Scaling-up HIV Prevention among Young People through Partnerships: East and Southern Africa

1. Scaling-up HIV Prevention among Young People through Partnerships: East and Southern Africa Global Meeting of IATT on Young People & HIV/AIDS Geneva, 15-17 April 2009 Mark Bryan Schreiner UNFPA Africa Regional Office, East and Southern Africa UN Regional HIV Prevention Working Group, ESA

2. Outline • Regional Mechanism for IATT/YP in ESA • What are the key drivers in our region? • What are we doing? • Review of the Response in ESA: • National UN / Joint UN Teams on AIDS • Regional Inter-Agency Support: Experiences • How can we help? • Opportunities for Partnership • Summary

3. IATT on Young People & HIV/AIDS IATT ON YOUNG PEOPLE & HIV/AIDS, through: • fostering a joint accelerated and expanded response • strengthening multi-disciplinary technical assistance and capacity at all levels • supporting regional/country programmes • Coordination between global, regional & county levels • Strengthen multi-disciplinary technical assistance and capacity at all levels • Coordination with UN partners based on comparative advantage

4. Inter-Agency Response on HIV & Young People in East & Southern Africa Fostering a joint accelerated response through integrating and strengthening existing structures: UN Regional Directors’ Team- ESA • Regional HIV and AIDS Team (RHATESA) • Inter-agency HIV Prevention Working Group (2007, 2008 -2010) • Way forward to expand inter-agency collaboration

5. Promoting Partnerships with and for Young People • Youth-Adult partnerships • Strategic alliances with youth networks and civil • society for advocating on priority issues • Facilitate institutional participatory mechanisms for • young people’s participation in policy dialogue, advocacy • and programming • Support leadership skills of youth advocates

6. HIV & Young People in ESA General Context • Epidemic in ESA sustained by cycle of vulnerabilities affecting young people, especially young women & girls • YP in region grow-up in context of extremely high-levels of HIV infection. For girls especially, with disempowering social and cultural norms governing sexual relations • Prevention efforts to reach young women and girls have focused largely on general program interventions, failing to address vulnerabilities of young women and girls • HIV prevalence is high or even rising in most Southern African countries among young women and girls • However, increasing evidence from ESA that identifies key drivers

7. Key Drivers in Southern Africa* Multiple and Concurrent Partners with low consistent, correct condom use and lack of male circumcision • Also high viral STIs, lack of male involvement, intergenerational/age-disparate sex, high sexual violence • Underlying context/drivers of gender and socio-economic inequalities, mobility, and other structural factors * as identified at SADC Expert Think Tank Meeting, Maseru

8. What does research tells us about patterns of sexual networking?* • Multiple concurrent partnerships are common and viewed as normal • Men & women seek multiple partners for a variety of reasons • Economic transfers of money or gifts are a normative feature in relationships. • Transactional sex is more than ‘survival sex’, consumerist aspects come with expansion of economies • Many women are active agents in seeking/exploiting partners for gain. • Intergenerational sex is common & has cultural resonance. * Lesotho, Romero-Daza 1994; Namibia, Mukonda 1998; Tanzania, Silberschmidt & Rasch 2001; Zimbabwe, Gregson et al 2002; South Africa, Leclerc-Madlala 2003, Swaziland, Mader 2004, Mozambique, Bagnol & Chamo 2004, Botswana, Ng’andu 2006).

9. What are women’s motivations for multiple concurrent partnering generally?* • Different partners largely fulfill different needs i.e. one for companionship, transportation, one for food or necessities, one for entertainment. • Faithfulness often perceived as ‘unstrategic’ sometimes ‘stupid’, concurrency viewed as a back-up strategy, way to ‘keep up’ with peers, a distraction from problems. * Lesotho, Romero-Daza 1994; Namibia, Mukonda 1998; Tanzania, Silberschmidt & Rasch 2001; Zimbabwe, Gregson et al 2002; South Africa, Leclerc-Madlala 2003, Swaziland, Mader 2004, Mozambique, Bagnol & Chamo 2004, Botswana, Ng’andu 2006).

10. What are men’s motivations for multiple concurrent partnerships?* • Young men: Peer pressure to prove normality and masculinity identified as #1. Concurrency also viewed as ‘strategic’, hedge against disappointment, recreational, means constant availability of a woman. • Older men: Report need for variety, relief from stress or boredom, also pressure to demonstrate manhood & social worth, feel ‘forced’ (Swidler & Watkins 2006). * Lesotho, Romero-Daza 1994; Namibia, Mukonda 1998; Tanzania, Silberschmidt & Rasch 2001; Zimbabwe, Gregson et al 2002; South Africa, Leclerc-Madlala 2003, Swaziland, Mader 2004, Mozambique, Bagnol & Chamo 2004, Botswana, Ng’andu 2006).

11. Focus on Vulnerabilities of Women & Girls* Key points highlighted in evidence*: • Biological risk and vulnerabilities • Secondary education • Gender-based sexual violence • Inter-generational sex • Knowledge, risk and behaviour • Economic Empowerment * UNAIDS RST ESA, 2008; Brief on Vulnerabilities of Young Women and Girls in Southern Africa

12. Focus on Vulnerabilities of Women & Girls* Recommended Actions: • Mobilization of communities for HIV Prev. • Expanding access to high quality, well integrated SRH and prevention services • Address the structural drivers of vulnerability • Strengthen country capacities for epidemiological and behavioral surveillance; to generate strategic information * UNAIDS RST ESA, 2008; Brief on Vulnerabilities of Young Women and Girls in Southern Africa

13. What are we doing?Review of Response Joint Missions to Support Countries Review the alignment and harmonization of agencies efforts towards HIV prevention Recommendations towards strengthened and strategic UN support to the National HIV Prevention Response Identify technical and operational capacity gaps of UN system and national partners to design regional inter-agency support programme

14. Common Mission Findings National Response • Lack of ownership of national prevention response • Fractured coordination at all levels • Weak coordination between key players • Increasing efforts to generate better data for HIV and AIDS programming • Poor planning, monitoring and analysis to support and guide the development and implementation of national HIV prevention interventions • Limited analysis of data and understanding of the underlying drivers of the epidemic • Untapped potential of civil society for national response

15. Common Mission Findings UN Response • Progress made around establishing the Joint UN Team on AIDS, but not effectively operational –domestication of Div of Labour, tech support leads and untapped capacity in-house • Joint Programmes of Support often reflect a retro-fitted design • Unclear structure and membership of inter-agency response for Joint programming and technical support

16. Opportunities for Action • Improved data - national behavioural and attitudinal data available (but requiring analysis) • Enabling environment: NSP and prevention strategy development exercises • Increasing financial resources in-country and apparent “good will” for collaboration (ie. PEPFAR, GFATM Rnd 9 & 10) • Many UNDAF’s are prevention focused • UN highlighted by key stakeholders as potential facilitator for coordinated national response • Strengthened human resources among Joint UN Team on AIDS

17. Next Steps: IATT/YP Guidance Briefs Field-Testing: how Joint UN Teams use briefs in country settings Roll-out: through Regional events; and inter-agency support missions Monitoring & Evaluating the Briefs in ESA, through JUNTA’s “Regionalization” of the Guidance Briefs • Use to intensify efforts on prevention – currently low coverage of HIV prevention services for young people • “knowing your epidemic” – supportive in addressing lack of action against drivers of HIV infection • Adapting global guidance to remain flexible to accommodate regional and country variations

18. How can we help?Opportunities for Partnership • Build and Share Knowledge Asset - publishing annual reports highlighting successful partnerships, lessons learned and good practices • Capacity-building and Knowledge Sharing with country-level and UN Country-Office Youth SRH/HIV focal persons • Joint-Global/Regional and in-country technical support to SRH/HIV and YP in countries, including facilitating inter-country support (“south-to-south”)

19. How can we help?Opportunities for Partnership • Support to Youth Empowerment and Participation in our policies and global/regional programmes, including through existing youth organizations/network members of IATT • Joint-Technical Support and Advocacy at Regional Intergovernmental fora (ie. AU, SADC, EAC…) • Mobilization and Leveraging of Resources in support of youth programming. ie. PRS’s, Global Fund Rnd 9/10 Proposals

20. Summary • Prevention success in ESA is key to global prevention success: 50% of global PLWHA, 57% of all new infections • Epidemics are complex and evolving. Success requires capacity to design strategies which achieve required scale • Resources need to be focused at drivers of new infection. Focus on what’s important, and stop what’s not. • Place HIV and Young People’s issues in overall development context

21. Summary • Build strategic alliances with young people through Youth-Adult Partnerships • Package our work within UN Reforms; integrate and strengthen existing inter-agency mechanisms to Deliver as One • Strengthen linkages between our global-regional-country-level mechanisms based on comparative advantages • The UN has and must play its strategic role

22. Thank-You Acknowledgements: *Lesotho, Romero-Daza 1994; Namibia, Mukonda 1998; Tanzania, Silberschmidt & Rasch 2001; Zimbabwe, Gregson et al 2002; South Africa, Leclerc-Madlala 2003, Swaziland, Mader 2004, Mozambique, Bagnol & Chamo 2004, Botswana, Ng’andu 2006 * Swidler & Watkins 2006 * SADC Expert Think Tank Meeting on HIV Prevention * UN Regional HIV Prevention Working Group for ESA; 2008 Annual Report to RDT; Annual Rolling Workplan (March 2009) * UNFPA ARO/SRO, Johannesburg * UNFPA HAB/Dr Otieno, New York * UNAIDS RST ESA, 2008; Brief on Vulnerabilities of Young Women and Girls in Southern Africa * UNAIDS RST ESA, 2008; Combination Prevention Brief