1. www.aidsdatahub.org HIV and AIDS Data Hub for Asia-Pacific Review in slides Young Key Populations Last updated: December 2015

2. www.aidsdatahub.org Data availability and data issues

3. 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.

4. 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

5. 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…

6. 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)?

7. 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

8. 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

9. HIV and AIDS Data Hub for Asia-Pacific 9 Bangladesh, China, India, Indonesia, Myanmar, Viet Nam 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 2010 and 2014 Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveys and www.aidsinfoonline.orgwww.aidsdatahub.org We need age disaggregated data to understand the epidemic among young key populations…and do we have it?

10. 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 www.aidsdatahub.org based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; and www.aidsinfoonline.orgwww.aidsdatahub.org Afghanistan, China, Fiji, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Pakistan, PNG, Philippines, Sri Lanka, Thailand,Viet Nam Cambodia, Fiji, Mongolia, Nepal, Pakistan, Philippines Afghanistan, Cambodia, Fiji, Indonesia, Lao PDR, Mongolia, Nepal, Pakistan, PNG, Philippines, Sri Lanka, Timor Leste, Viet Nam Afghanistan, Cambodia, China, Fiji, India, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Nepal, Pakistan, PNG, Philippines, RO Korea, Singapore, Sri Lanka, Timor Leste, Thailand, Viet Nam Data availability of FSW in behavioral surveys conducted between 2010 and 2014

11. HIV and AIDS Data Hub for Asia-Pacific 11 Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveys; Bio-Behavioural Surveys; www.aidsinfoonline.orgwww.aidsdatahub.org 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, Nepal, PNG, Philippines, Rep. of Korea, Singapore, Sri Lanka, Thailand, Timor-Leste, Viet Nam b)Afghanistan, Cambodia, Fiji, Indonesia, Mongolia, Nepal, PNG, Philippines, Sri Lanka, Timor-Leste c)Afghanistan, Bangladesh, Cambodia, China, Indonesia, Lao PDR, Malaysia, Mongolia, Myanmar, Nepal, PNG, Philippines, Sri Lanka, Thailand, Viet Nam

12. 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 www.aidsdatahub.org based on National HIV Sentinel Surveys; Global AIDS Response Progress Reporting; and www.aidsinfoonline.orgwww.aidsdatahub.org 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 2010 and 2014

13. HIV and AIDS Data Hub for Asia-Pacific Only about 15% of countries that conducted behavioural surveys among PWID reported age disaggregated data in survey reports 13 Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; Global AIDS Response Progress Reporting; and www.aidsinfoonline.orgwww.aidsdatahub.org Philippines Afghanistan, China, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Viet Nam Afghanistan, China, Malaysia, Nepal, Pakistan, Philippines, Thailand, Viet Nam Afghanistan, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Sri Lanka, Viet Nam Afghanistan, Cambodia, China, India, Indonesia, Japan, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Thailand, Sri Lanka, Viet Nam Nepal, Philippines Data availability of PWID in behavioral surveys conducted between 2010 and 2014

14. 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 (2008-2014) available from surveillance in 20 countries* Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveillance Surveys, HIV Prevalence Surveys and Global AIDS Response Progress Reportswww.aidsdatahub.org

15. HIV and AIDS Data Hub for Asia-Pacific The same is true for behavioral surveillance 15 Source: Prepared by www.aidsdatahub.org 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 (2007-2014) available from surveillance in 19 countries*

16. 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 www.aidsdatahub.org based on National HIV Sentinel Surveillance, HIV Prevalence Surveys and Behavioral Surveys; Global AIDS Response Progress Reports 2012 to 2014; UNGASS Progress Reports (2010).www.aidsdatahub.org 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, PWID 15); 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); Timor Leste (FSW, MSM 16) –18+yrs : Afghanistan (FSW, MSM,PWID 18); Cambodia (FEW 15, MSM 18. PWID 15);India (FSW, MSM, TG, PWID 18); Pakistan (PWID 18); Malaysia (MSM,PWID 18), Sri Lanka (FSW, MSM, PWID 18)

17. HIV and AIDS Data Hub for Asia-Pacific Considerable proportion of key populations are young people! 17 * Transgender sex workers Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveillance, HIV Prevalence Surveys and Behavioral Surveyswww.aidsdatahub.org

18. 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 www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Behavioral Surveillance Survey reportswww.aidsdatahub.org MSW TG SW FSW

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

20. www.aidsdatahub.org HIV prevalence and epidemiology

21. HIV and AIDS Data Hub for Asia-Pacific 600,000 young people (15-24) are living with HIV in 2014, 12% of people living with HIV in Asia and the Pacific 21 320,000 young female (15-24) 370,000 young male (15-24) Source: Prepared by www.aidsdatahub.org based on UNAIDS estimates 2014 and National Institute of Medical Statistics and National AIDS Control Organization (2015). India HIV Estimates 2015 - Technical Report.www.aidsdatahub.org Percent decrease between 2000 and 2014

22. HIV and AIDS Data Hub for Asia-Pacific Snapshot of young people and HIV infections 22 Young women 15-24 yr Young men 15-24 yr Number of new HIV infections among young people Number of young people living with HIV Source: Prepared by www.aidsdatahub.org based on UNAIDS estimates 2014 and National Institute of Medical Statistics and National AIDS Control Organization (2015). India HIV Estimates 2015 - Technical Report.www.aidsdatahub.org

23. HIV and AIDS Data Hub for Asia-Pacific Young sex workers are getting infected with HIV! 23 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org HIV prevalence among sex workers by age group, countries where data is available from 2010- 2014 Countries with HIV prevalence < 5% among SW < 25 years Countries with HIV prevalence > 5% among SW < 25 years * FSW only # FSW and MSW ** FSW, MSW and TG SW *** FSW and TG SW

24. HIV and AIDS Data Hub for Asia-Pacific Young MSM are getting infected with HIV! 24 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org HIV prevalence among MSM by age group, countries where data is available from 2009- 2014

25. HIV and AIDS Data Hub for Asia-Pacific Young PWID are getting infected with HIV! Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org HIV prevalence among PWID by age group, countries where data is available from 2010- 2014 *Sample size of <25 yr from 2014 survey is very small to make comparison with 25+ yr

26. www.aidsdatahub.org Risk behaviours

27. 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, 2006-2014 27 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org; Demographic and Health Surveys; Behavioural Surveyswww.aidsdatahub.orgwww.aidsinfoonline.org

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

29. HIV and AIDS Data Hub for Asia-Pacific Evidence from surveys: age of entry into risk behaviours 29 FSW MSW PWID MSM Age of entry into sex work Age at first drug injection Age of first male- to-male sex Indonesia (IBBS 2013): 38% of surveyed MSM had first male-to-male sex before the age of 20 (<15yr -2%, 15-19yr -36%) Philippines (IBBS 2013): Median age of first sex with male was 16 years Indonesia (IBBS 2013) : Almost half of the respondents started injecting drugs before the age of 20. (9% of surveyed respondents started injecting drugs before the age of 15 and 46% between 15-19 years) Philippines (IBBS 2013) : Age at first injection drug use was younger than 18 years in one-third of respondents, (33.8%) and (33.1%) respectively in Cebu and Manduae Viet Nam (HSS+2014) : 31% of sampled PWID started injecting drugs before the age of 20 Indonesia (IBBS 2013): About one in five female sex workers entered sex work before the age of 20 Philippines (IBBS 2013): Median age at first sex work was 20 for both registered and freelance FSW; median age at first accepted payment for sex was 20 among male entertainment workers Viet Nam (HSS+2014): About one-third of FSW (31)% entered sex work before the age of 20 Source: Prepared by www.aidsdatahub.org based on National Behavioral Surveillance Reports

30. 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, 2007-2014 30 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org * FSW only # FSW and MSW ** FSW, MSW and TG SW *** FSW and TG SW

31. HIV and AIDS Data Hub for Asia-Pacific Condom use among young MSM is generally lower than their older counterparts 31 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org Condom use at last anal sex among MSM by age group, countries where the data is available, 2009-2014

32. HIV and AIDS Data Hub for Asia-Pacific Low level of condom use among PWID including young PWID! 32 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org Condom use at last sex among PWID by age group, countries where the data is available, 2007-2014

33. HIV and AIDS Data Hub for Asia-Pacific Young PWID’s safe injection practice compared to that of older counterparts 33 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org Proportion of PWID reported using sterile injection equipment at last injection by age group, countries where data is available, 2007-2014

34. www.aidsdatahub.org Vulnerability and HIV knowledge

35. HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! 35 Proportion of sex workers with comprehensive HIV knowledge, by age group, countries where data is available, 2007-2009 Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 and 2010www.aidsdatahub.org

36. HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM with comprehensive HIV knowledge, by age group, countries where data is available, 2007-2013 36 Source: Prepared by www.aidsdatahub.org based on 1.UNAIDS Report on The Global AIDS Epidemic, 2010; 2. UNGASS Country Progress Reports ;www.aidsdatahub.org 3. Integrated Biological and Behavioural Survey Reports

37. HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! 37 Proportion of PWID with comprehensive HIV knowledge, by age group, countries where data is available, 2007-2009 Source: Prepared by www.aidsdatahub.org based on 1. UNGASS Country Progress Reports 2006,2008 and 2010; and 2. UNAIDS. (2010). Report on the Global AIDS Epidemicwww.aidsdatahub.org

38. National response

39. 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 39 Source: Prepared by www.aidsdatahub.org based on Department of Maternal, Newborn, Child, and Adolescent Health (WHO) at http://www.who.int/maternal_child_adolescent/documents/countries/indicators/dashboards/en/ (accessed Feb 4, 2015)www.aidsdatahub.org http://www.who.int/maternal_child_adolescent/documents/countries/indicators/dashboards/en/ 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

40. HIV and AIDS Data Hub for Asia-Pacific Creating an enabling legal and policy environment for young people to access harm reduction services 40 Source: UNESCO, UNAIDS, DLA PIPER, Youth LEAD, UNODC, & AIDS Data Hub. (2015). Creating an Enabling Legal and Policy Environment for Young People to Access Harm Reduction Services.

41. HIV and AIDS Data Hub for Asia-Pacific Compared to their older counterparts, 41 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

42. HIV and AIDS Data Hub for Asia-Pacific Lower prevention coverage among young sex workers under 25 years, 2007-2014 42 Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2012 to 2015www.aidsdatahub.org Proportion of SW reached with HIV prevention programmes in the last 12 months, 2007-2014 * FSW only # FSW and MSW ** FSW, MSW and TG SW *** FSW and TG SW

43. HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reached by prevention programmes, by age group, 2008-2014 43 Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting 2012 to 2015www.aidsdatahub.org Proportion of MSM reached with HIV prevention programmes in the last 12 months, 2008-2014

44. HIV and AIDS Data Hub for Asia-Pacific Only 1/3 of young sex workers know their HIV status 44 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org Indonesia is not included in regional median calculation since the denominator 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 Proportion of sex workers who received an HIV test in the last 12 months and know their results, 2008-2014 * FSW only # FSW and MSW ** FSW, MSW and TG SW *** FSW and TG SW

45. HIV and AIDS Data Hub for Asia-Pacific Over two-third of MSM surveyed in the region do not know their HIV status…. 45 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org Indonesia data is not included in regional median calculation since the denominator 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 Proportion of MSM who received an HIV test in the last 12 months and know their results, 2008-2014

46. HIV and AIDS Data Hub for Asia-Pacific Only 1 in 5 young PWID in the region know their HIV status 46 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.orgwww.aidsdatahub.org 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 Proportion of PWID who received an HIV test in the last 12 months and know their results, 2007-2014

47. HIV and AIDS Data Hub for Asia-Pacific 47 THANK YOU slides compiled by www.aidsdatahub.orgwww.aidsdatahub.org 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 www.aidsdatahub.org if slides are lifted directly from this sitewww.aidsdatahub.org