Preventing HIV:

Unite for Children. What works?

Unite against AIDS.
July 2008

Vivian Lopez
Regional Advisor HIV/AIDS
Latin America & the Caribbean
Are we preparing our to live in . . .
youth . . .
A world with HIV/AIDS

Western & Eastern Europe

Central Europe & Central Asia
North America 730 000 1.5 million
1.2 million [580 000 – 1.0 million] [1.1 – 1.9 million] East Asia
[760 000 – 2.0 million] 740 000
Middle East & North [480 000 – 1.1 million]
Caribbean Africa
230 000 380 000 South & South-East
[210 000 – 270 000] [280 000 – 510 000] Asia
Sub-Saharan Africa 4.2 million
Latin America 22.0 million [3.5Oceania
– 5.3 million]
1.7 million [20.5 – 23.6 million]
74 000
[1.5 – 2.1 million]
[66 000 – 93 000]

Total: 33 million (30 – 36 million)

Adolescents getting HIV

5.5 Million young people

between 15-24 living with HIV

45% of new infections in 2007

Children born with HIV
2.2 Million Children living with HIV
Western & Eastern Europe
Central Europe & Central Asia
North America <200 3200
[2400 – 4300]
<500 [<100] East Asia
[<200] 2000
Middle East & North [1200 – 3100]
Caribbean Africa
1800 5700 South & South-East
[1500 – 2100] [3800 – 8000] Asia
Sub-Saharan Africa 21 000
Latin America 330 000 [14Oceania
000 – 29 000]
4600 [300 000 – 360 000]
<1000
[4200 – 8300]

370,000 children newly infected with HIV

Sub-Saharan Africa is home to 90 % HIV+ children > 15
Children impacted by AIDS

12,000,000
children under 15
orphaned by
AIDS in sub-
Saharan Africa

This is a picture of AIDS orphans on the grave of their parents inside their home.
 Impact is Long Term
Millones

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10 Cu
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0
1980 1983 1986 1989 1992 1995 1998 2002 2005 2007 2010
Global HIV/AIDS commitments for
CHILDREN
UNGASS Declaration of
MDGs Commitment
MTSP 2006 - 2009 Global Campaign

Eradicate extreme Prevent HIV infection

poverty and hunger Reduce paediatric PMTCT
among young people
HIV infections;
and reduce their
Achieve universal increase treatment
primary education vulnerability
coverage for women
and children Paediatric treatment
Promote gender equality Reduce the
and empower women proportion of infants
Reduce child mortality infected More children Protection, care and
orphaned and made support for children
Improve maternal health vulnerable by affected by HIV/AIDS
Develop & implement
Combat HIV/AIDS, comprehensive care HIV/AIDS receive (Health / Education /
malaria and other strategies quality support Protection)
diseases
Ensure environmental Develop and
Reduce adolescent
sustainability implement national
risks and
policies and Primary Prevention
Develop a global vulnerability to
partnership for strategies / capacity
HIV/AIDS
development building
UNICEF Focus Areas for Children: Provide a child-focused
framework for nationally owned programmes around ‘Four Ps’

P1 Prevent Mother-to-Child Transmission (PMTCT) of HIV

Provide Paediatric Treatment of HIV

P2

P3 Prevent Infection among Adolescents and Young People

P4 Protect and Support Children Affected by HIV and AIDS

 P1 Prevent Mother-to-Child Transmission (PMTCT) of HIV

Only 12 % of pregnant women with HIV receiving ARVs for PMTCT in

low- and middle-income countries in 2007

Provide Paediatric Treatment of HIV

 New infections among children, 1990–2007

600 000

500 000

400 000

300 000

200 000

100 000

0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

This bar indicates the range

 P1 Prevent Mother-to-Child Transmission (PMTCT) of HIV

HIV + pregnant women receiving ARVs for PMTCT (%)

100 95.0

90
Provide Paediatric Treatment of HIV
80
74.2
71.0

70

60 0 - 30
30 - 60
50
42.6 60 - 90
41.0

40 37.0 90-more
35.0 34.0 34.0
31.0 30.0
28.8 28.5
30 26.5

20.0
20 14.6 14.0 13.0
10.5
9.0
10 5.0 5.0

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 Provide Paediatric Treatment of HIV
P2

% children receiving treatment in LAC 2005 - 2006

100
88
90 82
80
70
60
percent

2005
50
38 2006
40
26
30
20 15 14
11
7
10
0
Global Caribbean Central South America
America
Procurement of Pediatric ARVs
 1st line regimens
GPOvir S-30®
d4T+3TC+NVP
= 0.5 USD

Pedimmune ®
T-30 ®

(AZT+3TC)+EFV = 2.2 USD

B.

d4T+3TC+EFV = 2 USD

1
cm.
Participation of HIV+ Adolescents
•Support to Projects such as Tecer o Futuro
•Support to National Meetings of HIV+
Adolescents
 P3 Prevent Infection among Adolescents and Young People

In 2007, young people aged 15-24

accounted for about 45 per cent of
new HIV infections among
Provide Paediatric Treatment of people
HIV

aged 15 years and older. In 2007,

some 5.5 million young people aged
15-24 were estimated to be living
with HIV.
Overall, however, we are far from on track to reach the
target. We need to make Prevention a priority, act on
what we know can work and better tailor messages to
the young people getting infected.
Adolescents remain our “Window of Opportunity”
Estudios en países con epidemia generalizada de SIDA muestran que las mujeres son infectadas a
edades más tempranas que los hombres, usualmente por hombres mayores. La infección en los
hombres ocurre a edades más tardías. Para cambiar el comportamiento y prevenir infecciones
entonces, los programas de intervención deben enfocarce en adolescentes.

18
Mujeres
16
Hombres
14

12

10
Porcentaje

0
13-19 20-24 25-34 35-44 45+
Grupo de Edades (años)

Data: Masaka District Annual Survey, Uganda, 1997.

 Adolescents & Sex
100
90
80
70
60 52

50 52
40
35

Hombres
30 22

20 22

Mujeres
10
0
<12 13-15 16-18 % alguna vez ha
tenido relaciones
sexuales
*Antigua, Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Jamaica, and St. Lucia

Source: A portrait of adolescent health in the Caribbean, 2000, PAHO/WHO

 Comprehensive knowledge of HIV
among young people (ages 15–24), 1999–2007

100
2010 Target
2005 Target
80

60 Male
%
Female
40

20

0
1999–2003 2004–2007 2010

Year

Source: MEASURE DHS (2008)

 High levels of misinformation
% mujeres jóvenes (edad 15-19) quienes han tenido un concepto erróneo del VIH/AIDS o nunca ha escuchado del SIDA

99
100 96 97 98
95
94 9494 94

90 8889 89
84 84 84
82 81
78 79
80 77 78
74 73
72
71
69
70 6768
6465
62 61 6162
60 58
Misconceptions (%)

57

50
50
44

40 36

30

20

10

America Latina Este y Sur de Africa Africa Oeste y Central Medio Oriente Asia Este CEE/CIS
& y Norte de y el y los Estados
Caribe Africa Pacífico Bálticos
Conceptos erróneos:
HIV/AIDS puede ser transmitido por brujería; picaduras de insectos: o creer que una persona de apariencia saludable no pueda tener el virus
del SIDA.

Source: UNICEF/MICS, Measure DHS, 1999-2001.

 Victims of Forced Sex & Rape
Edad de algunas niñas (aged 15-19) reportan que ellas son iniciadas sexualmente
involuntariamente o por coacción (2001)

Just
happened
58%

Tricked
2%

Forced/
Raped
12%

Willing
N=266 28%

Source: Report of Adolescent Condom Survey, Jamaica, 2001, Commercial

Market Strategies / Jamaica, August 2001.
 Sex = Survival
% de trabajadoras y % VIH positivo, Myanmar

50%
47%
45%
43%
41%
40%
35%
HIV Prevalence (%)

35%

30% 28%
% of all Sex Workers
25%
22%
%HIV+ among Sex
21%
20% Workers
15% 14%

10%

5%

0%
15-19 20-24 25-29 30-34

Source: Sentinel Surveillance Data for March - April, 2000, AIDS

Prevention and Control Project, Department of Health, Myanmar.
Prejudices transferred between Generations
% de mujeres quienes expresan una actitud positiva hacia PVVS en respuesta a dos preguntas*
entre aquellos que han escuchado sobre el SIDA 1999-2001
100

75
% con actitud positiva

25-49
55 15-24
51
50 45
4343

36
33 34

27 28
25
25 25 25
24 24 2525
23
25 22
19 20 20
20
15 16 1616 14
14
16 15
13 12 13
1111 11
1011 1112
10
1211
8 89 8 8 9 9
6 7 6 5 6 5
4 32 3

0
Cameroon

Uzbekistan

Azerbaijan

Tajikistan
Guinea-Bissau
Chad

Swaziland
Trinidad & Tobago
Togo

Lesotho

Rep. of Moldova

Bosnia & Herzegovina

Sierra Leone

Gambia

Equitorial Guinea

Bolivia

Cuba

Somalia

Kenya

Botswana

Mongolia

Albania
Sao Tome & Principe
Côte d'Ivoire

Suriname

Dominican Republic

Comoros

Philippines
Central African Rep.
Niger

Burundi
*1. Debe permitirsele a un(a) maestro(a) quien es VIH+ pero luce saludable continuar trabajando?
2. Compraría Usted alimentos de un(a) tendero(a) que sea VIH+?

Source: UNICEF/MICS, 1999-2001.

 4 Pillars of Programming
Country context-driven with differing levels as entry points

PROGRAMMING COMPONENTS FOR ADOLESCENT DEVELOPMENT

ADVOCACY

x
Safe
Life skills Services Supportive
Knowledge Environm ent

PROGRAMME COMM UNICATION AND SOCIAL MOBILISATION

Note: Adolescent participation is cross-cutting these pillars

 Steady Ready GO!
A review of the evidence for the effectiveness of interventions
to prevent HIV in young people in developing countries

London School of Hygiene

and Tropical Medicine

And others!
 Recommendation for each type of
intervention
Go! Take these interventions to scale NOW!
Sufficient evidence to recommend widespread
implementation on large scale now, with careful
monitoring (coverage & quality … & cost)
Ready Implement widely but continue to evaluate
Evidence suggests interventions are effective, but
large-scale implementation must be accompanied
by further evaluation to clarify impact and
mechanisms of action
Steady More research and development still needed
Evidence is promising, but further intervention
development, pilot testing and evaluation
urgently needed before they can move into the
“ready” or the "do not go" categories
Do not go Not the way to go …

27
 Interventions that are GO!
Schools Curriculum-based, skills-based sexual
health education, led by adults +/- peers,
with specific characteristics (developing the
curriculum, content, implementation)*

Health Training of service providers and clinic staff,

Services facility improvements, and actions in the
community
Mass media Messages delivered through radio & other
media (eg. print media), with or without TV*

* Provided they follow best practice, both in terms of content and process
 Interventions that are Ready

Geographically Interventions that explicitly target

defined young people, and that are
delivered through existing systems
communities
and structures

Young people Interventions that provide

most at risk* information and services, through
facilities and outreach

* Including evidence from studies that did not disaggregate by age

 MASS MEDIA CAMPAIGNS
•Key partnerships in the region: MTV & UNICEF
documentaries
 IN-SCHOOL EDUCATION

Adolescent Support, Care and Treatment:

Brazil’s Health and Prevention in Schools (HPS) Programme

- In 2007, over 2 000 adolescent peer-educators were trained

- Topics such as HIV/STI prevention, adolescent pregnancy, sexuality, and

drug use and abuse incorporated in over 21 000 schools, reaching over 7 000
000 Brazilian adolescents

- Condoms now available in schools with goal to reach 30% of all public high
schools by end 2008

- Strengthened interactions between schools and health services at the

community level to improve adolescent health services
 CONDOMS
Male condom

Female condom
Condom use among Adolescents in LAC
100

90

80

70

60

50

40

30

20

10

0
15-19 20-29 30-39 40-49

Cuba Costa Rica Chile Dominican Republic

Porcentaje teniendo parejas casuales, de aquellos que han tenido sexo en los
últimos 12 meses
 STI Screening & Testing
HIV prevention among adolescents in Jamaica
The “Bashy Bus”
- Multicolored bus travels throughout Jamaica delivering
HIV/AIDS and sexual and reproductive health information

- Equipped with mobile clinic and

health care professionals offering
STI services, VCT, referral and
follow-up

- Over 42 000 young people were

reached with quality HIV prevention
information/skills in 2007 and 2 888
adolescents accessed VCT
 HIV TESTS
‰ Rapid Blood Test
‰ Standard Blood Test

BENEFITS
9 Protect yourself
9 Protect your partners
9 Protect your baby (if you’re pregnant)
9 Peace of mind
 Harm Reduction
ƒPrevent disease
Sterile syringe access to prevent HIV and hepatitis

ƒReduce mortality
Overdose prevention with training and naloxone
distribution; link to medical care and social services

ƒTreatment for drug dependence

Buprenorphine or Methadone Maintenance

ƒEmpower communities and reduce stigma

Community organizing and engagement
 Male Circumcision
Benefits of Circumcision
Urinary tract infections in infants
¾ 12 fold increased risk in uncircumcised boys
Syphilis
¾ 1.5-3.0 fold increased risk in uncircumcised men
Chancroid
¾ 2.5 fold increased risk in uncircumcised men
Human Papilloma Virus (HPV)
¾ 63% reduction in circumcised men
Invasive penile cancer in men
¾ 22 times more frequent in uncircumcised men
Cervical cancer in female partners
¾ 2.0 – 5.8 times more frequent in women with
uncircumcised partners
 Microbicides

When could we expect a microbicide?

• The current set of phase III trials will be yielding
results in early 2008 through 2009.

• Assuming one of these shows efficacy, a microbicide

may be available in a handful of countries in the next
5 years

• Initial availability will most likely be via “introductory

studies” prior to actual registration in country.

• If the current set of products does not prove effective,

the time horizon will be longer (although remember,
there are several second-generation leads already in
human safety testing)
Commitment from Media is Key
To tell her story . . .
To tell their story . . .
Thank you for all
you are doing!