Ending the AIDS Epidemic in Adolescents

Transcription

1 Ending the AIDS Epidemic in Adolescents Eastern and Southern Africa Regional Update on the ALL IN Overview 13 October 2015

2 AIDS-related deaths has declined for all age groups Except adolescents! Eastern and Southern Africa, ,000 Ages 0-4 Ages 5-9 Ages Ages , ,000 Deaths aged 0 4 years 120, ,000 80,000 Deaths in adolescents aged ,000 40,000 Deaths aged ,000 Deaths aged Source: UNAIDS HIV and AIDS estimates, August 2014

3 Over 80% of all adolescents living with HIV are in Sub-Saharan Africa Latin America and Caribbean 4% Industrialized Countries East Asia and 2% Pacific 4% CEE/CIS 1% Middle East and North Africa 1% South Asia 6% West and Central Africa 19% Eastern and Southern Africa 64% Estimated percentage of adolescents aged living with HIV globally, by UNICEF region, 2013 Source: UNAIDS 2013 HIV and AIDS estimates, July 2014.

4 Nearly 60% of all new HIV infections in adolescents are in 6 countries. South Africa 21% Rest of the world 31% India 9% Zimbabwe 3% Indonesia 7% Brazil 3% Lesotho 3% Kenya 4% Uganda 6% Nigeria 7% Mozambique 7% Estimated percentage of new HIV infections in adolescents aged living, by country, 2013 Source: UNAIDS 2013 HIV and AIDS estimates, July 2014.

5 1. Agenda for action to accelerate HIV results with and for adolescents. 2.Opportunity to complement adolescent-focused initiatives and resource mobilization. 3. Opportunity to support countries to improve data collection, analysis and utilization. 4.Platform to foster meaningful involvement of adolescents in programming and advocacy.

6 Vision: ZERO New Infections - ZERO Deaths - ZERO Discrimination ALL IN Strategic Framework End the AIDS Epidemic among Adolescents (ages 10-19) by 2030 Priority Population (10-14) and (15-19) Programmes* Targets to 2020 Adolescent leadership, mobilization and engagement; Human rights and Equity; Sexual and Reproductive Health and Education; Improved Data to drive planning and results Adolescents Living with HIV Adolescents who acquire HIV during adolescence Adolescents with vertically-acquired HIV (diagnosed and undiagnosed). At Risk Adolescent Population Groups Social and programmatic enablers HIV Testing, treatment and Care = reduce AIDS-related deaths among adolescents living with HIV by 65% Reduce new HIV infections among adolescents at risk of infection by 75% Adolescent girls (particularly in Sub-Saharan Africa) Adolescent key population groups i.e. adolescents who inject drugs; gay, bisexual and transgender adolescents; and adolescents who sell sex Combination HIV Prevention Zero stigma and discrimination (by impact target in development) *PACKAGE appropriate mix of proven programmes for each defined adolescent population group based on epidemiological context

7 ALL IN to end adolescent AIDS by = reduce AIDS-related deaths among adolescents living with HIV by 65% Reduce new HIV infections among adolescents at risk of infection by 75% Accelerating Children's HIV/AIDS Treatment Initiative (ACT) Zero stigma and discrimination (by impact target in development)

8 Country Assessment Process Phase 1: Rapid Assessment Phase 2: Targeted In-Depth Analysis Phase 3: Planning Key Steps National Adolescent Programme Context Analysis In-depth analysis of priority interventions in most deprived locations Evidence informed planning National multi-sectoral participatory review & validation Survey, data abstraction & admin record Existing planning & monitoring systems (thematic / cross-sectoral) Decisions Decision 1: HIV Priority setting (Goal, impact & outcome results and targets) Decision 2: Priority programme gaps (Enabling environ, supply, demand and quality) Decision 3: Priority Actions (Plans, resources & outputs) Strategic opportunities: Sectoral / cross-sectoral programme review, AIDS programme review, adolescent programme review etc and resource mobilization activities (e.g GFATM, PEPFAR) Key principle: adolescent and youth engagement at every step

9 Adolescent Assessment & Decision-Makers Tool 1. Data collation, review and validation of selected indicators from multiple data sources 2. Assess national programme enabling environment 3. Synthesize data into a dashboard report 4. Identify coverage gaps and define programme priorities

10 ALL IN Global Priority Countries In sub-saharan Africa (18): Botswana Cameroon Cote d'ivoire DRC Ethiopia Kenya Lesotho Malawi Mozambique Namibia Nigeria Rwanda South Africa Swaziland Tanzania Uganda Zambia Zimbabwe Outside sub-saharan Africa (7): Brazil Haiti India Indonesia Iran Thailand Ukraine

11 Adolescents aged years as a proportion of the total population About one fifth to a quarter of the population is adolescents aged Country % Botswana (Census, 2011) 22 Swaziland (UN Population estimates, 2013) 24 Zimbabwe (ZIMSTAT 2013 and 2014 Population Projections) 24

12 HIV Prevalence (%) among Adolescents and Young People Botswana Swaziland Zimbabwe Source: Botswana AIS IV, 2014 Source: 2014 Spectrum Estimates for Swaziland Source: 2014 SPECTRUM Estimates for Zimbabwe

13 Estimated number of adolescents and young people living with HIV Botswana Swaziland Zimbabwe

14 Child marriage, violence against girls & suicide attempts among adolescent boys and girls Married by 18 among girls Violence against girls Suicide attempts 50% 40% 35% 45% 33% 41% 30% 25% 20% 17% 10% 0% 2% Botswana Swaziland Zimbabwe Source: Botswana Youth and Behavioral Survey, 2012; Swaziland MICS 2010; Zimbabwe MICS 2014

15 Data-related observations & gaps Much of analysis based on old data that needs updating Surveys do not include year olds Limited or no data on adolescent key populations Lack of sub-national data and limited disaggregated data age, sex specially health facility data Small sample size for adolescents in behavioural surveys limits use of data Limited or no data on broader adolescent health & social issues (e.g. mental health, decision-making, PEP) Confounding data in some instances (e.g. condom use among adolescents boys in Swaziland is high, yet HIV prevalence remains high) Missing data (or not reported) for some HIV interventions and no national targets for some interventions and areas (e.g. family planning, PEP, mental health, harm reduction) 15

16 Phase 2: In-depth Assessment Phase 1: Rapid Assessment Phase 2: Targeted In-Depth Analysis Phase 3: Planning Key Steps National Adolescent Programme Context Analysis In-depth analysis of priority interventions in most deprived locations Evidence informed planning National multi-sectoral participatory review & validation Survey, data abstraction & admin record Existing planning & monitoring systems (thematic / cross-sectoral) Decisions Decision 1: HIV Priority setting (Goal, impact & outcome results and targets) Decision 2: Priority programme gaps (Enabling environ, supply, demand and quality) Decision 3: Priority Actions (Plans, resources & outputs) Strategic opportunities: Sectoral / cross-sectoral programme review, AIDS programme review, adolescent programme review etc and resource mobilization activities (e.g GFATM, PEPFAR) Key principle: adolescent and youth engagement at every step

17 Observations & Discussions Country and Government-lead process with participation of stakeholders, including Civil Society, is critical Important review, synthesis and validation of multiple data sources Need to strengthen engagement of adolescents, especially year olds, and youth; important not to have tokenistic adolescent participation Weak coordination mechanisms for programming on adolescents because of multiple delivery platforms and sectors Contradictory legal and policy provisions on consent (to sex, marriage, HTC, health services). How de we ensure multi-sectoral engagement? And how to effectively share information across sectors, countries and stakeholders? Data assessments should be seen as a means not an end in themselves planning, advocacy and programmatic review critical next steps

18 Thank you Renato Pinto HIV/AIDS Specialist, ESARO Anurita Bains UNICEF Regional HIV/AIDS Adviser, ESARO