1. The state of the national response to prevent HIV among young people: A review of national reporting in 20 high-prevalence countries I Birdthistle, S Dringus, L Knight, E Yankah, P Idele, C Suzuki, L Nguyen, S Kasedde

2. Evidence-Based Recommendations (Steady, Ready, Go! Review) Outline Purpose of the review Methods Epidemiology of HIV in countries studied Review Findings Conclusions

3. For 20 countries with generalized HIV epidemics, national reports were reviewed to assess the national response for YP in terms of: 1.Planning What priority is given to prevention among YP aged 10-24 in national AIDS plans? 2.Implementation Are HIV prevention programs reaching young people? If so, through what activities and settings? 3.Financing What are the absolute and relative amounts spent on youth-specific prevention activities, and are they adequate? Purpose of the review

4. Methods PREPARATION OF COUNTRY SUMMARIES Selection of 20 countries with generalised HIV epidemics Core documents identified and retrieved Construction of template summary and key tables Core documents reviewed and key information extracted for text and tables Country (phone) and IATT consultations to validate and revise summaries CROSS-COUNTRY COMPARISONS AND SYNTHESIS Findings on national planning Findings on program implementation & financing Finings on data reporting

5. East Africa (7) Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, Zimbabwe Southern Africa (5) Botswana, Lesotho, Namibia, South Africa, Swaziland West Africa (3) Cote d’Ivoire, Ghana, Nigeria Central Africa (3) Cameroon, Central African Republic, Gabon Caribbean (2) The Bahamas, Guyana 20 countries included in review

6. Documents Reviewed Type of core documentNumber of countries found and reviewed National AIDS Strategy / Plan (most recent or current) 19 Mid-term review of National AIDS Plan7 UNGASS Progress Report 201020 National Composite Policy Index20 National OVC Plan11 National AIDS Spending Assessment (or other national financial report) 16 And other important national reports where available (e.g., National Strategies for Behavior Change; National HIV Prevention Strategy, etc)

7. EPIDEMIOLOGICAL CONTEXT: ‘Know Your Epidemic’

8. Epidemiological Context: Summary *Source: Intl Group on Analysis of Trends, Sex Transm Inf 2010 [national data for 3 points in time] ^Source: UNAIDS Global AIDS Report 2010 [data for 2 points in time: 2001 and 2009 ] Progress toward the UNGASS goal for YP Botswana Cote d’Ivoire Kenya Malawi Namibia Zimbabwe Zambia CAR South Africa Tanzania Lesotho Nigeria Swaziland Bahamas Uganda Mozambique Cameroon

9. Epidemiological Context: Summary *Source: Intl Group on Analysis of Trends, Sex Transm Inf 2010 [national data for 3 points in time] ^Source: UNAIDS Global AIDS Report 2010 [data for 2 points in time: 2001 and 2009 ] Progress toward the UNGASS goal for Young People HIV decline among 15-24 yr olds since 2001? BotswanaYes >25% * Cote d’IvoireYes >25% * KenyaYes >25% * MalawiYes >25% (urban) * NamibiaYes >25% * ZimbabweYes >25% * ZambiaYes, females only * CARYes, females only ^ South AfricaYes, males only * TanzaniaYes, males only * LesothoYes, rural only * NigeriaYes, rural only * SwazilandYes, urban only * BahamasYes, urban * UgandaNo * MozambiqueNo, possible increase * CameroonNo ^

10. Epidemiological Context: Summary *Source: Intl Group on Analysis of Trends, Sex Transm Inf 2010 [national data for 3 points in time] ^Source: UNAIDS Global AIDS Report 2010 [data for 2 points in time: 2001 and 2009 ] Progress toward the UNGASS goal for YP HIV decline among 15-24 yr olds since 2001? Evidence of change in sexual behaviour? BotswanaYes >25% *Not clear Cote d’IvoireYes >25% *Yes, M&F * KenyaYes >25% *Yes, M&F * MalawiYes >25% (urban) *Yes, M&F * NamibiaYes >25% *Yes, M only * ZimbabweYes >25% *Yes, M&F ZambiaYes, females only *Yes, M&F * CARYes, females only ^Yes, M only * South AfricaYes, males only *No * TanzaniaYes, males only *Yes, M&F * LesothoYes, rural only *Not clear NigeriaYes, rural only *Yes, F only * SwazilandYes, urban only *Not clear BahamasYes, urban * UgandaNo *Yes, M&F * MozambiqueNo, possible increase *No * CameroonNo ^Yes, M&F *

11. Epidemiological Context : HIV prevalence by gender and age Swaziland

12. Numbers of orphans in 2001 and 2009 Epidemiological Context: Numbers of orphans 2001-2009 Source: UNAIDS Global Epidemic Report 2010

13. The state of national response 1. Planning 2. Implementation 3. Financing …and the quality of national reporting Findings from the review

14. Part 1: National Planning The review of all current and most recent National AIDS Plans showed that: All 20 countries include youth-specific strategies in their current national AIDS plan. A wide range of youth-specific strategies are included across countries School-based HIV prevention is the youth-specific strategy most often included …

15. Part 1: National Planning

16. The state of national response 1. Planning 2. Implementation 3. Financing …and the quality of national reporting Findings from the review

17. Scale of Programmes for YP “The majority of people in need have access to...?”

18. GO! Take these interventions to scale NOW! Interventions in SchoolsCurriculum-based interventions led by adults MediaMedia delivered through Radio AND TV READY Implement widely but continue to evaluate Interventions to improve young people’s access to, and acceptability of, health services Training service providers AND actions in the clinic to make them more youth friendly AND with activities in the community Training service providers AND actions in the clinic to make them more youth friendly AND with activities in the community AND involvement of other sectors Interventions in geographically defined communities Interventions targeting youth where a new mechanism or infrastructure to deliver the intervention is created Interventions targeting the whole community which are delivered through traditional networks Evidence-Based Recommendations (Steady, Ready, Go! Review) Evidence-based programming: ‘Steady, Ready, Go!’ review of research Adapted from SRG2 review in JoAH 2011

19. In-School Investment in Young People Focuses on Lifeskills Education

20. Assessing Quality

21. The state of national response 1. Planning 2. Implementation 3. Financing …and the quality of national reporting Findings from the review

22. Funding for HIV Prevention Breakdown of National AIDS Spending by ‘Broad Area’ in 2008

23. Funding for Youth-Specific HIV prevention Proportion of all national HIV prevention funds spent on youth-specific prevention

24. Example Cote d’Ivoire (2008) OVC: 3% Children and youth out of school: 0% Junior high / high school students: 0.47% General population of young people (15-24): 1.05% Spending by Beneficiary So, who are the main beneficiaries…? 1. General population not disaggregated: 50% 2. People living with HIV/AIDS, not disaggregated: 27%

25. Conclusions  Young people are a priority within national plans and strategies.  Relatively little is reported on youth specific coverage and investments in priority areas like HTC and condom promotion.  The intervention most widely planned, implemented and reported on for youth is school-based prevention.  Limited targeted spending on youth and predominant source of funding for youth programmes from external rather than government resources.  Critical to strengthen:  routine age-specific reporting  validation of quality  alignment of investments with evidence  domestic funding to ensure sustainability and effective scale of delivery.