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HIV in Education in Emergency

This presentation highlights the HIV epidemic in South Sudan, including key populations, vulnerable groups, risk factors, and the response plan.

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HIV in Education in Emergency

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  1. HIV in Education in Emergency Presentation to Education Cluster20 October 2014

  2. National prevalence: 2.6%

  3. The HIV Epidemic in South Sudan • Mixed epidemic – general population but also: • Akobo, Leer, KajoKejiandMaridihave recorded steady increase in new infections since 2007 Geographic hotspots Ezo = 14% Yambio = 8.4% Tambura = 6.5% Juba = 4.7% Nimule = 4.4% Maridi = 4.1% Key populations Clients of sex workers Uniformed services Casual sex partners Female sex workers Polygamous partners Men who have sex with men

  4. Proportion of new infections by risk group Ref: Modes of Transmission Analysis, 2013

  5. Other vulnerable groups • Prevalence and incidence among women and girls is twice that of men and boys: • Gender inequalities – low status of women and girls, no decision making power, economic inequality • Early sex debut – <15 years: 11% national; 20% in WE; 18% in WBG; 14% in Unity & CE; 11% in EE; 10% in Warrap; 6% in Warrap & NBG; 3% Lakes & UN • Gender based violence – sexual violence, intimate partner violence • Harmful traditional practices – widow inheritance, polygamy (risk of infection is 6 times higher for partners in polygamous relationship) • Male attitudes and behaviours – casual sex/sex workers/multiple partners, low condom use, low male circumcision etc • Risk of mother to child transmission still stands at 29%; 2,400+ new infections in 2013 = 16% of all new infections

  6. Young People • South Sudan is a young population: 72% under 30 years, 51% under 18 years • 20,000 young people <15 years living with HIV • Most young people do not have access to sexual and reproductive health information and services • Risk factors include early sex, inter-generational sex, gender based violence, no access to condoms etc • 2010 KAP study in Greater Equatoria: • 21% early sex debut, mean age of 10.75 • Very low comprehensive knowledge of HIV (11.3%) • Low knowledge of correct condom use (31%)

  7. Risk and Vulnerability Factors Risk Factors • Early sex debut • Low condom use • Low male circumcision • Sex work in urban settings • Multiple sexual partners • Low Knowledge of HIV and HIV prevention methods • GBV including sexual violence • Stigma, denial & discrimination Vulnerability Factors Gender Factors: • Low status of women • Harmful traditional practices • Gender inequalities Humanitarian Factors: • Broken social structures / family • Negative coping mechanisms • Sex work/transactional sex • GBV including sexual violence • Low access to HIV services

  8. Getting to Zero • 10 HLM 2011 Declaration and Targets towards 2015: • Reduce new HIV infections and AIDS-related deaths by 50% • Retargeting towards 2020 - post 2015 towards 2030; focus on treatment as prevention plus prevention targets: • 90% of all people living with HIV will know their HIV status. • 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. • 90% of all people receiving antiretroviral therapy will have viral suppression. • Prevention targets 2020: • 90% awareness (face to face, interactive media – KP, YP) • 90% empowerment (young women, sex workers, MSM) • 90% service access (KP, condoms, PrEP) • 90% uptake (high impact interventions – condoms, VMMC, PrEP) Zero new HIV infections Zero Discrimination Zero AIDS-related deaths

  9. HIV Response in South Sudan • Ratio of newly infected to initiated on treatment 4:1 (Africa avg ≈2:1); 20:1 ratio of new infections to ever enrolled on treatment • Less than 5% of PLHIV are on treatment (9% at CD4 count 350) • Only 20% of HIV positive pregnant women are able to access prevention of mother to child transmission services • MoH estimates 50,000 people test for HIV every year, we need to reach 700,000 a year to scale up treatment • About 10 million condoms are reported to be distributed annually, about 8% of what is required (110 million) to have an impact on new infections

  10. HIV Situation by State (2012 ANC Survey)

  11. National Strategic Plan 2013 - 2017 1. Reduction of new HIV infections by 50% by 2017 3 Outcomes: Reduction of risky sexual behaviour; PMTCT; health care settings 2. Reduction of mortality among men, women and children living with HIV by 50% by 2017 3 Outcomes: ART increased to 80% (in both adults & children) by 2017; retention on HIV care and treatment; and access to safety nets and IGAs. Priority target groups: • key populations: sex workers & clients; mobile populations -truck drivers, traders & migrant workers; uniformed groups • populations of humanitarian concern : refugees, IDPs and returnees • young people (10 – 24 years). Priority regions and locations: • Greater Equitoriaregion – high prevalence and hotspots • North-western South Sudan – low prevalence, low knowledge/access to services

  12. HIV-Humanitarian Strategy 2014 - 2016 • Provides a national framework for the provision of HIV prevention, treatment and care services to populations of humanitarian concern • Aims to build sustainable national capacity for HIV programming in emergency contexts • Seeks to foster stronger collaborative arrangements between HIV and humanitarian actors at national and local levels Three key actions for Education Cluster: • Conduct Behavioural Change Communication programmes whenever the operational context is conducive (linked to life skills program) • Conduct in-house and partner trainings on HIV mainstreaming • Establish and strengthen HIV in the Workplace programmes targeting all staff

  13. IASC Guidelines: HIV in Education • Children and young people with access to education are also more likely to delay onset of sexual activity and avoid alcohol and substance abuse • Education can provide life-saving knowledge, skills and services to children and young people vulnerable to HIV infection • Education can provide additional protection for those already infected and affected • Education can help raise awareness in the larger community IASC Guidelines: http://www.humanitarianinfo.org - IASC Products: HIV/AIDS Also INEE Minimum Standards Toolkit: HIV/AIDS www.ineesite.org/uploads/documents/store/doc_1_INEE_toolkit_-_HIV-AIDS.pdf

  14. IASC Guidelines: HIV in Education

  15. HIV situation stemming from crisis ≈ 40,000 PLHIV affectedwith little to no access to treatment, care and support networks ≈ 25,000 PLHIV displaced and likely in urgent need of HIV treatment, care and support services ≈ 1,000PLHIVhave interrupted treatment Vulnerability factors: • Family separation – high risk sexual behaviors, especially among young men • GBV - rape, sexual exploitation, intimate partner violence • Negative coping mechanisms – transactional sex, sex work • Little knowledge of HIV and HIV prevention • Low access to HIV services and prevention commodities (condoms) • Displacement to higher HIV prevalence locations

  16. HIV in humanitarian response • Tracing and referring clients on ART, CTX and TB treatment • Provision of HIV services in IDP sites: • Awareness/behavioral change communication – HIV, GBV • Condom promotion • HIV counseling and testing • Prevention of mother to child transmission • Mobile and referral for treatment • SRH and MNCH linkages, including PSS and PEP for GBV survivors, and STI management • Resource mobilisation – GFATM, Humanitarian?

  17. Opportunity for integration: IEC materials for BCC Five sets developed and approved, in English and Arabic: • HIV Basic Information • HIV Counseling and Testing • Prevention of mother to child transmission • Stigma and Discrimination • Snakes and Ladders Game for young people For your own sets, contact Mango Tree: Mathias Mwene – Country Manager, MT South Sudan mmwene@mangotreeuganda.org Tel South Sudan: +211927221638 Uganda: +256 703 071 172 / +256 312 263 263 Cost: ≈ USD250 for all 5 sets HIV IEC materials developed for UN staff also available for work place programme

  18. Mumtaz Mia – Program Adviser Email: miam@unaids.org Mobile: 0912 112 299 www.aidsandemergencies.org Omar Dia – Humanitarian Adviser Email: diao@unaids.org Mobile: 0912 154 719 www.unaids.org

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