Katharine McCarthy1, Kelly Hallman1, Aroldia Mulokozi2, Subilaga Kaganda2, Fatma Mrisho2, Nuru Mbarouk3, and Alison Jenkins4 1 Population Council 2 Tanzanian Commission for AIDS (TACAIDS), 3 Zanzibar AIDS Commission (ZAC) 4UNICEF Tanzania The Adolescent Experience In-depth: Using Data to Identify and Reach the Most Vulnerable Young People in Tanzania I am presenting on behalf of a great team. Government in the lead (TACAIDS and ZAC commissioned this work), Population Council and UNICEF. In particular, Dr Subilaga Kaganda was meant to deliver this presentation, but was unable to attend the conference.

Background UNICEF TANZANIA/2014/ Holt

Three sources of data were analysed: In Tanzania, HIV prevalence among adolescents between 15-19 has not decreased in the past five years TACAIDS and ZAC commissioned a secondary analysis of existing national survey data: to better understand youth vulnerabilities to HIV to guide policy makers and program implementers in HIV, health, nutrition, education, child protection, and social protection. Three sources of data were analysed: Tanzania Demographic Health Survey (2010) Tanzania HIV and Malaria Indicator Survey (2011) Tanzania Violence Against Children Study (2009)

Methods Pictures to represent technology UNICEF TANZANIA/ZIFF/2009

~40 indicators were examined by sex, age (10-14, 15- 19, 20-24 years), geographic region and, in some cases wealth quintile. Conclusions were drawn based on general trends in the data across surveys.

Results mapped: Diversity of young people (parental co-residence, orphan status, current school attendance, in school at grade for age, literacy) Context of sexual activity (marital status, age at first marriage, age at first sex, pregnancy, sex partner age difference, gender norms around domestic violence) Exposure to violence (forced first sex, exposure to and perpetrators of physical/sexual violence, violence during pregnancy);

Results mapped: HIV/AIDS (knowledge, attitudes, testing, prevalence) Sexual risk behaviors (multiple partners, transactional sex, condom use, attitudes towards negotiating condom use) Reproductive and maternal health (current contraceptive use by marital status, antenatal care at most recent pregnancy, delivery assistance by provider type) Exposure to mass media

Results As we go through the results, keep in mind that all of these indicators were “unpacked” by region. UNICEF TANZANIA/2014/ Holt

Demographics Most (80%) of early adolescents (ages 10- 14) live in rural areas Many are not residing with either parent (especially girls in urban areas) 1 in 5 rural adolescents 10-14 years are not residing with their parents.

Education Girls less likely than boys to attend secondary school, especially in rural areas Boys, particularly in rural areas, are less likely to be at their grade for age. Percent Enrolled in School by Gender and Year of Age (2010 TDHS)

Child marriage Rural girls, and the poorest girls, are more likely to be married as children Child marriage is strongly associated with illiteracy; 58% of females (15-24 years) married by 15 years cannot read a sentence, compared to 12% of their unmarried peers.

Violence High rates of sexual violence Males reported higher rates than females in Zanzibar (although lower rates observed in Zanzibar overall). On Mainland, opposite trend Early exposure to sexual violence was associated with sexual risk-taking behaviors in adulthood among both males and females. We observed striking gender differences. We are very concerned about this not only because of the debilitating effects of violence, but also because it has other negative impacts (risk taking and the perpetuation of violence). *sexual violence by husband/partner; ever forced to perform unwanted sexual acts by anyone; ever forced to have sex by anyone other than current partner in past 12 months; and first sex was forced by anyone

HIV knowledge and attitudes Comprehensive HIV knowledge is low overall, especially in rural areas and Zanzibar; increases with age Attitudes towards people living with HIV vary dramatically by region.

Multiple sexual partners Rates of reported multiple sexual partners are low for females Rates increase considerably with age among male youth Among males, rates of multiple sexual partners higher in rural compared to urban areas.

Condom use Only 60% of sexually active unmarried girls and boys ages 15-24 in Tanzania reported using a condom at last sex. Even fewer report using condoms during higher risk sex Only 34% of females and 41% of males ages 15-24 (who had more than one partner in the last 12 months) reported using a condom the last time they had sex. Only half of males who paid for sex reported condom use.

Lessons learned & next steps Cover photo: © Khanga Rue Media/2014/Olvera UNICEF TANZANIA/2014/ Holt © Khanga Rue Media/2014/Olvera

Large variations across regions for most indicators means that national strategies must be adapted to regional context The findings provide data to advocate for policy/guideline change related to child marriage, age of consent for HIV testing and counseling, school re-entry after dropout. The study highlights the need for improved coordination, dissemination and implementation of existing policies that protect the sexual and reproductive health and rights of young people. Need to highlight what GoT has done in response to each point Development of RHASPs, using regional data in Situation Analysis as baseline indicators. Some of the findings informed PEPFAR and Government’s co-design of DREAMS. We are using the data in the All In! Assessment towards ending adolescent AIDS. We have further evidence for developing policy briefs on HTC age of consent and child marriage Endorsed and moving forward on ESA Commitments, All In, implementing DREAMS and ACT with ambitious targets

Based on the study findings, 43 recommendations are outlined in the final report. For example: #13: Scale up best practices in securing economic livelihoods for youth, and prioritize women ages 18-24. #18: Develop and disseminate guidelines to facilitate re-entry to school after dropout, marriage, or pregnancy. #29: Increase youth access to friendly HIV and SRH services, including contraception, condoms, and post- violence services. #37: Systematically monitor both the quality and the coverage of life skills, HIV/AIDS, and sexuality education in schools across the country (primary, secondary, tertiary).

The report has been uploaded to TACAIDS and ZAC websites and disseminated to stakeholders at national, regional, and zonal meetings (e.g., parliamentary committee; multi-sectoral youth stakeholders; regional authorities; youth representatives). Factsheets for Zanzibar, Mainland, and 25 regions have been published and disseminated at national and regional levels.

Learn more in The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People, Tanzania 2009-2012. Dar es Salaam: Population Council, TACAIDS, ZAC and UNICEF Tanzania. Link to report: http://www.tacaids.go.tz/index .php?option=com_content&vi ew=article&id=76&Itemid=171

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