1. Dangers and pleasures: risk perception among young injecting drug users in Eastern Europe Maria Phelan- Harm Reduction International

2. Global Data Snapshot A global population size estimate for people who inject drugs under the age of 18 is unavailable The contribution of injecting among under-18s to HIV epidemics is largely unknown. National population size estimates are exceptionally rare and age disaggregation in HIV surveillance is poor.

3. Ukraine: No. of adolescents who inject drugs versus access to Int’l HIV/AIDS Alliance harm reduction services See: O. Balakireva et al Population Size Estimate of Most-At-Risk Children and Youth in the 10–19 Age Group, Kyiv: Unicef, 2011 and D. Barrett, N. Hunt and C. Stoicescu Injecting drug use among under 18s: A snapshot of available data, London: Harm Reduction International 2013.

4. Available studies show… Low ages of initiation across regions. In some countries significant proportions of people who inject drugs are adolescents (e.g. Nepal, 20%) Important differences between younger people who inject drugs and older counterparts, including in risk- taking behaviour and access to services Specific groups of young people are at increased risk, in particular those who are street involved Significant variations between countries and within them

5. Indonesia: % people who inject reporting needle sharing disaggregated by age See: National AIDS Commission (2011) Report: Age group disaggregation of survey and research data. Jakarta: KPA

6. Context is key: To what extent are good practices transferable?

7. Step by Step: Preparing for work with children who inject drugs. A tool for harm reduction service providers

8. WHO? WHY? The global data snap shot highlighted a huge gap in provision of harm reduction services to under 18s and the existence of laws and policies that limit access. We wanted to help service providers think through how to do this work and to be better prepared to deal with the complex issues of children and injecting drug use.

9. The tool is intended to help organisations ; Explore attitudes to working with and supporting young injectors; Understand the need for safeguarding and protection of children within services Assess current capacity to work with young people; Map available services for back up and support Develop policies and procedures for working with children who inject drugs. WHAT? Step by Step was designed to assist harm reduction service providers work through the ethical, legal and practical dilemmas in working with children who use drugs.

10. The guide offers practical exercises/ case studies that explore Child protection protocols Mapping laws and policies Exploring consent and young peoples right to decide Organisational policy and position development

11. HOW? The draft tool was developed with a harm reduction expert and revised by the team. A stakeholder workshop was held in Nepal by Save the Children and Youth Rise with support from UNICEF with young drug users and service providers A technical review was carried out by each organisation and their technical advisers Pilot testing: Save the Children, IHAA and Youth Rise will work with in-country partners in Nepal, Ukraine and Romania to test this tool in a service delivery context. Launch/promotion at IAC 2014

12. Thank you! Maria.phelan@ihra.net www.ihra.net