A Brighter Future for Tanzanian Teens Living With HIV: A Situation Analysis of Adolescents Living with HIV and Available Services Aroldia Mulokozi 1, Fatma Mrisho 1, Victoria Chuwa 2, Alison Jenkins 2, and Rick Olson 3 1 Tanzanian Commission for AIDS (TACAIDS), 2 UNICEF Tanzania, 3 UNICEF Eastern and Southern Africa Regional Office

Background UNICEF TANZANIA/2014/ Holt

Almost 1 in 4 Tanzanians is an adolescent ( years) (~11 million) 140,000 adolescents living with HIV (ALHIV) HIV is the leading cause of death among adolescents in Africa Between Tanzania’s last two national HIV surveys (in 2007 and 2011): prevalence among year olds did not decrease gender disparities remained

HIV risk rises sharply in transition to adulthood, particularly for females Age (years) % HIV positive

ALHIV are heterogeneous 1.Sexual transmission: especially older (15-19 years) adolescent girls. Recently infected; may not know HIV status. 2.Mother to child transmission: as PMTCT was only scaled up in last decade. “Long-term survivors” UNICEF TANZANIA/2015/Schermbrucker 3.Illicit drug transmission: An increasing problem in the last decade, especially in Zanzibar and Dar es Salaam 4.Iatrogenic transmission

In 2013, TACAIDS and UNICEF assessed the situation of ALHIV in Tanzania and the support services available to them. UNICEF TANZANIA/2015/Schermbrucker

Methods UNICEF TANZANIA/2014/ Holt UNICEF TANZANIA/ZIFF/2009

15-19 year old ALHIV participated recruited by care and treatment providers familiar to them. asked for informed consent. permission was sought from parents or guardians of ALHIV under 18. In 7 regions of Tanzania, selected based on HIV prevalence, geographic representativeness, and urban/rural balance.

Quantitative survey (n=456; 251 F, 205 M) Interviews with year old ALHIV conducted by research assistants. Focus group discussions (n=14): A total of 198 ALHIV (107 F and 91 M). In-depth interviews (n=14): Conducted with two ALHIV per region (one male and one female).

Key informant interviews (n=145), with: health workers representatives of relevant NGOs/CSOs, networks of PLHIV, government officials from relevant ministries, development partners parents/guardians of ALHIV community members residing in study area

Results UNICEF TANZANIA/2014/ Holt

The majority of respondents in both rural and urban areas preferred to get information through media. Radio was the major source of child protection information. Teachers and peers were important sources of SRH and HIV information Parents were another source of SRH and HIV information for ALHIV.

ALHIV are sexually active 40% of ALHIV (15-19 yrs) reported they were sexually active (44% F, 36% M). Two-thirds reported that last sexual intercourse was with a boy/girlfriend, and 14% with a spouse. Only half (54% F, 51% M) used condoms at last sex. Reasons for not using condoms were: long-standing partner; know each other's status; don’t like condoms; and use other means of family planning.

Of the ALHIV who were sexually active: 88% reported last sex was consensual. 32% of ALHIV reported previous experience of sexual violence, with perpetrators usually familiar to them. However, few discussed it with friends/relatives or reported it to authorities. These results are similar to findings of the 2009 Tanzania Violence Against Children Study.

While 90% of ALHIV knew of HIV services, only one third knew of family planning, STI, maternal and child health, and child protection services. Health services were not adolescent-friendly: Limited privacy, confidentiality, and/or respect Inconvenient time and location. Low youth involvement. No adolescent-specific services: HIV positive children are usually transitioned from pediatric to adult clinics at 8-12 years. Insufficient disclosure support.

Other problems identified: Age of HTC without guardian consent is 18 years Challenges disclosing HIV status. Difficulty following care schedules and poor ART adherence, exacerbated by stigma and not understanding importance. Lack of peer support groups. Low provider and parent capacity to address adolescent sexuality issues.

Conclusions/Recommendations UNICEF TANZANIA/2014/ Holt UNICEF TANZANIA/ZIFF/2009

Despite the growing number of ALHIV, health systems, interventions, and strategies have not changed sufficiently to address their requirements. ALHIVs’ needs are not being met, particularly in relation to: support for disclosure of HIV positive status, with impacts on adherence to treatment. lack of peer support groups for adolescents. low health provider capacity to handle adolescent sexuality issues.

We need adolescent-sensitive and differentiated services, as specified in WHO guidelines. Improved data on ALHIV are also critical, e.g.: How many ALHIV tested and know their status? How many enrolled in care services? How many retained in care? How many ALHIV eligible and have initiated ART? How many truly adhere to ART? How many on ART retained in care? What are treatment outcomes for ALHIV?

Programmatic Recommendations Provide ALHIV with peer support, condom promotion and access, family planning services, and disclosure and treatment adherence support. Train health workers, social welfare officers, and teachers to identify and support at-risk adolescents, in a confidential and non- judgmental way (pre-service and in-service). Deliver life skills training to address HIV, SRH, and protection of all adolescents, including ALHIV, in and out of schools. Improve ALHIV communication with parents/guardians Provide materials and innovative platforms to improve access of ALHIV to needed information. Address gender-specific vulnerabilities and rights.

Advocacy, Policy and Research Recommendations Implement “All In!” to address data/programmatic gaps and identify priority actions Take forward the 2013 ESA Commitments on comprehensive sexuality education and health services for young people. Articulate relevant HIV issues in education and child protection sector policies and strategies. Scale up HIV-sensitive child protection system. Improve age disaggregation of routine health/HIV service data

@unicef_aids #AIDSFreeGen ASANTE SANA! THANK YOU!