1. Forging Pathways to an AIDS-Free Generation Young People and VMMC 11 th November 2014

2. Young People and HIV  8% of the world’s adolescents (10-19 yrs.) living with HIV are in Tanzania (UNAIDS 2012)  Approximately 1% of the 15-19 yr. old boys in Tanzania are HIV+ (UNAIDS - GAP)  About 79% of the 15-19 yr. old men in Tanzania never tested for HIV (THMIS 2012)

3. VMMC for HIV Prevention  Jhpiego has received USAID funding for VMMC since late 2009.  The program launched in September 2009 with a pilot site in Iringa region and has now scaled up in three regions – Iringa, Njombe and Tabora  Focus on men aged 10–34 years

4. Why VMMC for Young People  VMMC is a key priority HIV prevention intervention for adolescents in settings with high HIV prevalence and low circumcision rates (UNICEF, 2013)  Adolescence as a period of transition: most either about to become sexually active or just began Age of sexual debut for men in Tanzania is 18.7 yrs. In Tanzania, 7% and 44% of men reported to have engaged in sex by age 15 and age 18 respectively (THIMS 2012)  Opportunity for adolescent men to access sexual and reproductive health services

5. VMMC service data

6. Campaigns mostly reaching adolescents

7. HIV Testing Source : HTC in VMMC study

8. Sexual Behavior and HIV Testing  Self reports of sexual intercourse engagement indicate:  0.09% of 10-14 yrs. old  9% of 15-19 yrs. Old  0.4% of circumcised adolescent were HIV+ compared to 1% of all VMMC clients

9. Benefits Beyond 60% Decrease in HIV Acquisition  0.45% of 33,017 boys aged 15-19 were diagnosed and treated for STI symptoms (excluding HIV)  Counseling and condom use demonstration likely to improve future use

10. Challenges in Age Appropriate Counseling  Currently condom promotion and safer sex counseling is designed for sexually active individuals  Providers offer separate group education, ensuring risk reduction counseling is age appropriate  About 68% of 18-19 yrs. olds reported to be less satisfied with counseling compared to the 52% of 15-17 boys or 42% of the 20+ yrs. men ( Source: HTC in VMMC study )

11. Turning the Tide Against AIDS  Requires concentrated focus on young people (UNICEF)  VMMC provides only partial protection  Adolescents needs continual access to other services:- HIV counseling and testing Condoms and other prevention technology HIV education in schools Treatment and prevention of other STI Care and treatment services

12. Collaboration with a local NGO in Makete to reach adolescents  UNICEF/Jhpiego/SUMASESU (“Support Makete to Self Support”)  Demand creation in advance by SUMASESU (funded by UNICEF) as they have local intelligence and can better engage local leaders and the community to seek VMMC services, focusing on youths  VMMC services offered in the targeted communities using trained VMMC providers supported by Jhpiego  Conducted 3 VMMC outreaches reaching 2,080 clients since Feb 2014. Majority (more than ¾) are adolescents

13. Results of the collaboration Number of outreaches3 Total VMMCs2,080 Adolescents1,587 (76.3%) HIV testing2,070 (99.5%) Positive35 (1.6%) Total number of facilities involved20 SUMASESU OUTREACHES

14. Asante Sana!