NATIONAL AIDS CONTROL COUNCIL

YOUNG PEOPLE, SEX AND HIV:WHAT IS THE FUTURE?

HIV ADOLESCENCE WORKSHOP 2019

Dr Nduku Kilonzo

NACC

‘Closing’ Statements

• HIV starts and ends with Behaviour, everything is in between

• HIV is a social issue, not about sickness!

• “… a biomedical response aimed at rapidly scaling

up testing and treatment is essential but will not

be sufficient to control the epidemic…”

• HIV response - the future

• Sex and young people

• The structure of the HIV response

• What do we need to do differently?

Cost of care increases due to age – KE

statistics • Median age of Kenyans is 19 years

• Cost of Health Care will increase as the country’s average age increases

• Population based changes and considerations – who is at risk and when?

Issue 1: Demographic transitions

Issue 2: Epidemic transitions

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• Changing disease patterns have implications for financing

• More young people with increased NCDs?

Can this statement be said for DIABETES, CARDIOVASCULAR

DISEASE, CANCER MANAGEMENT

BA BA

BA

At least 1 NCD: 33% (2018) to 38% (2035)

At least 1 NCD: 68% (2018) to 79% (2035) What does the future therefore look like?

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Financing transitions and the costs to the economy and for young

people

• Diminishing resources for HIV

• Other national and global priorities

• Prevention is the most cost containment strategy for UHC and sustaining its benefits in perpetuity

Rethinking HIV prevention and control

• HIV response - the future

• Young people, Sex and HIV

• What do we need to do differently?

A Kenya free of HIV Infections, Stigma and AIDS related deaths9

So, who are we talking about?

1. 15 – 24 - 30 years old

2. Little patience with great creativity

3. Active participants, not bystanders - often than not, they take action

4. Purpose driven by being a part of something larger than themselves – peer action

5. Risk averse and self health is not a priority

6. Highly exposed with access to information – the good, the bad, the ugly

7. ‘Success’ is different from our past – creatives, flexible work, get rich quick

8. Dialogue not instructions

9. Desire for transparency and good leadership

Millennials really just want to matter and impact lives!

A Kenya free of HIV Infections, Stigma and AIDS related deaths10

Here’s what you need to know…

• There are a lot of ‘them’ – almost half population in Sub Sahara Africa

• Many don’t go to school

• Many are married at about 12 years

• Over 50% use the internet

• More worried about: their future – jobs; their social status – peers; the future of the world – climate change etc

A Kenya free of HIV Infections, Stigma and AIDS related deaths

Here is what we know……

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• Globally, AIDS is the 2nd leading cause of death among young people (aged 10-24) and it 1st in Africa.

• Young women are more vulnerable than young men are

• The increasing bulge in the youth population threatens to increase the HIV burden

• Unprotected sex is the common route for new HIV infection among Adolescents and Young People

Is HIV a priority for young people?

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Rethinking HIV prevention and control

• HIV response - the future

• Young people, Sex and HIV

• What do we need to do differently?

So is health really a priority for young people?

And should this influence how we approach HIV programming for them?

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THE HIV PREVENTION and CONTROL ROADMAP – will it take us where we need to go for young people?

Early population-levelsuccesses (late 1980s)

Behavior change (Uganda)

100% Condom use (Thailand)

STI Treatment

Grosskurth, Lancet 2000,(likely to work mainly in HIV epidemics /sub-populations with high bacterial STIs)

Male & female condoms

Male circumcision

Auvert, PloS Med 2005; Bailey, Lancet 2007; Gray, Lancet 2007

Coates, Lancet 2000Sweat, Lancet 2011(effects mostly for persons who test HIV positive and couples)

HIV testing & counselling

Post-exposure prophylaxis

Cohen, NEJM, 2011; Donnell, Lancet 2010; Tanser, Science 2013

Treatment as prevention

Oral pre-exposure prophylaxis

Grant, NEJM 2010 (MSM)Baeten, NEJM 2012 (Couples)Paxton, NEJM 2012 (Heterosex.); Choopanya, Lancet 2013 (PWID)

Ongoing research

Vaccines

Vaginal ring

Antibodies

Long-actingInjectable ARVs

Carey, 1992Weller, Cochrane DBS 2002

Hanenberg, Lancet 1994

Stoneburner, Science 2004

Harm reduction

Ljungberg, AIDS 1996Des Jarlais, Lancet 1996 Hurley, Lancet 1997

Influences of sexual health behavior

• Influences of sexual reproductive health behaviour • Religious and Community Beliefs • Cultural practices – FGM, Early Marriages, Moranism• Sexual health Knowledge - comprehensive, accurate, accessible• Personal agency and peer agency• Economic opportunities• Social and family context• Risk Perceptions; health seeking behaviour• SGBV • Social factors – peer influence, entertainment, media

HIV

res

po

nse

fi

nan

cin

g

Government

Budget allocations

Counterpart financing

County Government funds

Sectoral finances

UN Agencies TA to GOK and CSO

Global Fund State (on-budget financing)

Non-state (off-budget)

PEPFARGoK Commodity support

NGO/IP grants

Other donors (private funders)

NGOs (with ltd GOK grants)

• Where are young peoples issues in this approach?

• Where are the young people?

National AIDS Control Council

Programmes follow funds

We have the answers, but….

“… where are the young people after the science?”

– Economic Empowerment of women and girls (IMAGE studies; cash transfer programmes)– Secondary education for girls and young women and girls– Community empowerment – consistent organized action– Behavioural interventions – uptake of prevention

Picture this as our current status as we engage young people

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Are we talking to their issues? Or ours?

TB

HIV

SRHSGBV

STI

Mental health

Safety (GJLOS)

Wellnes(Health)

Economic

empowerment

Social protectio

n

MENTAL HEALTH

Private sector

Sports

Legislation

Education

What platforms can we leverage on within and without the health sector?

What is the role and place of young people

Private sector

Foundations

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HIV STARTS AND ENDS WITH BEHAVIOUR, EVERYTHING ELSE IS IN BETWEEN

‘Every young person, old person literate or now knows where to get a ‘bamba 20’ in Kenya.

Why do they not know where to get a condom?’ (Mukoma 2016)

How is it that we cannot leverage the same communication expertise to drive wellness?

Do we have the right data to understand and inform them…..

Are we measuring what matters?

✓data disaggregation

✓analytical capacity and data use

✓feedback mechanisms to relevant stakeholders

✓Silo approach to data analysis and use

✓How do we know which interventions are working?? Innovation, scale up, funding…

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Roles that can be played by young people

• Decision makers

• Programme designers and managers

• Peer mobilizers

• Advocates

• Innovators and disruptors of our way of doing business

Closing Statements

• HIV starts and ends with Behaviour, everything is in between

• HIV is a social issue!

Challenge to young people:

What is the UBER of YOUR FUTURE WELLBEING? What is the m-PESA of the African HIV response?

Thank you