"ALL IN...recognizes the importance of a holistic, multi-sectoral approach towards addressing risk and vulnerability in adolescents, seeking to drive this fast-track effort through partnerships that combine forces to improve leadership, commitment, investments and programmes, and strengthen data, implementation and systems for adolescent engagement across a wide range of areas..."
The purpose of this report is to showcase the research, community mobilisation, programmes, and policy actions aimed at ending the AIDS epidemic in adolescents (ages 10-19) in support of the ALL IN! agenda. The United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the ALL IN platform in February 2015 to galvanise global action, with a focus on 25 lead countries that contribute to 86% of all new HIV infections in adolescents. With the goal of bringing adolescents into focus in fast-track efforts to end the AIDS epidemic by 2030, it provides 3 targets for the year 2020 to frame this acceleration agenda: reduce new HIV infections among adolescents by at least 75%; reduce AIDS-related deaths among adolescents by at least 65%; and end stigma and discrimination. (For further details about ALL IN, see Related Summaries, below.)
This report presents an update of the key results and contributions from the ALL IN agenda in 2015 and 2016, as well as the impact of these on:
- Global strategic direction, partnerships, resource mobilisation, and advocacy.
- Country-level service and programme prioritisation, innovation, adolescent engagement, and social change.
To that end, the report is comprised of 2 components: a global summary and a section of country-specific briefs. It also presents recommendations from both country and global perspectives on immediate priorities, and underlines opportunities for acceleration in priority countries. The document was produced by the UNICEF HIV Programme (Programme Division) and UNAIDS in collaboration with UNICEF and UNAIDS regional teams as well as joint UN country teams on HIV and AIDS in 27 countries and ALL IN! partners representing: Education Development Center; Elizabeth Glaser Pediatric AIDS Foundation (EGPAF); the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund); Ford Foundation; International Labour Organization (ILO); John Snow, Inc. (JSI); Pact; the United States President's Emergency Plan for AIDS Relief (PEPFAR); Save the Children; United Nations Development Programme (UNDP); United Nations Educational, Scientific and Cultural Organization (UNESCO); the United Nations Population Fund (UNFPA); UN Women; the World Health Organization (WHO); and the World Bank.
As detailed here, in 2015 and 2016, member states renewed their political commitment to key areas of sustainable development through high-level agreements, such as the 2030 Agenda for Sustainable Development by the United Nations General Assembly - with its Goal 3 (includes a specific target to end the AIDS epidemic by 2030) and Goal 5 (includes a specific target to ensure universal access to sexual and reproductive health). Furthermore, in June 2016, member states came together at the UN General Assembly for a High-Level Meeting on HIV/AIDS. The outcome of this meeting was a Political Declaration, which includes a renewal of concrete targets to End the AIDS Epidemic by 2030 (includes targets to reduce new HIV infections among adolescents by 95% and to increase to 81% those on treatment)
In response to such high-level political momentum, at the global, regional, and country levels, "adolescent and youth networks have come together to support the response to HIV in adolescents and lay the foundation for sustained and meaningful engagement for social change....Young people, including adolescents, have also claimed critical spaces of participation to inform the HIV response, strengthen their advocacy and build further cohesion for country-level action. For example, UNAIDS together with IPPF [International Planned Parenthood Federation] and the PACT, a global coalition of 25 youth-led networks and organizations working on HIV and SRHR [sexual and reproductive health and rights], lead the ACT!2015 social mobilization initiative. This joint effort, which is now entering its fourth phase, focuses on youth-led, data-driven accountability for the SDGs and the HIV Political Declaration in 12 priority countries."
The report shares data to clarify the status of the global HIV epidemic in adolescents. For example, noting that stigma and discrimination remain significant barriers to inclusion, access to prevention, treatment, care, and support among adolescents living with HIV, adolescent girls and young women, and adolescent key populations (adolescents who sell sex, adolescents who inject drugs, transgender adolescents, and gay and bisexual adolescent males), UNAIDS and the Global Network of People Living with HIV, the International Community of Women Living with HIV, and IPPF have developed a Stigma Index to help communities understand the experiences of people living with HIV (PLHIV) with stigma and discrimination, and to inform advocacy and formulate plans to end this. Over 50 countries have used this tool to learn, for example, that one out of every three adolescents aged 15-19 living with HIV in Zimbabwe feared being gossiped about, and adolescents were more likely than any other age group among PLHIV to feel ashamed of their infection, blame others for it, feel suicidal, and exclude themselves from social gatherings with other adolescents.
Next, the report explores the status of the global response, in areas including: HIV testing and prevention; HIV treatment in adolescents; and cross-sectoral investments – girls' education and teenage pregnancy. It is noted, for instance, that efforts were made in 2015-2016 to engage adolescents in local advocacy and mobilisation efforts, identify the locations and adolescent populations with the highest HIV burden, determine the bottlenecks limiting effective delivery of key interventions, and define with partners priority actions and innovative approaches to reach the most vulnerable adolescents.
Support of global and country action for adolescents has been coordinated through 4 ALL IN workstreams; highlights of the results from these are summarised below:
- Engage, mobilise, and support adolescents as leaders and agents of social change - The ALL IN partnership focused efforts on three main areas: (i) support adolescent participation in the HIV response; (ii) review and reform age of consent laws that pose obstacles for adolescents to access HIV and sexual and reproductive health services; and (iii) foster a social movement to address stigma, discrimination, harmful gender norms, adolescents' access to social protection, and adolescents' empowerment. For example, in 2015, the 'Engagement + Empowerment = Equality' programme mobilised more than 1,000 young women and girl advocates, including those living with HIV, to voice their concerns at local, regional, and national levels. In addition, UN Women successfully advocated for gender-transformative national HIV strategies that highlight the HIV-specific needs of adolescent girls and young women, and engaged young advocates in planning and decision-making processes in Kenya, Mozambique, Uganda, and Cambodia.
- Sharpen adolescent-specific elements of national AIDS programmes by improving data collection and analysis, and use this to drive programming and results - In partnership with UNAIDS and others, UNICEF has led the design of tools and guidance to support countries that undertake comprehensive assessments, in a bid to strengthen national responses to HIV in adolescents. In addition, work led by ALL IN partners continues to strengthen operational evidence around implementation. Several examples are provided. To cite only one: In northern Malawi, the ILO trained 200 youth as peer educators on HIV and AIDS issues. Two girls among them created a group to address the many challenges they face in terms of access to appropriate information and services. Furthermore, multiple investments have contributed towards improved use and evidence around m-Health tools and the integration of technology, including: Youth Voices Count, in partnership with the multi-country South Asia Global Fund HIV Programme, developed an animated video on youth-friendly health services, which is now available with subtitles in 7 languages. The video discusses the challenges that young people face in accessing existing health services and what could be done to overcome them.
- Foster innovation in approaches that improve the reach of services for adolescents and increase the impact of prevention, treatment, and care programmes - ALL IN partners focused on 3 areas to drive innovation and bring to scale those models which work to address adolescents and HIV: (i) community accountability and monitoring by adolescents on services for prevention and treatment; (ii) platforms for innovation; and (iii) strengthening family support for adolescents, including girls, young key populations, and adolescents living with HIV, and improving scientific knowledge base. The key advances sought to design, build, and document innovative approaches that: egaged adolescents, were built around an expressed need of adolescents, and promoted new and creative ways of communication between adolescents and the public health practitioners who aim to support them. Some key examples highlighted by partners in the 3 areas are listed in the report, along with lessons learned. For example:
- Creative social media channels can be a gateway to significant numbers of young people and adolescents, and provide a great resource for polling.
- The validity and reliability of data gathered through social media must be considered when it is analysed and applied. Working with adolescents and young people themselves to validate data can be an effective way of improving data use, as well as by engaging them in the design and planning of programmes.
- Innovation is required to respond to expressed needs outlined in the ALL IN assessments (and other data sets), and better linkages with the assessments could improve the quest for innovation.
- Music and entertainment are effective in driving engagement of adolescent in youth, but programmes must apply a rigorous design and evaluation methodology to promote effective responses.
- Social movements must ensure that adolescent and youth voices can be heard in all their diversity, and that support is provided to ensure that the most marginalised have access to high-level platforms.
- Advocate and communicate at the global, regional, and country levels to generate political will to invest in adolescent HIV and mobilise resources - For example, in 2016, ALL IN launched the Start Free, Stay Free, AIDS Free global agenda, which provides a roadmap for the urgent work ahead, elevating and amplifying key initiatives that are already accelerating progress for children, adolescents, and young women.
As a part of this reporting exercise, UNICEF and UNAIDS reached out to adolescents and youth through global ALL IN partners and those in all 25 lead countries, inviting their perspectives on ALL IN, its major contributions to adolescent HIV programming and, in particular, the main ways they have been involved since its launch in 2015. A total of 133 adolescents and youth responded to the English and French language surveys. The survey feedback revealed that the key areas of engagement of adolescents in ALL IN in 2015-2016 were advocacy, training, support to referral, and social mobilisation. While some respondents noted that the ALL IN agenda is helping to foster better coordination and focus on adolescents, as well as providing a platform for adolescents to raise their voices, others pointed out that there is still a need to improve the engagement of adolescents and young people since they themselves have either not been involved or are yet to see results from ALL IN.
The second part of the report presents country profiles featuring data summaries drawn from global databases, as well as narrative summaries of lessons learned in the 4 areas of work supported through ALL IN during the period 2015-2016. Specifically, each country narrative describes the following lessons:
- Social change and adolescent engagement: Results related to meaningful adolescent participation in decision-making, review of policies and access laws to services, and support for adolescent-led social movements to address HIV risk and vulnerability, including stigma, discrimination, and harmful gender norms.
- Programme scale-up and acceleration: The application of findings from country assessments to upscale HIV response among adolescents, including partnerships and leveraging of resources.
- Innovation: Results associated with the use of online and mobile technology, social incentives, and new programming tools to improve access, utilisation, and quality of HIV interventions for adolescents, including improving community monitoring and accountability systems.
- Advocacy and communication: Results associated with the outcome of advocacy efforts, including political commitment, public awareness, and optimisation of resource allocation such as resource gap mapping and expenditure tracking to inform investments in HIV among adolescents.
UNAIDS website, September 20 2017. Image credit: © UNICEF/UNI177053/Palasi