Priscilla Idele, PhD

1. Strengthening strategic information for Adolescents and Young Key Populations: Data gaps and challenges of using existing data Priscilla Idele, PhD SESSION: TUWS08 Sampling and Estimating the Size of Adolescent and Young Key Populations at Higher Risk of HIV Using Respondent Driven Sampling Date: 22/07/2014 (14:30-17:30 PM) Room: Room 103

2. Epidemiology of HIV among adolescents Estimated number of adolescents aged 10-19 living with HIV by UNICEF regions, 2012 Source: UNICEF analysis of unpublished UNAIDS 2012 HIV and AIDS estimates

3. Adolescent AIDS -related deaths: the only group where deaths are increasing

4. Infections among adolescents not slowing fast enough

5. HIV prevalence among male and female sex workers in Asia and the Pacific Source: UNAIDS, The Gap Report, 2014

6. Percentage of female sex workers, men who have sex with men, and people who inject drugs who are under 25 years of age in countries with data available Source: UNAIDS, The Gap Report, 2014

7. Percentage of adolescents 15-19 and young people 20-24 with comprehensive correct knowledge of HIV by sex and age in countries with available data, 2008-2013 Source: UNICEF global databases, 2014, based on Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and other national surveys, 2008-2013.

8. Percentage of adolescents 15-19 and young people 20-24 who had first sex by age 15 by sex and age in countries with available data, 2008-2013 Source: UNICEF global databases, 2014, based on Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and other national surveys, 2008-2013.

9. Policy context • 2013 WHO HIV treatment guidelines – children, adolescents, adults and key populations • 2013 WHO adolescents guidelines on HIV testing and counselling and HIV care and treatment • The Impact and Cost of the HIV/AIDS Investment Framework for Adolescents • Post-2015 discussions on new goals and targets, with emphasis on adolescents • 2014 WHO Strategic Information (SI) Guidance – under development, emphasis on age disaggregated data, including for adolescents and key populations • But … changing HIV/AIDS programming landscape – integration, mainstreaming, shifting funding priorities – means need for more evidence for advocacy, policy change, and programme strategies

10. Data needs

11. Data availability: East Asia & Pacific *Other countries have ranges and wide uncertainties that can’t be published Data Sources: a - UNAIDS 2012 HIV and AIDS estimates; b - UNICEF analysis of UNAIDS 2012 HIV and AIDS estimates

12. Data availability: East Asia & Pacific Data Sources: c - UNICEF global databases, 2013 based on DHS, MICS and other national surveys, 2008-2013

13. Data availability: East Asia & Pacific

14. Data disaggregation considerations • Age • Sex • Geographic areas • Residence (urban, rural) • Education • Wealth • Ethnicity • Religion • Marital status • Key adolescent populations • Other stratifiers Where possible, indicators could should be disaggregated by:

15. Some data challenges Routine programme data • Limited or lack of disaggregated data on routine programme service statistics on HIV testing, care and treatment for adolescents and young key populations • Currently, routine programme data need additional resources for data abstraction from health facility registers Population-based surveys • Most surveys (MICS, DHS) start from age 15; not 10-14 • More disaggregation possible with household survey data, but small sample sizes for 15-19 year olds cannot allow for meaningful adolescent-specific analysis Behavioural Surveillance Surveys • Indicator definitions, disaggregations, study methodologies often not harmonized within and across countries, hence difficult to have any meaningful comparisons • Sometimes the geographic scope and target populations change from one study to another

16. Age at first sex, ever had an HIV test, and condom use at last sex with client among sex workers/entertainment workers in selected countries with data available • -Over 60% of adolescent key populations, had first sex by age 15-19; • -HIV testing is low;

17. Some data challenges Population size & HIV estimates of adolescents and young key populations • Unknown population size estimates • Limited epidemiologoical data on adolescent and young key populations • Wide uncertainties of HIV estimates for adolescents living with HIV, new infections and AIDS-related deaths Legal, programmatic and ethical barriers • Age of consent laws, policies and ethical barriers to HIV programming for adolescents also hinder data collection, availability and use • Need for parental consent for interviews; • Contradictory laws on age of consent for marriage, sex, and access to medical services • Discriminatory laws and criminalization of key populations behaviours

18. What is the Way forward? • Age disaggregation of routine programme data – access, coverage and quality of HIV testing, ART, retention and HIV-related health outcomes and mortality • Age expansion to 10-14 years in standard household and BSS surveys – but need a decision on the specific topics/questions or indicators to include • Oversampling of adolescent respondents in standard household and BSS surveys to allow reasonable sample sizes • Harmonize indicator definitions, age and other disaggregations, including study methodologies for adolescent and young key populations • Technical guidance and support for adolescent and young key populations HIV data collection, analysis and use • High level advocacy needed to address legal, policy, programmatic and ethical barriers to HIV data collection and use for adolescent and young key populations

19. Acknowledgements • Shirley Mark Prabhu • Tyler Porth • Wing-Sie Cheng