HIV/AIDS
programming for Most-At-Risk-Adolescents in Eastern Europe and Central Asia
September 2009
Dr Nina Ferencic, UNICEF
AIDS: a recent epidemic...
1.7 Million people living with HIV = 20 fold increase in less than 10 yrs(affecting: youth, IDUs, women, children….)
Transition affecting 300 M peopleYouth unemploymentMulti-substance abuse, Suicides Institutionalization of children Abandonment, withdrawal of parental rights, « social orphans » OVC – 90% lost their fathers
38%
13,5%
<20%
20-40%
40-60%
60-80%
21%
16,6%
16.3%
8,3%
10.2%
>80%
47%
25.5%
12%
18,8%
60%
20%
55%
3%
9.2%
44%
6.2%
16%
40%
15%
3%
30%
16%
82%
6%
61%
14.2%
26%
11.4%
52%
9.6%
1.5%
15%
HIV cases under age of 25 NOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports;
17.4%
15%
7%
25%
84%
2%
<20%
20-40%
40-60%
60-80%
50%
6%
6.1%
13%
10%
>80%
81%
25.5%
11%
8.2%
90%
57%
83%
29%
64%
74%
60%
16%
4%
19.4%
7%
15%
16%
<1%
24%
87%
60%
68%
14.5%
71%
5%
6%
IDU as % of all HIV/AIDS casesNOTE: % of AIDS cases in countries not reporting HIV Sources: EuroHIV; national reports;
0%
11%
17%
20%
5%
82%
2%
51%
3%
14%
16%
1.8%
16%
32%
29%
16%
34%
82%
80%
86%
71%
"The world changes before your eyes. You look at a picture of an elephant and suddenly you see that it smiles at you and splashes water all over you with its trunk..." – Vladik, 11, Odessa
(escaping harsh reality, explaining how he feels when on drugs)
HIV infections – among street kids 15 to19 in St Petersburg,
CDC study 2007
HIV prevalence – close to 40%HIV prevalence in subgroup of orphans: 63%
Factors associated with HIV prevalence:- No place to live - Being a single or double orphan- Ever living in an orphanage- Out of school for 3 years- History of drug use and STI
Behaviours:- Sexually active: 97%- Multiple partners 65%
Barriers to Programming for most-at-risk adolescents
(MARA)Controversial mix: drugs, sex, minorsLack of dataStigma, discrimination and exclusion « Innocent » vs. « lost causes »Parental denial, disengagement Community, Social, Religious oppositionLegal barriersService-provision barriers
UNICEF support to programmes for MARA
Get the evidenceBuild political & community support
Remove barriers to provision, access & use of servicesBuild partnerships
Photo courtesy Humanitarian Action, St. Petersburg, Russia
The MARA Agenda is a Controversial Agenda
A political « hot potato »Practical vs ideological Harm reduction vs « rescue & rehabilitation» Linking HIV & protection Social exclusion / social justice Child rights & human rights
The response - A mix of:
Advocacy Activism UN diplomacySystemic interventions Capacity buildingFinancing Inclusion
Thank you!
Photo courtesy Humanitarian Action, St. Petersburg, Russia