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HIV/AIDS programming for Most-At-Risk-Adolescents in Eastern Europe and Central Asia

HIV/AIDS programming for Most-At-Risk-Adolescents in Eastern Europe and Central Asia September 2009 Dr Nina Ferencic, UNICEF. AIDS: a recent epidemic. 1.7 Million people living with HIV = 20 fold increase in less than 10 yrs (affecting: youth, IDUs, women, children….)

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HIV/AIDS programming for Most-At-Risk-Adolescents in Eastern Europe and Central Asia

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  1. HIV/AIDS programming for Most-At-Risk-Adolescents in Eastern Europe and Central Asia September 2009 Dr Nina Ferencic, UNICEF

  2. AIDS: a recent epidemic... • 1.7 Million people living with HIV = 20 fold increase in less than 10 yrs (affecting: youth, IDUs, women, children….) • Transition affecting 300 M people • Youth unemployment • Multi-substance abuse, Suicides • Institutionalization of children • Abandonment, withdrawal of parental rights, « social orphans » • OVC – 90% lost their fathers

  3. <20% 20-40% 40-60% 60-80% >80% 10.2% 38% 16.3% 16,6% 8,3% 13,5% 21% HIV cases under age of 25NOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports; 17.4% 1.5% 25.5% 15% 11.4% 61% 16% 60% 25% 47% 55% 15% 52% 6% 15% 3% 44% 16% 3% 12% 9.2% 82% 30% 7% 6.2% 26% 40% 14.2% 20% 9.6% 18,8%

  4. <20% 20-40% 40-60% 60-80% >80% 10% 84% 6.1% 6% 13% 2% 50% IDU as % of all HIV/AIDS casesNOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports; 11% 0% 25.5% 19.4% 17% 14.5% 87% 16% 90% 34% 81% 83% 6% 71% 82% 80% 16% 24% 5% 71% 29% 29% 82% 20% 2% 74% 86% 16% 32% 7% 64% 11% <1% 15% 51% 60% 68% 4% 60% 14% 3% 57% 5% 8.2% 16% 1.8% 16%

  5. "The world changes before your eyes. You look at a picture of an elephant and suddenly you see that it smiles at you and splashes water all over you with its trunk..." – Vladik, 11, Odessa (escaping harsh reality, explaining how he feels when on drugs)

  6. HIV prevalence – close to 40% HIV prevalence in subgroup of orphans: 63% Factors associated with HIV prevalence: No place to live Being a single or double orphan Ever living in an orphanage Out of school for 3 years History of drug use and STI Behaviours: Sexually active: 97% Multiple partners 65% HIV infections – among street kids 15 to19 in St Petersburg, CDC study 2007

  7. Barriers to Programming for most-at-risk adolescents (MARA) • Controversial mix: drugs, sex, minors • Lack of data • Stigma, discrimination and exclusion « Innocent » vs. « lost causes » • Parental denial, disengagement • Community, Social, Religious opposition • Legal barriers • Service-provision barriers

  8. UNICEF support to programmes for MARAGet the evidenceBuild political & community support

  9. Remove barriers to provision, access & use of servicesBuild partnerships Photo courtesy Humanitarian Action, St. Petersburg, Russia

  10. The MARA Agenda is a Controversial Agenda • A political « hot potato » • Practical vs ideological • Harm reduction vs « rescue & rehabilitation» • Linking HIV & protection • Social exclusion / social justice • Child rights & human rights

  11. The response - A mix of: • Advocacy • Activism • UN diplomacy • Systemic interventions • Capacity building • Financing • Inclusion

  12. Thank you! Photo courtesy Humanitarian Action, St. Petersburg, Russia

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