Washington D.C., USA, July 2012www.aids2012.org Geeta Rao Gupta, Deputy Executive Director, UNICEF

Washington D.C., USA, July 2012www.aids2012.org A Perspective of the World in 2000: A Global Epidemic With Many Faces

Washington D.C., USA, July 2012www.aids2012.org The 2011 HIV Investment Framework Sy Reduce Risk Reduce likelihood of transmission Reduce mortality and morbidity  Condoms  Male circumcision  PMTCT  Treatment  Key populations  Behavior change BASIC PROGRAMME ACTIVITIES CRITICAL ENABLERS SYNERGIES Source: Schwartlander B, et al. The Lancet, 377 (9782), 2011

Washington D.C., USA, July 2012www.aids2012.org Women and Girls’ vulnerability to HIV Limited Access to Education Limited Control of Productive Resources Income Land Employment Limited Social Capital Gender Equality

Washington D.C., USA, July 2012www.aids2012.org 4.8 million young people aged 15 – 24 years are living with HIV. 3 million (two out of every three) are girls Note: Global summary in title from UNAIDS, Together We Will End AIDS, 2012

Washington D.C., USA, July 2012www.aids2012.org Outline Adolescent Girls Why What How

Washington D.C., USA, July 2012www.aids2012.org Source: Regional summaries by gender: UNICEF, Progress for Children, 2012 derived from 2010 estimates Country data: UNAIDS 2009 estimates Adolescents Living with HIV 2.2 million [2.2 million – 2.5 million] of whom 60% are girls

Washington D.C., USA, July 2012www.aids2012.org Panel Slide – Boys and Girls in the Life Cycle Source: UNICEF, Boys and Girls in the Lifecyle, 2011

Washington D.C., USA, July 2012www.aids2012.org Early Sexual Debut Source: UNICEF, Progress for Children, 2012 (based on national household surveys) Note: Data not available from Middle East and North Africa, East Asia and the Pacific, Central Europe and the Commonwealth of Independent States, and for males in Latin America and the Caribbean

Washington D.C., USA, July 2012www.aids2012.org Child Marriage 1 out of 3 women aged in the developing world were married before they turned 18 1 out of 2 women aged in the least developed countries were married before 18 Source: UNICEF, Progress for Children, 2012 (based on national household surveys)

Washington D.C., USA, July 2012www.aids2012.org

Washington D.C., USA, July 2012www.aids2012.org Sexual Violence Source: Based on estimates by G. Andrews et al., in WHO, Comparative Quantification of Health Risks (2004)

Washington D.C., USA, July 2012www.aids2012.org SOCIAL PRESSURE & MOTIVATIONS Boosts status among peers Helps build social networks & capital Coercion Pressure to conform PERSONAL MOTIVATIONS Affirms self-worth Proves she is desirable Boosts self-esteem To take control Material & Financial gain Employment opportunities Strategy against poverty/hunger Strategy for protection Distraction from emotional problems Fun Transactional Sex Girls’ Motivations for Transactional and Age-Disparate Sex Source: S. Leclerc-Madlala, Multiple and Concurrent Partnering in Southern Africa: The Ethnographic Perspective, 2008.

Washington D.C., USA, July 2012www.aids2012.org The Investment Framework Reduce Risk Reduce likelihood of transmission Reduce mortality and morbidity  Condoms  Male circumcision  PMTCT  Treatment  Key populations  Behavior change BASIC PROGRAMME ACTIVITIES CRITICAL ENABLERS SYNERGIES Social norms and protection: to address child marriage, sexual violence, etc... Education: to address financial and opportunity costs that keep girls from school Empowerment: to address false sense of security and transactional sex SYNERGIES Adapted from: Schwartlander B, et al. The Lancet, 377 (9782), 2011

Washington D.C., USA, July 2012www.aids2012.org A Business as Usual Approach Source: UNICEF and Futures Institute (Ongoing), Making the Case for Adolescents. Based on Investment Framework in Schwartlander B, et al. The Lancet, 377 (9782), 2011

Washington D.C., USA, July 2012www.aids2012.org The HIV Investment Framework Reduce Risk Reduce likelihood of transmission Reduce mortality and morbidity  Condoms  Male circumcision  PMTCT  Treatment  Key populations  Behavior change BASIC PROGRAMME ACTIVITIES CRITICAL ENABLERS SYNERGIES Adapted from: Schwartlander B, et al. The Lancet, 377 (9782), 2011

Washington D.C., USA, July 2012www.aids2012.org What Could we Achieve if we Applied the HIV Investment Framework to work on Adolescents? Source: UNICEF and Futures Institute (Ongoing), Making the Case for Adolescents. Based on Investment Framework in Schwartlander B, et al. The Lancet, 377 (9782), 2011

Washington D.C., USA, July 2012www.aids2012.org Effective Strategies to Work with Adolescents for HIV Prevention Outcomes SettingStrategyRecommended for: Go! Take these interventions to scale NOW! SchoolAdult-led sexual health education programmes Influencing reported sexual & reproductive health behaviour and knowledge Mass mediaMessages delivered through radio AND TV and other media (e.g. print) Influencing knowledge and reported self-efficacy Ready: Implement widely but continue to evaluate Health FacilityStrengthening of youth-friendly health services complemented by community action Influencing utilisation of health services Community- based Targeting adolescents to deliver interventions in geographically defined communities Influencing reported sexual & reproductive health behaviour Sources: Doyle A, et al, IAS, 2010; LSHTM and NIMR, HIV prevention among young people in sub-Saharan Africa the way forward (2009)

Washington D.C., USA, July 2012www.aids2012.org Recommendations to Accelerate the Pace

Washington D.C., USA, July 2012www.aids2012.org Recommendation 1: Relevant and Resourced National Plans for High Impact Source: Birdthistle I, Dringus S, et al. (2012). Investing in young people: A review of national-level spending on HIV prevention for young people in 16 countries with generalized HIV epidemics. XIX International AIDS Conference. Washington DC. Proportion of all National HIV Prevention Funds Spent on Youth in and out of School

Washington D.C., USA, July 2012www.aids2012.org Recommendation 2: Educate girls Source: UNICEF, Opportunity in Crisis, 2011 (based on data from UNESCO Institute for Statistics)

Washington D.C., USA, July 2012www.aids2012.org Recommendation 3: Make Adolescents Visible in Monitoring and Routine Data Systems

Washington D.C., USA, July 2012www.aids2012.org Strengthening Service Access, Delivery & Retention Youth Networks Recommendation 4: Invest in innovation Social Media engagement for Strategy Design Behaviour Change & Demand Creation Monitoring

Washington D.C., USA, July 2012www.aids2012.org Recommendation 5: Engage Adolescents

Washington D.C., USA, July 2012www.aids2012.org “We invest so much in keeping children alive in the first decade of life. We must not lose them in the second.” Anthony Lake Executive Director, UNICEF

Washington D.C., USA, July 2012www.aids2012.org