin, Elizabeth Pisani

4. 10 m FSW and 75 m clients; 20 m MSM and IDU - with links to ‘low risk women’ An estimated 75% of all HIV infections are directly or indirectly caused by these behaviours in Asia 95% of new infections in young people are in most at-risk young people – those who are drug users, sex workers, men who have sex with men (only 5% of young people) Report of the Commission on AIDS in Asia 2008

5. HIV prevalence/ incidence in Most at Risk young people Cumulative HIV incidence in the Bangkok MSM Cohort Study by age, 2006 – 2009 (N=1,002) Courtesy Dr F van Griensven, Thailand MOPH-US CDC collaboration Source: Myanmar surveillance reports 2003 IBBS MARPs, FHI & CDC MoH, 2007

6. Challenges? • Data • Planning/programming • Coverage • Additional barriers • Increased risk taking

7. Fighting the epidemic with little data • We do not have age disaggregated data on UNGASS indicators for most countries Source: www.aidsdatahub.org from multiple sources of country data, 2008, UNICEF, UNAIDS, WHO & ADB

8. A lack of data/poor data • World drug report 2009: • few countries know the prevalence of illicit drug use • large data gaps - in Asia and Africa very few countries report illicit drug use

9. Programming: the Big Mismatch Source: reported allocation of resources for young people by Joint UN Work-plan Commission on AIDS in Asia 2008

10. Coverage of most-at-risk populations reached by targeted prevention programmes is low inSouth-East Asia Source: Coverage of selected services for HIV/AIDS Prevention, care and treatment in low and middle income countries in 2005. USAID, UNAIDS, WHO, UNICEF, POLICY. July 2006

11. Young people are reached less than those over 25 Challenges IBBS MARPs, FHI & CDC MoH, 2007 cited by the National AIDS Commission, Republic of Indonesia, in UNGASS Country Report (2006-2007)

12. Young people face greater barriers to safe sex Challenges 2007 Survey of SRH of sex workers in Thailand, unpublished data FHI AIDS in Asia, Bangladesh MOHFW 2002

13. Challenges The use of psychoactive substances is to be expected, • Young people react to changes in drug availability and social perceptions about drug use more quickly than older people (more adventurous?) substance use is also more prevalent among young people than in older age groups Sources: Neuroscience of Psychoactive Substance Use and Dependence. WHO 2004; World Drug Report 2009.

14. Challenges Drug dependence among young people is part of a broader vulnerability Starting to use at an early age is linked to negative health and social consequences later Sources: Spooner, C. (1999). Evidence Supporting Treatment. ANCD research paper 3. ANCD 2001; World Drug Report 2009.

15. Illicit drug use appears to be lower in developing countries, but signs of increase in cannabis, cocaine and ecstasy Source: World Drug Report 2009

16. Challenges • Interventions for young people need different delivery: • E.g. successful peer education programmes for MSM in China did not reach young MSM. While older MSM meet in social venues, younger MSM were making social contact through internet. • Policy is an enormous barrier for youngeraged most at risk young people • Research often does not include most at risk young people • Representation is missing for most at risk young people • rarely members of  sex work, MSM and IDU networks and so are not involved in community consultation and development initiatives

17. Challenges • How to reach them? The most vulnerable and at risk young people do not identify as ‘young’ • Identity and education • What are their lifestyle determinants? – how do they see themselves? • Which tribe are you? • Policy change to accommodate work with those who are younger

18. What can the UN do (in Asia)? • Policy • Technical Assistance • Scale up/mainstreaming • Where we are implementing agencies • Community development – What tribe do you belong to? • Strategic information/research capacity development

19. Involve young people who are vulnerable and most-at risk in the development and implementation of interventions Make a compelling case for a focus on most at risk young people Age-disaggregated data (including IBBS) How /if most at risk young people differ from most at risk people Need estimates to better inform programming Similarities, differences and overlaps between people engaging high risk behaviours Strengthen the evidence-base for interventions to decrease risk How best to reach the most at risk with services - INTEGRATION National plans for HIV and on drugs should include dedicated research capacity building strategies Provide leadership and advocacy Target the programme Key policies and legislation that protect those most vulnerable and at risk; and service providers to allow them to reach those who are younger and at risk Planning and Programming With thanks, Bruce Dick, WHO

20. Programme Activities focused on most at risk young people in the Region Policy Thailand lowered the age from 18 to 15 (without parental consent) for access to medical service and testing in public sector (including reimbursement) Strategic Information Pakistan, Nepal conducted situational analysis and mapping of MARA/MARYP and developed policies and programmes Joint data collection processes on MARA and MARYP in Bhutan, Cambodia, Lao PDR and Pacific countries Some success and new developments

21. Programme Activities focused on most at risk young people in the Region Services Outreach / PE programs using 15-19 IDU’s for young IDUs and drug use prevention education programs (Vietnam) Partnerships Most at risk young people, service providers, community based organizations, researchers, policy makers, development partners ICAAP, August 2009 Regional Task Team established, September 2009 ASEAN meeting planned Some success and new developments

22. Thank you Acknowledgements: Asia Pacific Regional Task Team on most at risk young people Jan Wijngaarden, UNESCO, Jo Sauvarin, UNFPA Margaret Sheehan, UNICEF Judith Ulrisch, UNODC