Adolescent - Friendly Services in Iran Scaling up Effective Harm Reduction Programmes for Y P By: Najin Yasrebi Inter-Agency Task Team Meeting on HIV and Young People June Paris

UNICEFType your title in this FOOTER area and in CAPS HIV Epidemic in Iran The prevalence of HIV/AIDS among the general population in Iran is low at 0.15%.; The actual registered cases (21 March 2011) stands at 22,727 (91.7% men & 8.3% women); Estimated number of people living with HIV/AIDS in Iran for 2010 was 91,000; Modes of Transmission: 69.7% via injecting drug use; 18.6% means of transmission is unknown; 9.8% via sexual transmission; 1.1% blood & blood product; 0.8% mother-to child; Last year figures: Almost the same percentage (66.2%) via injecting drug use; 20.8% sexual transmission and substantial decrease of unknown cases! Almost 40% of all reported HIV cases in Iran are among year olds and just over half (51%) of the females who have tested positive for HIV are aged years.

HIV Epidemic in Iran (cont.) Modeling of new HIV infections based on exposure groups in Iran is being finalized. MOT study shows % of new HIV cases and their 95% uncertainty level disaggregated by exposure groups as : UNICEFType your title in this FOOTER area and in CAPS

HIV and Drug Use Currently there are some 1,200,000 to 1,600,000 drug users in Iran. In 2007, females represented 5.2% of all drug users; In 2007, the ratio of drug injectors to the total number of drug users was estimated at 21.3%, signifying a tremendous increase from the 2004 figure of 12.2%; Based on the estimates derived from different studies, some 15-20% of IDUs share needles and, on average, each person has 12 partners with whom s/he shares a needle eight times per annum; More than three quarters of IDUs report that they are sexually active, but approximately two thirds of their sexual contacts with their spouses, with sex-workers or non-sex-workers were reported to have been without the use of condoms. UNICEFType your title in this FOOTER area and in CAPS

HIV and Drug Use (cont.) In 2007, an average of 14.3% of IDUs were HIV- infected; Coverage of harm reduction and MMT programme is low: Only 33% of IDUs were covered by MMT and 27% had received injection supplies from service centers in 2007; Synthetic drugs, primarily amphetamine-type-stimulants (ATS), are being manufactured and distributed domestically; A small qualitative/quantitative study amongst meth users shows impact on sexual arousal and desire; sexual performance; interpersonal interactions and behaviors; risk taking in sexual practices and seeking of alternate, unusual practices; compulsive nature of the sexual activities. Type your title in this FOOTER area and in CAPS

UNICEFType your title in this FOOTER area and in CAPS HIV, SWs and MSMs National BSS on SWs is on-going; Certain studies estimate the number of FSWs in Iran as being somewhere between 30,000 and 60,000; Different studies portray that the prevalence of HIV among FSWs who are not IDUs has not reached 5% yet while this prevalence among the FSWs who are IDUs is similar to that of other IDUs; In a study conducted on MSM in Iran, it was estimated that some 52% of them were married, only 14.5% of them lived with their spouses; 82% of MSM have had more than one male partner in the last six months; 88% of them have had female sexual partners in the last six months; 64% of these individuals have had drug injection in the last month; Infection prevalence rate within this group is estimated around 14.8%.

HIV and Young People More than 35% of Iranian population are between the ages of ; Current average marriage age is 27.9 years for females and 29.7 for males; A lot of controversy around age of drug initiation; An important trend is that drug use is moving to younger generations, with almost 50% of drug users aged below 29 years; Only 16.3% of young people aged have accurate knowledge on HIV; A UNICEF-supported study conducted amongst 2000 young people (10-24) indicates that 21% of the boys and 5.5% the girls have pre/extra marital sex out of which 28% of girls and 57.5% of boys reported having more that one sexual partner. This is while only half used condom in their last sex. UNICEF

HIV and Young People (cont.) Still a lot of young people live in conservative and traditional families,although this is changing drastically; There are no systematic HIV education in school or through mass media; There are no specific health services for adolescents and young people; High level of unemployment and various levels of hopelessness amongst the Iranian youth are amongst factors statistically correlated with drug and alcohol use. UNICEFType your title in this FOOTER area and in CAPS

UNICEF Adolescent-Friendly Services When: As a part HIV component of UNICEF and IRI CP ( ); Partner: Ministry of Health, CDC Beneficiaries: Most at risk and at risk Young people. Where: 14 centers in 7 Cities, 6 provinces.

Adolescent-Friendly Services (cont.) AFS model key strategies: Advocacy to create an enabling environment; Capacity building of service providers; Empowerment of beneficiaries through provision of AFS. Specific objectives (linked with the 3 rd strategy): Delay in onset of sex; Adopting safe sex practices (avoiding multiple concurrent partners & constant and correct condom use); Abstaining from drug/substance use (for those who are at risk); Increased knowledge about and improved safe injection practice.

UNICEFType your title in this FOOTER area and in CAPS Mobile/outreach peers education Counseling Distribution harm reduction supplies Static group sessions Referrals AFS: Service Package Extra curricular activities Drug Abuse SRH HIV/ STIs Life skills & gender ADVOCACY & SOCIAL MOBILISATION PARTICIPATION ENABLING ENVIORNMENT

AFS Initial Results Service use: (2009 – 2011) 29,703 utilized static services out of which 40% are most at risk + at risk; 33,993 have utilized outreach services out of which 25% are most at risk/ at risk. Service utilization (esp peer outreach education and counseling) is statistically correlated with increased knowledge on HIV amongst This is while AFS-based activities has showed more positive impact on attitudes of 20-24; Good connection as a part of referral services with VCT and addiction treatment services. More attention of policy makers to adolescents/youth (NSP3): AFS is serving as an entry point to some general discussions on boarder sexual and reproductive health discussions with MOH. UNICEF

AFS Challenges Data: situation of young people, behaviors and the predisposing factors; Service package for 10-14; MARYPs a subpopulation of MARPs vs. MARYPs a subpopulation of young people who engage in high risk behavior; Scale up; Integration of AFS-generated data into country HIV profile and epidemiological data; Standardization and quality of services; Sustainability of peer outreach component; Aged based appropriateness of HIV prevention educational services.

The way forward Strengthening quality assurance systems and monitoring Social determinants of HIV: Root causes of situations prompting vulnerabilities/exposure to risky behaviors; linking up with child protection and education prog; Evaluation of pilot outcomes: tangible quantitative and qualities results of AFS; Roadmap: What are the key remaining steps until a full hand-over to government; Advocating for health sector reform and establishment of youth-friendly spaces; linking them with HIV related services; Combination prevention.

UNICEFType your title in this FOOTER area and in CAPS THANK YOU!