Dr Susan Kasedde Senior Specialist, HIV Prevention UNICEF NY IATT Meeting, 28 June 2011

1. Dr Susan Kasedde Senior Specialist, HIV Prevention UNICEF NY IATT Meeting, 28 June 2011

2. Commitments MADE and the state of the epidemic in young people

3. Then… • Millennium Declaration 2000 – leaders commit to a collective responsibility to ensure equitable development for all people, especially children and the most vulnerable. • MDG 6: Halt and reverse the spread of HIV. • UN General Assembly Special Session on AIDS 2001. • By 2005, reduce HIV prevalence among young men and women aged 15 to 24 in the most affected countries by 25 per cent and by 25 per cent globally by 2010challenging gender stereotypes and attitudes, gender inequalities, and encouraging active involvement of men and boys. • By 2005, ensure that at least 90 per cent, and by 2010 at least 95 per cent of young men and women aged 15 to 24 have access to the information, education, including peer education and youth - specific HIV education, and services to reduce vulnerability. • Globally 5.7 million [5.0 million–6.7 million] young people living with HIV in 2001

4. … Now … • An estimated 5 million [4.3 million – 5.9 million] young people aged 15–24 were living with HIV in 2009, a 12 per cent reduction since 2001

5. … And … • An estimated 2 million [1.8 million – 2.4 million] adolescents aged 10 - 19 were living with HIV in 2009, 65% of them adolescent girls.

6. New Infections in Young People • Young people aged 15 – 24 account for 41% of all new adult infections (aged 15 years and older) in 2009. • In 2009, an estimated 2500 young people aged 15 – 24 were infected every day for a global total of 890,00 [810,000 – 970,000]. • Nearly 1 in every 3 in South Africa and Nigeria. • 80% in sub-Saharan Africa • 6% in South Asia • 5% in Latin America and the Caribbean • 4% in East Asia and the Pacific • 3% in the Middle East and North Africa • 2% in Eastern Europe and Central Asia

7. 4 Key Points about young women and girls • Driven by the huge numbers and gender disparities in sub-Saharan Africa, young women aged 15 – 24 make up more than 60 per cent of all young people living with HIV globally. • In sub-Saharan Africa, the figure is 72%: • the lower the household income, the less likely both young men and young women are to have accurate knowledge of HIV and AIDS. • The larger the age gap between sexual partners, the greater the likelihood of being HIV-infected. • The road from childhood to adulthood is perilous for young people and particularly for young women: • 11% of adolescent girls have had sex before age 15 (ranging from 8% in south Asia to 22% in Latin America). • A direct result of early sexual debut, adolescent girls account for 16 million births every year. • A 2005 multi-country study found between 1% – 21% women experience sexual abuse before age 15. • Between 3.6% - 20% of adolescent boys also experience sexual abuse. • The most common place where young women and girls experience sexual coercion and harassment is in school. • Diagnosis: Communities have too often turned a blind eye to early sexual debut, multiple sexual partnerships, age-disparate sex and sexual violence. Governments and donors have not done enough to establish systems to protect young women and girls and shape a landscape that can help prevent HIV.

8. Most at Risk Young People • In Eastern Europe and Central Asia, four out of five people living with HIV are under age 30. One out of every three new HIV infections occurs among young people aged 15–24. • In some parts of sub-Saharan Africa, HIV prevalence among young men (18-24) who have sex with men have up to 6 times higher HIV prevalence than other men the same age.

9. Combination Prevention: A Continuum These core interventions are effective when part of a combination prevention approach.

10. Access

11. Progress in Testing Significant progress made in HIV testing most notably for young women through linkage to ANC for PMTCT

12. Safe practices of young injecting drug users Variable progress made in ensuring access to condoms, HIV testing and harm reduction programmes across countries but all have missed the target.

13. Young female sex workers: Condom use and testing Substantial progress made against target in making sex work safer in Asia but still missing the mark.

14. Young men who have sex with men: Condom use and testing Substantially less progress in Latin America and the Caribbean when compared to the target set.

15. Some progress but more to do in sub-Saharan Africa • Where the epidemic has hit hardest, comprehensive knowledge is low despite reporting showing an increasing coverage of lifeskills based HIV education in schools • In a study in sub-Saharan Africa that looked at knowledge levels among sixth graders (aged 13–14 on average), two thirds did nor have basic knowledge. • Condom use remains low • The percentage of young people aged 15–24 with multiple partners who reported using a condom at last sex was 47 per cent of young men and 32 per cent of young women. • HIV testing especially low in young men • No entry point comparable to maternal health programmes that provide testing and services for PMTCT for young women. • Medical male circumcision in certain countries offers critical platform for prevention support for young men.

16. Solutions informed by Evidence

17. Early Adolescence:Ages 10 - 14 Critical Interventions: • Sexuality Education • Mass Media • Parent-child Communication • Strengthening the protective environment Highlight: • Age-appropriate sexuality education can increase knowledge and contribute to more responsible sexual behaviour. • A 2010 evaluation of Jamaica’s Health and Family Life Education programme found much greater knowledge of HIV among sixth-grade students in schools that took part in the programme than among students whose schools did not participate. By the ninth grade, these differences in knowledge levels disappeared, but students in the programme were less likely to engage in risky behaviours and more likely to refuse sex.

18. Older Adolescence:Ages 15 - 19 Critical Interventions: • Sexuality Education and Sexual and Reproductive Health • Harm Reduction and risk reduction through prevention of initiation • Mass Media and technology • Engaging young people and the community to change social norms • Cash transfers to change behaviours • Addressing stigma, discrimination and legal barriers to access Highlight: • A 2009 survey pf children living on the street in the Ukraine show that more than 15% reported injecting drugs and nearly half of them shared the equipment. • In Albania efforts are being made to ‘break the cycle’ of new injecting drug use among young people by working with current users. Participants are taught skills and asked not to help other users initiate injecting drug use, not to inject in front of non-injecting drug users and not to talk about the ‘benefits’ of injecting drug use in front of non-users. Preliminary findings show that adolescents who would like to try injecting drugs are beginning to be rebuffed by older users.

19. Young Adults:Ages 20 - 24 Critical Interventions: • Biomedical interventions • Condom provision and uptake • Sexual and reproductive health, family planning and PMTCT • Reaching young people in the workplace Highlight: • Young people aged 15 – 24 make up 40% of the world’s unemployed. • Innovative approaches linked to the workplace that can meet the needs of young people exist. In South Africa, the Techno Girls Career Mentorship Programme focuses on skills development among adolescent girls, particularly in the male-dominated subjects of math, science and technology. The programme seeks out high-achieving or motivated girls in grades 10–12 from disadvantaged backgrounds, particularly in rural areas, and pairs them with companies operating in South Africa. The girls work for one-week periods, three times a year, for three years. Since Techno Girls was launched with support from UNICEF in 2006, more than 2,000 adolescent girls and young women have been placed with companies in four provinces, with the effort now set to go nationwide.

20. Adolescents and Young People Living with HIV Critical Interventions: • Increase opportunities for early diagnosis • Greater involvement of young people living with HIV • Provide support for adherence, disclosure and elimination of stigma • Expand comprehensive services to meet learning, emotional and psychological needs Highlight: • The Botswana-Baylor Children’s Clinical Center of Excellence works with many HIV-positive children, including many adolescents, offering a broad range of medical, psychological and education services and support. • Mildmay International in Uganda uses an integrated approach that reduces stigma and dependency among adolescents and enhances their self confidence. • The Centre for the AIDS Programme of Research in South Africa (CAPRISA) has made promising headway supporting adolescents living with HIV in disclosing their status; disclosure was identified as an extremely difficult area for adolescents as well as for their parents and caregivers.

21. Opportunities for action

22. Provide young people with information and comprehensive sexuality education. • Strengthen child protection and social protection measures to prevent exploitation of vulnerable children and adolescents. • Engage young people.

23. Engage communities in shaping a positive social environment that promotes healthy behaviour. • Establish laws and policies that respect young people’s rights. • Scale up proven interventions for HIV prevention.

24. Increase the number of adolescents and young people who know their HIV status. • Expand comprehensive services for young people living with HIV, paying special attention to adolescents. • Strengthen monitoring, evaluation and data reporting on young people, particularly adolescents.

25. ThANKyOU