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