HIV and AIDS Data Hub for Asia-Pacific Review in slides Young Key Populations Last updated: May 2015

Data availability and data issues

HIV and AIDS Data Hub for Asia-Pacific 3 95% “The analysis carried out by the Commission shows that over 95% of all new HIV infections among young people occur among most-at-risk adolescents.” Report of the Commission on AIDS in Asia. Redefining AIDS in Asia: Crafting an Effective Response (2008), p. 146.

HIV and AIDS Data Hub for Asia-Pacific What do we need to know to prioritize populations for the AIDS response? 4 HIV-related risk in populations –Sexual risk: levels and frequency of unprotected vaginal and anal sex –Injection risk: sharing of needles HIV and STI prevalence of sub-populations Sizes of higher risk and vulnerable sub-populations Geographic location of risk populations

HIV and AIDS Data Hub for Asia-Pacific Main data collection components of HIV/STI surveillance systems Size estimates of key populations Reported HIV and AIDS cases HSS - HIV sentinel surveillance (facility-based) BSS/IBBS - Bio-behavioral surveys in key populations (or general population) STI Surveillance Additional strategic information sources: Mapping of sub-populations Special surveys Program M&E, other…

HIV and AIDS Data Hub for Asia-Pacific The ethical considerations needed to include minors in studies that ask questions that relate to their sexual behavior, use of drugs and other risk behaviors What is different about surveying young key populations(YKPs)?

HIV and AIDS Data Hub for Asia-Pacific Ethical review and approval: Weigh community benefit Ethics approval granted for a person of any age to participate Surveillance deemed as non-research activity by the Ethics Committee Surveillance does not require Ethics Committee Review Parental consent requirements: Parent/ guardian consent required Parent/ guardian consent waivered Consent from Dept. of Education or school principal sufficient Special adjustments for minors: Protection of respondents built into design and questionnaires Sensitive sexuality questions removed for very young students Strategies to ensure consent secured without coercion Referral to appropriate services. Only 9 out of 47 studies reviewed described ethical procedures specific for minors: Afghanistan, Cambodia, Indonesia, Lao PDR, Maldives, Pakistan, PNG, Thailand, Vanuatu Ethical procedures for surveyed young populations

HIV and AIDS Data Hub for Asia-Pacific Data need for young key populations To understand how HIV affects young key populations… Surveys have to include enough of young key populations to yield meaningful results Reports of surveys have to include the age disaggregated data and results

HIV and AIDS Data Hub for Asia-Pacific 9 Bangladesh, China, India, Myanmar, Sri Lanka Cambodia, Myanmar, Viet Nam Bangladesh, Cambodia, India, Myanmar, Sri Lanka, Thailand, Viet Nam Bangladesh, Cambodia, China, India, Indonesia, Myanmar, Sri Lanka, Thailand, Viet Nam Data availability of FSW in HIV sentinel surveillance surveys conducted between 2009 and 2013 Source: Prepared by based on National HIV Sentinel Surveys and We need age disaggregated data to understand the epidemic among young key populations…and do we have it?

HIV and AIDS Data Hub for Asia-Pacific 10 Apart from the data reported in global AIDS reporting, availability of age disaggregated behavioural data for FSW is limited Source: Prepared by based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; and Afghanistan, China, Fiji, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Pakistan, PNG, Philippines, Viet Nam Cambodia, Fiji, Mongolia, Nepal, Pakistan, Philippines Afghanistan, Cambodia, Fiji, India, Indonesia, Lao PDR, Mongolia, Nepal, Pakistan, PNG, Philippines, Timor Leste, Viet Nam Afghanistan, Cambodia, China, Fiji, India, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Nepal, Pakistan, PNG, Philippines, RO Korea, Singapore, Timor Leste, Thailand, Viet Nam Data availability of FSW in behavioral surveys conducted between 2009 and 2013

HIV and AIDS Data Hub for Asia-Pacific 11 Source: Prepared by based on HIV Sentinel Surveys; Bio-Behavioural Surveys; Age disaggregated HIV prevalence and behavioural data for young MSM is scarce, especially from survey reports a)Afghanistan, Bangladesh, Cambodia, China, Fiji, India, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Myanmar, Nepal, PNG, Philippines, Rep. of Korea, Singapore, Thailand, Timor-Leste, Viet Nam b)Afghanistan, Cambodia, Fiji, India, Indonesia, Lao PDR, Mongolia, Nepal, PNG, Philippines, Timor-Leste, Viet Nam c)Afghanistan, Bangladesh, Cambodia, China, Indonesia, Malaysia, Mongolia, Myanmar, Nepal, PNG, Philippines, Thailand, Viet Nam

HIV and AIDS Data Hub for Asia-Pacific Only one in 3 countries that conducted HIV sentinel surveillance surveys among PWID reported age disaggregated data in survey reports 12 Source: Prepared by based on National HIV Sentinel Surveys; Global AIDS Response Progress Reporting; and Bangladesh, China, India, Myanmar Myanmar and Viet Nam Bangladesh, China, India, and Viet Nam Bangladesh, India, Myanmar, Thailand, and Viet Nam Bangladesh, China, India, Myanmar, Thailand, and Viet Nam Data availability of PWID in HIV sentinel surveillance surveys conducted between 2009 and 2013

HIV and AIDS Data Hub for Asia-Pacific Less than one fifth of countries that conducted behavioural surveys among PWID reported age disaggregated data in survey reports 13 Source: Prepared by based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; Global AIDS Response Progress Reporting; and Philippines Afghanistan, China, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Afghanistan, China, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Afghanistan, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Viet Nam Afghanistan, Cambodia, China, India, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Nepal, Philippines Data availability of PWID in behavioral surveys conducted between 2009 and 2013

HIV and AIDS Data Hub for Asia-Pacific 20 of 31 country HIV surveillance systems include key populations – two third or less have a reasonable proportion of young key populations represented 14 Review of HIV prevalence data ( ) available from surveillance in 20 countries* Source: Prepared by based on National HIV Sentinel Surveillance Surveys, HIV Prevalence Surveys and Global AIDS Response Progress Reportswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific The same is true for behavioral surveillance 15 Source: Prepared by based on National Behavioral Surveillance Reports and Global AIDS Response Progress Reportswww.aidsdatahub.org * Afghanistan, Bangladesh, Cambodia, Fiji, India, Indonesia, Lao, Malaysia, Maldives, Mongolia, Myanmar, Nepal, Pakistan, Philippines, PNG, Sri Lanka, Thailand, Timor Leste & Viet Nam Review of behavioral data ( ) available from surveillance in 19 countries*

HIV and AIDS Data Hub for Asia-Pacific Age of inclusion of YKPs in surveys of key populations, based on available data from survey reports 16 Source: Prepared by based on National HIV Sentinel Surveillance, HIV Prevalence Surveys and Behavioral Surveys; Global AIDS Response Progress Reports 2012 to 2014; UNGASS Progress Reports (2010). HIV prevalence surveys –9-14yrs : Maldives (FSW 13, MSM 10); Pakistan (MSW 13); PNG (FSW 14, MSW 9) –15+yrs : Cambodia (FSW 15, MSM 18); Lao (MSM, TG 15); Maldives (PWID 17); Myanmar (FSW, MSM, PWID 15); Nepal (FSW, MSM, PWID 16); Pakistan (FSW, Hijra 15); Viet Nam (FSW, MSM, PWID 16) –18+yrs : Afghanistan (FSW,MSM, PWID 18); India (FSW, MSM, TG, PWID 18); Pakistan (PWID 18); Malaysia (MSM,PWID 18) Behavioral surveys –9-14yrs : Maldives (FSW 13, MSM 10); Pakistan (MSW 13); PNG (FSW 14, MSW 9 ) –15+yrs : Bangladesh (FSW, MSW, MSM, TG, PWID 15); Lao (FSW, MSM, TG 15); Maldives (PWID 17); Myanmar (FSW, PWID 15); Nepal (FSW, MSM, PWID 16); Pakistan (FSW, Hijra 15); Sri Lanka (FSW, MSM 16, PWID 17); Timor Leste (FSW, MSM 16) –18+yrs : Afghanistan (FSW, MSM,PWID 18); Cambodia (FEW, MSM 18);India (FSW, MSM, TG, PWID 18); Pakistan (PWID 18); Malaysia (MSM,PWID 18)

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of surveyed FSW, MSM and PWID who are under 25 years of age where data is available FSW (22 Terai Highway ); MSM (Kathmandu Valley); PWID (Eastern Terai Highway) 2013 FSW data is only for registered female sex workers 2006, people who inject drugs and men who have sex with men <20–25 years old, calculated median value Men who have sex with men (Yangon and Mandalay-2009) Service women (2011); Men who have sex with men <20 yr (2009) 100 per cent Source: Prepared by based onwww.aidsdatahub.org 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Behavioral Surveillance Survey reports

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! A large proportion of surveyed sex workers are under 25 years of age Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Behavioral Surveillance Survey reportswww.aidsdatahub.org MSW TG SW FSW

HIV and AIDS Data Hub for Asia-Pacific Available information on Size Estimates of young key populations is extremely limited! 19

HIV prevalence and epidemiology

HIV and AIDS Data Hub for Asia-Pacific 610,000 young people (15-24) are living with HIV in 2013, 13% of adults (15+) living with HIV in Asia and the Pacific ,000 young female (15-24) 370,000 young male (15-24) Source: Prepared by based on UNAIDS estimates 2013www.aidsdatahub.org Percent decrease between 2005 and

HIV and AIDS Data Hub for Asia-Pacific Estimated HIV prevalence among young people (15-24), Source: Prepared by based on Young females (15-24) (%)Young males (15-24) (%) Afghanistan <0.1 Bangladesh <0.1 Bhutan 0.1<0.1 Cambodia 0.2 Fiji <0.1 Indonesia Lao PDR <0.1 Malaysia < Maldives <0.1 Mongolia <0.1 Myanmar Nepal <0.1 Pakistan <0.1 Papua New Guinea Sri Lanka <0.1 Thailand 0.3 Viet Nam <0.1

HIV and AIDS Data Hub for Asia-Pacific Young sex workers are getting infected with HIV! 23 Source: Prepared by based on HIV prevalence among sex workers by age group, countries where the data is available from

HIV and AIDS Data Hub for Asia-Pacific Young MSM are getting infected with HIV! 24 Source: Prepared by based on HIV prevalence among MSM by age group, countries where the data is available from

HIV and AIDS Data Hub for Asia-Pacific Young PWID are getting infected with HIV! 25 Source: Prepared by based on HIV prevalence among PWID by age group, countries where the data is available from

Risk behaviours

HIV and AIDS Data Hub for Asia-Pacific Proportion of young people (15-24) who had sex before the age of 15, countries where data is available, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific People do start risk behaviors when they are young … 28 Source: Prepared by based on National Behavioral Surveillance Reports ; Global AIDS Response Progress Reports- Country Reports (2012) ; UNGASS Progress Reports (2010). ≥ 25 yr

HIV and AIDS Data Hub for Asia-Pacific Condom use at last sex among sex workers by age group, countries where the data is available, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Condom use among young MSM is generally lower than their older counterparts 30 Source: Prepared by based on Condom use at last anal sex among MSM by age group, countries where the data is available,

HIV and AIDS Data Hub for Asia-Pacific Low level of condom use among PWID including young PWID! 31 Source: Prepared by based on Condom use at last sex among PWID by age group, countries where the data is available,

HIV and AIDS Data Hub for Asia-Pacific Young PWID’s safe injection practice compared to that of older counterparts 32 Source: Prepared by based on Proportion of PWID reported using sterile injection equipment at last injection by age group, countries where data is available,

Vulnerability and HIV knowledge

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! 34 Proportion of sex workers with comprehensive HIV knowledge, by age group, countries where data is available, Source: Prepared by based on UNGASS Country Progress Reports 2006,2008 and 2010www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM with comprehensive HIV knowledge, by age group, countries where data is available, Source: Prepared by based on 1.UNAIDS Report on The Global AIDS Epidemic, 2010; 2. UNGASS Country Progress Reports ; 3. Integrated Biological and Behavioural Survey Reports

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! 36 Proportion of PWID with comprehensive HIV knowledge, by age group, countries where data is available, Source: Prepared by based on 1. UNGASS Country Progress Reports 2006,2008 and 2010; and 2. UNAIDS. (2010). Report on the Global AIDS Epidemicwww.aidsdatahub.org

National response

HIV and AIDS Data Hub for Asia-Pacific Laws and regulations that allow adolescents to seek services without parental/spousal consent, countries where data is available 38 Source: Prepared by based on Department of Maternal, Newborn, Child, and Adolescent Health (WHO) at (accessed Feb 4, 2015) Country (reporting period) Contraceptive services except sterilization HIV testing and counselling services Harm reduction services for young PWID Cambodia (Dec-2013) India (Feb-2014) Indonesia (Jan-2014) Kiribati (Jun-2014) Lao PDR (Dec -2013) Malaysia (Dec -2013) Myanmar (Feb- 2014) Nepal (Jan-2014) Pakistan (Feb-2014) Papua New Guinea (Jan-2014) Philippines (Mar-2014) Solomon Islands (Dec-2013) Sri Lanka (Jan-2014) Timor Leste (Jan-2014) Vanuatu (Dec -2013) Viet Nam (Jan-2014) Yes No No information

HIV and AIDS Data Hub for Asia-Pacific Compared to their older counterparts, 39 less young key populations are being reached by prevention programmes less young key populations have access to HIV testing services and approximately 3 in 4 young key populations do not know their HIV status

HIV and AIDS Data Hub for Asia-Pacific Lower prevention coverage among young sex workers under 25 years, Source: Prepared by based on * FSW only ** FSW and MSW *** FSW and TG SW ++ MSW and TG SW +++ FSW, MSW and TG SW

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reached by prevention programmes, by age group, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Less than 1/3 of young sex workers know their HIV status 42 Source: Prepared by based on Malaysia and Indonesia data is not included in regional median calculation since the denominators of reported proportion for HIV testing coverage do not reflect total surveyed sex workers and these denominators represent only those who answered HIV testing related questions

HIV and AIDS Data Hub for Asia-Pacific 3 in 4 young MSM surveyed in the region do not know their HIV status…. 43 Source: Prepared by based on Malaysia and Indonesia data is not included in regional median calculation since the denominators of reported proportion for HIV testing coverage do not reflect total surveyed MSM and these denominators represent only those who answered HIV testing related questions

HIV and AIDS Data Hub for Asia-Pacific Only 1 in 5 young PWID in the region know their HIV status 44 Source: Prepared by based on Indonesia data is not included in regional median calculation since the denominator of reported proportion for HIV testing coverage do not reflect total surveyed PWID and the denominator represent only those who answered HIV testing related questions

HIV and AIDS Data Hub for Asia-Pacific 45 THANK YOU slides compiled by Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge if slides are lifted directly from this sitewww.aidsdatahub.org