empowering young people to protect themselves from hiv business case

EMPOWERING YOUNG PEOPLE TO PROTECT THEMSELVES FROM HIV

Business Case

Process till date2

Working Group formed Discusses process Consultation designed Country level survey commissioned on priorities

BC Drafts developed by UNFPA, UNESCO, UNICEF, WHO and ILO Draft compiled for consultation

Desk study completed of 65 documents: 26 NSPs from 7 regions 8 key meeting / consultation reports 22 Technical and Research papers 9 other resources

Business case – how organized ?

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1. Rationale – why it is important 2. Goal statement and focus3. What is working well (to be scaled up)4. What is not working well (why)5. What needs to be done (strategies)6. Key stakeholders and resources7. Role of UNAIDS , including leveraging assets,

structures of UNAIDS 8. Engaging external partners and stakeholders9. Accountability and measuring progress10. Moving forward (priority countries, epidemics)

Business case – 4 Sections4

1. Rationale – why it is important 2. Goal statement and focus3. What is working well (to be scaled up)4. What is not working well (why)5. What needs to be done (strategies)6. Key stakeholders and resources7. Role of UNAIDS , including leveraging assets,

structures of UNAIDS 8. Engaging external partners and stakeholders9. Accountability and measuring progress10. Moving forward (priority countries, epidemics)

Process for this session5

Introduction the Business Case (10 mts) Presentation of section 1 (10 mts) Buzz Group for Section 1 (10 mts) Presentation & Buzz group –Section 2 (20 mts) Presentation & Buzz group –Section 3 (10 mts) Presentation & Buzz group –Section 4 (10 mts) Buzz group report back – 3 mts per group / 10

groups (30 mts) Plenary conclusion (10 mts)

Presentation structure6

Each of the 4 sections have sub-sections Each section is presented as:

What is in the Business case (now) What are the gaps (vis a vis format &

requirements) What are the other resources available

(from desk study) to fill these gaps

RATIONALE, GOAL & FOCUS

Section 1

Section 1: Rationale, goal & focus

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a. Rationale – why it is important a. Summary of the context and the priority areas’ importance

to the AIDS response, b. Differences among regions and epidemic contexts

b. Goal statement and focusa. High-level goal statement for 2015 and a longer-term

(post 2015) vision statement. b. Quantification of success (e.g. number of people

affected, impact over time).c. Effects on other priority areas, the overall AIDS

response, and on the MDGsd. Three strategic and measurable and time-bound

intermediate objectivese. Geographic, epidemiological, and other factors that

affect the focus or implementation of the strategy.

Rationale9

Young – defined as 10-24 33 million living with HIV, 62 % in SS Africa 45 % of new infections amongst 15-24 age Young disproportionately more affected, particularly girls/women 2/3rd of infection in complex emergency countries MARPS who are young have specific and special needs

(particularly hyper and generalized epidemics) Low awareness (only 40 %) aware of HIV and its transmission

(Target 95 %) SRH needs of young not addressed High levels of stigma, particularly for young people who are HIV+ Migration phenomenon – particularly important for young people Loss of parents Sexual exploitation, gender based violence

Gaps10

Regional differences particularly Asia and Pacific, Latin American, Caribbean,

West and Central Africa and Middle East and North Africa Diversity of epidemic scenarios and vulnerabilities

Hyper, generalised, concentrated and low and its effects. Tighter and clearer arguments and justifications for

WHY young people as a priority area – Estimation of young people to be reached, Epidemiology,

risks, vulnerabilities, challenges in reaching them effectively and the benefit for AIDS response for addressing young people

Focus and special groups Age disparate & inter-generational sex How the definition of 10-24 reached

Additional resources11

UNFPA & UNAIDS – Disproportionate argument strengthening Social drivers and structural factors (Addressing social drivers of

HIV/AIDS) Macro and micro trend variation on sexual behaviour and other

determinants (Education & Vulnerability - role of schools) Age disparate & inter-generational sex

Odds of HIV infection is 40-70 % higher when partner > 5 years older Impact of abstinence approach HIV risk and education

Increases by 8 % for those without sec education How young have different needs 4.3 million young PLHIVs do not know their status – testing Female Sex workers typically start young; age at initiation

dropping significantly in many countries and majority of sex workers < 25


70 % of injecting drug users < 25 years of age (half started between 16-19)

Young MARPs disproportionately affected: Myanmar - the highest HIV rates among female sex

workers and injecting drug users occurred at ages 20 to 24 (41 percent and 49 percent, respectively),

Bangkok - HIV incidence among young MSM (ages 15-22) has nearly doubled in recent years (4.1 % in 2003 to 7.7 % in 2007)

Barriers to access and unmet needs Different needs of Young PLHIVs and within them –

children, adolescents Need for contextual analysis of young

Focus, estimates and needs

Goal statements13

1. Young people to be more engaged, and UNAIDS Programme (at country, regional and Global) to be more accountable and coordinated to meet existing national and global coverage and outcome targets for HIV prevention, treatment and care and support for young people, and aggressively collect age and sex disaggregated data by 2015.

2. To increase young people’s access to and utilization of HIV prevention, treatment, and care services to reach the goal of universal access by 2015.

3. UNGASS Target is 1) By 2010 at least 95% of young men and women aged 15 to 24 have access to the information, education, and services necessary to develop the life skills required to reduce their vulnerability to HIV infection. (2) By 2010 reduce HIV prevalence among young men and women aged 15-24 globally by 25%.

Gaps14

Only goal statements attempted. Even these are not clear, direct and

focused. Targets (quantity) need to be clearly

thought through (Impact, outcomes, outputs) and it should be time bound

Connection to MDGs – needs more elaboration


Promoting realistic options for young adults leads to safer sexual behaviour

Understanding and addressing the social drivers of HIV Community driven empowerment and behaviour

change in men Movement for social transformation Rights based approach Reduction of stigma Sustained and informed leadership which mobilises

and retains focus Reduce school drop out rates Social marketing to address the less educated /

literate Socio economic status and empowerment

BUZZ GROUP 117

Pls form groups of 4-5 people Discuss the Section 1 presentation Document separately

Gaps Suggestions and Queries

in three different sheets / cards Total time – 10 mts

WHAT WORKS WELL, WHAT DOESN’T AND WHAT NEEDS TO BE DONE

Section 3

Section 219

What is working well (and scaled up) What is not working well (and why) What needs to be done

Summary / overview. Geographic and other focus

What is working well20

Surveys in 35 countries indicate sexual behaviors improving (condom use with non-regular partner, partner reduction, age at first sex) Where improvements made, factors unclear

Evidence that school AIDS Programmes work Needs to implemented in quality and scale Focus on education, training, counseling

Work place programmes targeting the young have an impact, particularly peer education

Analysis of the costs and benefits of 41 programmes targeting young people in developing countries - investments in youth yield the highest economic returns.

Promotion of a ‘basic minimum package' of topics and learning objectives

Mode of transmission studies to inform strategies Active youth organizations and networks to develop

leaders Comprehensive programmes addressing – biomedical,

behavioural and structural aspects

What is working - gaps21

Specific examples and a summary of evidence informed interventions

Joint programming at country level (need examples of success).

Interventions need to scale up and what should be the reach

What is working well-Resources

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Using opinion leaders Youth friendly services One stop services Addressing other needs as the PLHIV progresses

through different stages of life Supportive policies and standards Involvement of YPLHIV, Support groups Listening to young people voices Innovative intervention through mass media

challenging societal norms that create vulnerability eg Fataki campaign

Campaign against homophobia, working with social networks

What is not working well23

Although rates are falling, younger people still account for highest new infections 21 countries reporting comprehensive coverage – Only 9-50 % of children

reached Women/girls consistently having lesser outcomes and greater negative

impact Differentiated and prioritized interventions; which are evidence based

Single and isolated interventions (lack of comprehensiveness) don’t work Higher knowledge not always translating into less risky behaviour

(Kenya, Namibia) Out of school – very few have strategies in place and implemented Legal and policy constraints – largely unaddressed Where well developed policies exists for MARPs – very little for young

people within them Weak co-ordination at country level The ‘hows’ of dealing with adolescent mind Effective participation of young people (voice and response) Sex and age disaggregated data

What is not working well - Gaps

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Country examples ‘what if’ analyses (if these were not

removed)

What is not working - Resources

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Simplistic understanding (e.g. poverty) of deeper linkages

Abstinence programs not very effective in comparison to comprehensive program

lack of planning, standards and consistent resources

Lack of linkages Inappropriate package of services

What needs to be done26

Define and scale up access to appropriate HIV prevention, treatment, care and support

Reinforce the requirement for strategic information on young people

Innovative approaches to support existing HIV prevention programmes for young people: Interventions focusing on structural change (including

“large-scale” and “upstream” aspects of this) New technologies (eg from microbicides to information

and communication technologies (ICTs)) Existing interventions adapted for young people (eg

male circumcision and voluntary counselling and testing)

What needs to be done27

Invest in meaningful activism and participation and capacity building of young people

Developing and evaluating structural interventions that go beyond young people themselves, such as: interventions for communities as a whole interventions to change social norms that impact

transmission/acquisition focusing on adults, especially adult men in generalized

epidemics (where the virus is coming from) interventions to mitigate the consequences of increased

vulnerability

What needs to be done - gaps

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Geographical and epidemic contexts and the changes required in strategies

Costing

What needs to be done- resources

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Need for addressing social determinants Specific strategies and processes by every country, keeping in

mind context Address state, service provision, communities, families and

individuals. Community Mobilisation Increase access to SRH services Adequate technical and financial resources to address structural

driver Strengthen country capacity for Strategic information Generate demand and provide youth friendly community services Mental health and psychological services Respectful SRH services, focussing on retention of client Collect disaggregated data Policies and standards which are youth friendly Detailed evidence gathering in-country on context and local

epidemic and tailored programs. Costing and economic analysis

BUZZ GROUP 231

Pls form groups of 4-5 people Discuss the Section 2 presentation Document Gaps, suggestions and

queries in three different sheets / cards Total time – 10 mts

ROLES AND PARTNERSHIPS

Section 3

Section 3 – Roles and partnerships

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1. Key stakeholders and resources2. Role of UNAIDS , including leveraging

assets, structures of UNAIDS 3. Engaging external partners and

stakeholders

Roles34

Young people addressed transversally in division of labour

Structures: IATT on Young people, convened by UNFPA; IATT on Education, convened by UNESCO; IATT on Children Affected by AIDS and on

PMTCT, both convened by UNICEF AIDS Security and Conflict Initiative (ASCI)

Governments Research and institutions Young people

Roles35

Role of UNAIDS: Promotion of systems wide response to HIV and long

term investment Intersectoral nature of the response which enables the

provision of response across communities and an individual’s lifecycle.

Policy direction and impetus (encouragement!) for changing social norms related to sensitive issues.

Technical guidance for intervention development/implementation based on intervention research and operations research

Provision of strategic information, sharing knowledge and state of the art innovations.

Roles36

Normative guidance, building support, convening stakeholders.

Target setting and support for monitoring Capacity building of regional institutions to provide

technical support at country level Coherent and coordinated response through the Unified

Budget and Work-plan and the division of labour. Strong partnership framework both with UN agencies,

civil society and people living with HIV Strengthen existing coordination mechanisms at Global

level-the Interagency Task Team (IATT) on young people, IATT on Education and IATT on Children) as well as those at country level

Roles gaps37

Roles undefined: Civil society and international NGOs Youth organizations the Interagency Youth Working Group (IYWG) Bilateral agencies and donors Other development partners, including Global fund

Roles not linked to objectives Huge expectations from UNAIDS (Unrealistic?) Human, technical and financial capacity at

country, regional and global level to support implementation

Is this based on core strengths of UNAIDS and its partners

New opportunities to add value

Roles gaps38

What UNAIDS structures, systems, plans and policies already exist that can guide / inform action in this Priority Area?

What UNAIDS Secretariat and Cosponsors need to change in order to make the largest possible contribution to the priority area

How the Joint Programme should work in new ways across the cross-cutting strategies

Requirements at country level (focus on required country team contribution and consider differences between types of country/region if relevant)

Current and proposed mechanisms at the country levels (improvement based on experiences)

BUZZ GROUP 340

Pls form groups of 4-5 people Discuss the Section 3 presentation Document gaps, suggestions and


ENSURING ACCOUNTABILITY & MEASURING PROGRESS

Section 4

Section 4: Ensuring accountability & measuring progress42

How to ensure accountability for agreed products and milestones

How to measure the Secretariat’s and Cosponsors’ progress, including metrics and milestones. The current monitoring and evaluation approach should change only if it is insufficient or not working

Ensuring accountability & measuring progress

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a) To begin with, hold ourselves accountable for operationalizing the plan ( )

b) Hold policy makers to account for facilitating and providing the political leadership to operationalize their policies as well as involving young people not only as beneficiaries of the services, but as actors.

c) Develop a system of performance evaluation, including establishing realistic benchmarks and indicators for evaluation

Ensuring accountability & measuring progress

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d) Improve Programme monitoring to ensure increased quality in data and evidence to further guide programmes.

UNGASS data needs to be age and sex disaggregated that enables and analysis of most-at-risk young people and provides detailed trend analysis for young people

e) Resources allocated to prevention need to be flexible to ensure that programmes can be adjusted based on evidence and trends

f) Long term investments are needed to enable effective behavior change programming to ensure impact at a generational level.

Ensuring accountability & measuring progress - Gaps

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Not specific, does not address the questions How to address accountability and what should

be the metrics to measure progress? What are the current mechanisms (other

UNGASS mentioned) will be used? For each of the milestones and strategies

identified above, who is accountable? How measure UNAIDS and its cosponsors

accountability towards each of the agreed strategies? A table linking the organizations with each of the

agreed strategies and the indicator to measure each of them will be clear and will be useful.

BUZZ GROUP 447

Pls form groups of 4-5 people Discuss the Section 4 presentation Document Gaps, suggestions and


DOCUMENTS REVIEWED

National Strategic Plans

Five Regions, 26 Countries Asia-Pacific- Malaysia, Pakistan, PNG, Thailand,

Sri Lanka Caribbean- Guyana, Jamaica Eastern Europe and Central Asia- Macedonia,

Moldova, Serbia East and Southern Africa- Botswana, Kenya,

Swaziland, Uganda, Zimbabwe West and Central Africa- Cameroon, Central

African Republic, Ghana, Ivory Coast Middle East and North Africa-Algeria, Morocco,

Tunisia Latin America- Belize, Costa Rica, Peru, Bolivia

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Meeting Reports1. Working draft report of recommended next steps 22 Sept. –

Consultation on Strategic Information and HIV Prevention amongst Most-at-Risk-Adolescents, Geneva

2. Recommendations to Policy makers – HIV Prevention among young people in sub-Saharan Africa: the way forward, Tanzania

3. Aids2031 programmatic response working group: Addressing social drivers of HIV/AIDS

4. Strengthening the health sector response to care, support, treatment and prevention for young people living with HIV, Malawi, WHO/UNICEF 2008

5. HIV prevention among young people in sub-Saharan Africa: the way forward- Report on workshop in Dar Es Salaam, September 2009

6. Young People Most at Risk for HIV/AIDS- A Report from the Interagency Youth Working Group, U.S. Agency for International Development, and the United Nations Inter-Agency Task Team on HIV and Young People, Working Group on Most at Risk Young People- Draft Report

7. Consultation on Strategic Information and HIV Prevention amongst Most-at-Risk Adolescents 2 – 4 September, 2009

8. 2009 Young Leaders’ Summit 2031 Report

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Technical Papers9. Addressing Social Drivers of HIV/AIDS Some Conceptual,

Methodological, and Evidentiary Considerations10.Education and vulnerability: the role of schools in protecting

young women and girls from HIV in southern Africa11.Exploring the role of economic empowerment in HIV

prevention 12.Age-disparate and intergenerational sex in southern Africa:

the dynamics of hyper vulnerability13. Introduction: Addressing the vulnerability of young women

and girls to stop the HIV epidemic in southern Africa14.Responding to HIV prevention needs of adolescents and

young people in Asia towards cost-effective policies and programmes.

15.Costing interventions for young people 16.Responding to the HIV prevention needs of adolescents and

young people in Asia: Towards (cost-) effective policies and programmes

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Technical Papers

17. The impact of abstinence and comprehensive sex and STI/HIV education programmes on adolescent sexual behavior

18. The effect of educational attainment and other factors on HIV risk in South African women: results from antenatal surveillance, 2000-2005

19. Preventing HIV/AIDS in young people. Evidence from developing countries on what works

20. More positive living. Strengthening the health sector response for young people living with HIV/AIDS

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Technical Papers

21. What countries need - Investments needed for 2010 targets22. UNAIDS Outcome framework 2009-201123. Second Draft - Strategic Position Brief- Priority area young

people 24. Draft business case inputs 25. Young People and HIV/AIDS: Responding to Unmet Needs

through Innovative Approaches 26. Initiatives to increase use of health services by adolescents 27. Young people and HIV/AIDS - fact sheets. Various countries in

south.-east Asia 28. Emerging issues: condom policy and programming Protecting

young people for HIV and AIDS. The role of health services29. Comprehensive LGBTQ-inclusive sexual health care for youth in

state custody as a human right30. Knowledge of Correct Condom Use among Adolescents in sub-

Saharan Africa education the link between orphan hood and HIV/HSV-2 risk among female adolescents in urban Zimbabwe?

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Other Resources

31. Support for comprehensive sexuality education; perspective from parents of school-age youth School-based HIV Prevention Programmes for African YouthGirl Power – The Impact of Girls’ Education on HIV and Sexual Behavior

32. UNGASS country reports – Synthesis on HIV and young people 33. Report on the Global AIDS epidemic34. Financial Requirements for Global Investments in Priority health

Interventions for Adolescent Girls35. Estimated Costs of Scaling‐Up Priority Interventions for

Adolescent Girls’ Health And Policy Recommendations for Improved Tracking of Global Health Expenditures on Adolescent Girls

36. Education sector engagement with AIDS and aid funding architecture at country level & Global Fund analysis

37. Young people and HIV/AIDS - fact sheets. Various countries in south.-east Asia

38. UNICEF stock taking report – 4th Stock Taking Report 200939. Report on AIDS Commission on Asia

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Limitations of desk review

Unvalidated data- have seen incorrect data presented in paper

Differences in numbers/percentages reported

Rapid study done of key resources Most data reports 15-24 ( youth) thereby

missing out 10-14 age group Very little on Asia, West Africa, Americas

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empowering young people to protect themselves from hiv business case

Documents