HIV/AIDS programming for Most-At-Risk- Adolescents in Eastern Europe and Central Asia September 2009 Dr Nina Ferencic, UNICEF

AIDS: a recent epidemic Million people living with HIV = 20 fold increase in less than 10 yrs (affecting: youth, IDUs, women, children….) Transition affecting 300 M people Youth unemployment Multi-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 cases NOTE: % 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, minors Lack of data Stigma, discrimination and exclusion « Innocent » vs. « lost causes » Parental denial, disengagement Community, Social, Religious opposition Legal barriers Service-provision barriers

UNICEF support to programmes for MARA Get the evidence Build political & community support

Remove barriers to provision, access & use of services Build 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 diplomacy Systemic interventions Capacity building Financing Inclusion

Thank you! Photo courtesy Humanitarian Action, St. Petersburg, Russia