Transcript Slide 1

Preventing HIV Infections in Adolescents & Young People:
Progress and Key Challenges
Dr. Susan Kasedde
Senior Specialist, HIV Prevention
UNICEF, NY
Web-Conference: Strengthening HIV Prevention through Sexuality Education
29 April, 2010
Presentation Outline
• Why it is important to focus on young people
• Progress and challenges for prevention in
young people
• Strategic opportunities
Why Young People?
• An opportunity to slow the epidemic down because young people
contribute significantly each year to new infections globally.
• Most infections globally are transmitted sexually and sexual behaviour is
initiated and modeled early. Young people are important allies for
changing social norms.
• Where declines in ante-natal prevalence have been observed in high
prevalence settings (Botswana, Malawi, Tanzania, Zambia, Zimbabwe),
population based surveys have confirmed sexual behaviour changes
among young people.
• With the roll out of paediatric treatment and improved care, growing
number of adolescents living with HIV are maturing sexually. Important
partners for prevention. Critical to improve their guidance, care and
support for prevention.
In the last three years, young people have
accounted for more than one third of all new
infections
Distribution of New HIV Infections by Year
0%
20%
40%
60%
80%
100%
Children Under 15
2006
12%
35%
53%
Young People (15 - 24yrs)
Adults 25 yrs+
2007
2008
14%
16%
39%
34%
47%
50%
Disclaimer: Due to
changes in the
methodology used to
generate estimates, the
data presented should not
be interpreted as trend
data.
Source: UNAIDS, 2006, 2008, 2009
Gender disparities in prevalence reflect
inequalities in social and economic
opportunities and access to services
Distribution of HIV infections between young males and females, aged 15 – 24 yrs in
countries with highest gender disparity
100%
80%
60%
40%
Females (15 - 24 yrs)
Males (15 - 24 yrs)
20%
0%
Source: UNAIDS, Dec 2008 with additional analysis by UNICEF
Prevention efforts in concentrated settings
must have strong focus on most-at-risk
Adolescents
HIV prevalence data showing contrast between general population prevalence and
prevalence among most at risk populations in capital cities in countries with low and
concentrated epidemics
30
24.1
23.5
23.1
General adult population (15 - 49)
Per cent
20
Sex workers
Men who have sex with men
11
10
10.3
9
Injecting Drug Users
6.7
2.4
2.7
1.1
4.2
3.7
1.1
0.9
0.3
0.3
0
Suriname
Dominican
Republic
Russia
Country
Tajikistan
Vietnam
Source: UNAIDS 2008
• Young people constitute a significant proportion of most-at-risk populations with behaviours
initiated primarily during adolescence.
• A national survey in Ukraine found up to 98% of IDU started before age 18 (UNICEF, 2008).
• Between 72 – 96% of IDU started before age 25 in 12 cities across the world (WHO, 1998).
Strengthening communities and
families is essential for prevention
Children’s Living Arrangements
Living with both parents (%)
Living with mother only (%)
Living with father only (%)
Not living with either parent (%)
Tanzania 2007-08
60
19
Malawi 2006
59
20
Cameroon 2006
59
Zambia 2007
58
Mozambique 2008
58
Uganda 2006
Zimbabwe 2005-06
Namibia 2006-07
Swaziland 2006-07
26
22
20
4
27
26
4
5
15
6
24
38
19
3
20
33
17
4
24
40
18
5
19
47
17
2
18
55
Lesotho 2004
5
29
36
6
34
Source: UNICEF, Stocktaking Report, Dec 2009
Strengthening communities and
families is essential for prevention
Children’s Living Arrangements
Living with both parents (%)
Living with mother only (%)
Living with father only (%)
Not living with either parent (%)
Tanzania 2007-08
60
19
5
17
59
2
18
Four countries with very
high HIV prevalence 20also have
Cameroon
2006
59
18
5
17
especially
high proportions
of adolescents living
without
the
day
from both parents.
Zambia
2007 to day care and protection
58
19
4
19
Malawi 2006
Mozambique 2008
58
Adult prevalence
Uganda 2006
23.2%
Lesotho 2004
15.3%
Zimbabwe 2005-06
15.3%
Namibia 2006-07
26.1%
Swaziland 2006-07
24
55
20
47
22
33
38
20
4
27
26
4
5
15
6
24
40
26
3
29
36
6
34
Source: UNICEF, Stocktaking Report, Dec 2009
Progress towards increased condom use
during high risk sex is uneven
•
Condoms are an essential tool for HIV prevention with the opportunity for expansion of access available through
well established facility-based and outreach SRH services as well as private sector outlets.
•
Yet, data availability on condom use in young people remains a problem in many countries - reflective of
continued reluctance in many countries, to programme specifically on condoms for sexually active young people.
•
In 2001, States committed to ensuring expanded access to essential commodities for HIV prevention including
male and female condoms.
Condom use at last sex among young men and young women
reporting more than one sexual partner in 12 months
100
90
80
70
60
50
Male
40
Female
30
20
Source: UNICEF
Stocktaking Report, Dec
2009
10
0
Botswana Cote d'Ivoire
Kenya
Lesotho
India
Swaziland
Haiti
Changing Global Financial
Landscape
AIDS Spending/Projected Need – US$ Billions
25
AIDS Spending/Projected Need
20
13.8
7.9
2005
8.8
2006
11.3
2007
Economic crisis followed by
signals of reduced growth in
AIDS funding with strong
implications for HIV
prevention
2008
2009
2010
Source: UNAIDS, 2006, 2008, 2009
Improvements in comprehensive correct knowledge
among young women and men aged 15-24 but most
countries far from 2010 target
Developing countries with 10 or more percentage point increase in the percentage of young women and men aged
15-24 with comprehensive correct knowledge of HIV
Young women aged 15-24
Global 2010 target (95%)
31
Namibia 2000-06/07
33
Trinidad and Tobago 2000-06
54
23
Rwanda 2000-05
36
50
Cambodia 2000-05
37
50
25
19
Haiti 2000-05/06
15
Cameroon 2000-06
16
Jordan 2002-07
28
Haiti 2000-05/06
17
India 2001-05/06
39
34
31
35
21
Nigeria 2003-08
23
17
0
Indonesia 2002/03-2007*
3 13
0
10
40
36
14
Benin 2001-06
32
Uzbekistan 2000-05 3
5
42
39
26
Tanzania 1999-07/08‡
29
Tanzania 1999-07/08‡
41
15
Central African Republic 2000-06
54
41
18
Dominican Republic 1999-2007
7
20
Rwanda 2000-05
42
27
Suriname 2000-06
Armenia 2000-05
62
44
Moldova 2000-08*
Gambia 2000-06
41
Namibia 2000-06/07
44
11
Sao Tome and Principe 2000-06
Global 2010 target (95%)
51
Guyana 2000-06
Viet Nam 2000-06
Young men aged 15-24
65
20
30
40
50
60
70
80
90
100
0
Source: UNICEF global databases, 2010 (MICS, DHS and other national surveys, 2003-2008)
33
15
20
40
60
80
100
Critical to reach young people before they are sexually active with
opportunities to build skills and age-appropriate information to
raise risk perception and knowledge on HIV and prevention
•
Early age at first sex, unprotected vaginal or anal sex, age disparate sex and sex with multiple
and concurrent partners are the behaviours driving sexual transmission of HIV.
•
High levels of school attendance among adolescents provides a window of opportunity to
reach young people to focus on these behaviours and build competence to reduce their risk
for infection before they become sexually active.
Table Showing Access to Primary School at the Grade 5 Level (age 10/11)
Country
Proportion Reaching
Grade 5 (M/F)
Country
Proportion Reaching
Grade 5 (M/F)
Botswana
80/85
Guyana
64/65
Cambodia
61/64
Indonesia
92/94
Cameroon
64/64
Kenya
81/85
Central African
Republic
61/57
Lesotho
68/80
Côte d’Ivoire
83/73
Nigeria
82/84
Dominican Republic
66/71
South Africa
82/83
Gabon
68/71
Swaziland
76/88
Source: UNFPA, State of the World Population Report, 2009
Conclusions and Recommendations
• Strengthen basic understanding of national and sub-national epidemic and
its drivers.
• Critical to define expected results from an appropriate combination
prevention approach including support and partnership with PLHA
• Establish a clear coordination mechanism for their achievement.
– Define clear accountabilities of all partners.
– Address quality of services and balance interventions to create demand as
well as improve delivery.
• Direct services including information and support to those most at risk.
• Invest in systems to build more efficient service delivery, tracking and
design.
Thank You!