ADOLESCENTS & HIV RELATED STIGMA Workshop on reduction of HIV related stigma & discrimination Musanze, October 2011 Presenter: Grace MURIISA, Pediatric HIV Specialist, UNICEF-RWANDA

Presentation Outline 1. A few definitions 2. HIV among adolescents & young people (Global & National picture) 3. Adolescents & HIV related Stigma 4. Modeling service delivery in Musanze DH & RBC/IHDPC clinic (Key elements of the model) 4. Perspectives

1.DEFINITONS (WHO) Adolescents: years Young People: 15-24years Youth (Rwanda Context): 15-35years

2. HIV AMONG ADOLESCENTS & YOUNG PEOPLE

Why Focus on Young People? (Global Context) 1.An opportunity to slow the epidemic because young people contribute significantly each year to new infections globally (900,000 new infections among young people in 2008). 2.Most infections, globally, are transmitted sexually and sexual behavior is initiated and modeled during adolescence. 3.Young people are important allies for changing social norms and are leading the prevention revolution by choosing to have sex later, having fewer partners and increasing their use of condoms. New infections among young people have declined by more than 25% in 7 countries(1)

Why Focus on Young People(cont’d) 4.With the roll out of treatment and improved care of children living with HIV, there will be more adolescents living with HIV. They have specific needs and it is critical to improve guidance, treatment, care and support for prevention. 5.In concentrated epidemics, young people constitute a larger proportion of "most-at-risk populations" (i.e. people who inject drugs, people who sell sex and men who have sex with men)

Why Focus on Young People(cont’d) The Millennium Development Goal (MDG) 6 includes the following targets: Halt and begin to reverse, by 2015, the spread of HIV/AIDS Indicators relevant to young people: 6.1 HIV prevalence among population aged years 6.3 Proportion of population aged years with comprehensive correct knowledge of HIV/AIDS Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it 2001, United Nations General Assembly Special Session (UNGASS) on HIV/AIDS includes the following targets: Reduce HIV prevalence among young people aged 15 to 24 by 25 per cent globally by 2010 Ensure that 90 per cent of young people aged 15 to 24 have the knowledge, education, life skills and services to protect themselves from HIV by 2005, and 95 per cent of them by 2010

Young People Living with HIV Of the 1.8 billion worldwide, an estimated 5 million young people aged 15–24 were living with HIV in 2009, a 12 per cent reduction since 2001

Why Focus on Young People(cont’d) (National Context) Over 80,000 PLHIV on treatment (ART) About 8,000 are children < 15 years of age Challenges: Paucity of data to guide programming Health services not yet tailored to the special needs of adolescents- lack of “friendly” environment of care Unmet non-health needs including psychosocial support and stigma reduction (Poverty, orphan hood, 1994 genocide, cultural & religious influences, inadequate access to quality education, food insecurity, substance abuse, etc…)

Modeling service delivery for ALHIV A few sites: 2 sites through the One UN/RBC/IHDPC/MUSANZE DH partnership Key elements of the model: Training of health workers, development of tools, psychosocial support including peer education & life skills training, stigma reduction, adherence to care, positive prevention of HIV transmission, SRH, family-centered care including positive parenting skills, linkages for sustainable provision of essential non-health needs, community participation, school centered support. All interventions planned and reviewed according to site specific needs assessments

Adolescents & HIV related STIGMA

HIV related STIGMA Key Facts AIDS related stigma exists worldwide since the epidemic began (Taylor, 2001; Klein et al., 2002; Valdiserri, 2002). Interferes with effective response to AIDS Imposes hardships on those affected and infected (Herek,1999; Lee et al., 1999; Schiff et al., 2003).

HIV related STIGMA (Cont’d) Key Facts (cont’d) Much knowledge about HIV transmission (>85%) Less knowledge about how HIV is not transmitted (London & Robles, 2000; Herek et al, 2002).(<55%) Fear of HIV transmission through casual contact feeds stigma Correct knowledge about transmission associated with positive attitudes to PLHIV

Factors associated with HIV related stigma Misunderstandings about transmission Overestimating the risk of casual contact Negative attitudes towards social groups which are disproportionately affected Cultural, gender & religious beliefs

Some specifics among adolescents Girls seemed more knowledgeable about how HIV is and is not transmitted – (Ref to a specific study not to be generalized) Education level Socio-economic status Involvement in peer led discussions/activities Access to written/media broadcasted information on HIV

A few quotes “AIDS is a dangerous, lethal and incurable disease: It’s like having a knife at your throat. It’s not only knowing that you are going to die... its all the suffering that you are going to go through”. Concern about being discriminated: “What worries me the most is to stay isolated and to live all my life with a label: “she has AIDS””

PERSPECTIVES A focus on adolescents & young people in district level stigma reduction activities Stigma-free HIV prevention services Stigma-free HIV Care & Treatment services Generation of evidence Participation of the adolescents & young people Family/community centered approaches Friendly health environment at health facility level Multisectoral approaches

MURAKOZE