1. HIV PREVALENCE REDUCTION AMONG YOUNG PEOPLE THE ZIMBABWEAN EXPERIENCE TUDOR HOTEL NEW YORK CITY 26 OCTOBER 2009 PRESENTED BY SIBUSISIWE MARUNDA ZIMBABWE NATIONAL AIDS COUNCIL

2. PRESENTATION OUTLINE  Background Information  Working Definition  Policy Environment  Identified drivers of the epidemic  What is working well  Barriers  What can we do better

3. Background Information  Zimbabwe is a landlocked African country with a total land area of 390 757 square kilometers with a total of 12,121,565 people of which 5, 870,088 are males while 6,251, 477 females Youth Population Women (15-24)1,337,816 Women (15-49)2,994,457 Men (15-49)2,735,461 Men (15-54)2,882,213 Children (0-14)4,981,963

4. HIV Historical trend 200720082009 Adult prevalence 15-49 years 14.7% (12.8-16.0) 14.1% (12.1-16.0) 13.7% (11.9-15.0) Prevalence males 15-24 years 3.4% (2.6-4.0) 3.4% (2.7-4.0) 3.5% (2.8-5.0) Prevalence females 15-24 years 7.5% (6.2-10.0) 7.3% (6.0-10.0) 7.5% (6.1-10.0) Prevalence children 0-14 2.1% (1.3-3.0) 2.1% (1.3-3.0) 2.1% (1.3-3.0)

7. The estimate of HIV incidence peaked in 1993 at 4.6%. In 2008 it is estimated at 0.98% and in 2009 at 0.96.

8. Zooming on 2009 Statistics 200720082009 HIV Adults + Children1,131,384 959,762 – 1,281,486 1,103,988 937,339 – 1,254,194 1,102,864 934,143 – 1,249,673 HIV Adults 15+1,022,209 862,611 – 1,155,22 996,600 840,668 – 1,131,292 997.123 845,507 – 1,134,403 HIV 15+ female609,942 479,083 – 701,805 595,181 467,273 – 685,459 594,847 469,071- 688,140 HIV population- Children109,175 142,197 – 66,635 107,388 65,934 - 139,188 105,740 66.126 – 136.898 Prevalence Adult14.7 12.75 – 16.0 14.1% 12.1 – 16.0 13.71% 11.9 – 15.0 Prevalence- Males aged 15 to 24 3.37 2.63 – 4.0 3.39 2.66 – 4.0 3.54 2.77 – 5.0 Prevalence- Females aged 15 to 24 7.46 6.2 – 10.0 7.33 6.03 – 10.0 7.45 6.07 – 10.0 Summary of HIV Estimates 2007, 2008 and 2009

9. Estimation Method  Data Inputs ANC Sentinel Surveillance ZDHS+ 2005-2006 Census and Inter-censal Demographic Data Monitoring and Evaluation Data

10.  African Youth Charter 10-35  United Nations 10-24  Zimbabwe National Youth Policy 10-30  African Youth Charter 10-35  United Nations 10-24  Zimbabwe National Youth Policy 10-30 Working Definition of Youth

11. Zimbabwe adopted a multisectoral response to HIV and AIDS Response is underpinned by 3 Ones, i.e. #One national Coordinating Authority (NAC) #One national M & E system #One agreed Strategic Plan (ZNASP) Three ones create order, harmony and accountability in national response The Response

12. HIV Policy Environment Zimbabwe national policies Draw from International and regional policies:  Millenium Development Goals  UNGASS Regional policies  SADC Business Plan 2010-2015  SADC Strategy on OVCY  Abuja Declaration  Maseru Declaration

13. Policy Environment Contd Regional Policies and Commitments inform the national umbrella policy: The Zimbabwe HIV and AIDS Strategic Plan(ZNASP)-2006-2011. Provides bases for advocacy, resource mobilization and programming. Informs the following sector policies: National Behavior Change Strategy 2006-2010

14. Policy Environment Contd The Zimbabwe Health Sector HIV Prevention Strategic Framework 2007- 2010 Zimbabwe National Plan of Action on Women & Girls and HIV & AIDS 2006- 2010 National Adolescent Sexual and Reproductive Health Strategy 2009- 2015 (Draft)

15. National Female Condom Strategy 2006 – 2010 The National HIV Testing and Counselling Strategic Plan 2008-2010 Plan for the Nationwide Provision of Antiretroviral Therapy 2008-2012 PMTCT and Paediatric HIV Prevention, Treatment and Care National Plan 2006- 2010 Policy Environment Contd

16. National Action Plan for Orphans and other Vulnerable Children 2004-2010 National Youth Policy- seeks to proffer guidelines with regards to concerns of young people in Zimbabwe like ASRH, HIV and AIDS

17. Sex workers Multiple Concurrent Partnerships Combined with: Low risk perception in long-term relationships Low condom use in long-term relations Low levels of male circumcision Identified key drivers of HIV: The ‘Highway of HIV Transmission’ “Dry sex”? STIs (HSV-2) Early debut Cross-generational relations Unprotected casual sex MTCT Gender imbalances StigmaMobility Underlying vulnerability factors:

18. How has the Reduction in Prevalence rate been Achieved? Prevention of new infections has constituted the cornerstone of the national response. The ZNASP acknowledge the importance of: oMaintenance and adoption of safe behaviors among young people oAdolescence sexual and reproductive health programs including community based, peer education & youth friendly services oTrained lecturers to teach life skills based on HIV&AIDS in teachers and technical colleges

19. Conti…  Improved support for individuals, families and communities, Through: support to OVC, the infected and affected by HIV and AIDS, livelihoods support, etc  Effective management and coordination of the national HIV and AIDS response (including resource mobilization).

20. Conti… oVulnerable Groups. The Young People are explicitly noted as a vulnerable group that requires innovative strategies, focusing on their empowerment & inclusion in decision making as well as allocation of resources oUniversal Access. The principle of UA will include deliberate targeting of the vulnerable groups including the young oEvidence and Result-Based Strategies. These includes programs targeting youth which are tailored to meet their specific needs oAdherence to International Goals and Principle.

21. What is working well 1. National Young People’s Network on HIV and AIDS ( launched in 2007 by NAC facilitates youth involvement in the national response ) 2.Social Transformation Empowerment Project's (STEPS) Screening Program“Tariro” 3.Global Fund supported Youth friendly centres providing youth friendly reproductive health services

22. 4. The Nation wide campaign on the Zero Tolerance of Child Abuse which has created increased awareness and triggered an increase in reported cases of rape 5.The Young People We Care mulit-partner program 6. Pooling of resources to create basket funds eg ESP, POS-multi-partnerships 7. The National AIDS Trust Fund What is working Well contd

23. What is working well contd 8. Multi-partner Behaviour change Strategy role out- there are plans to scale out 9.Structured Coordination at all levels 10.Livelihoods programs for older OVC as an HIV prevention strategy 11. Use of the media to promote monogamy and fight stigma

24. Barriers  The legal age of consent for testing is 16-leaving out the 12-15 sexually active adolescents  Children living outside the family  The Ministry’s refusal to consider the option of condoms in schools

25. Barriers Contd  Implementation gaps for legislation eg Domestic Violence Act and the Criminal Law Codification and Reform Act  The economic environment continues to create conditions conducive to transactional and intergenerational sex  Limited Linkages between programmes e.g mitigation should have stronger linkages with prevention

26. What can we do better 1. Decline is encouraging but one in seven people among the 15-49 age group is infected 2. Support should therefore continue to focus on behavior change, scale up of prevention strategies and care and treatment to decrease incidence and mortality specifically:  Make Participation of Young people in policy formulation and advocacy more meaningful  The Young People’s Network on HIV should scale out to all districts and have clear linkages with other programs

27. What can we do better  Continue Public education including law enforcement officers on relevant legislation  Scale up livelihoods programs to encourage economic independence for women and girls  Programmes for children on the streets should aim at reintergration.  There is room to build on Global Fund Youth Programmes-the UN could partner with NAC and the Family Planning Council  Continue use of the media and revive the Zero Tolerance of Child Abuse Campaign

28. Thank you…