“At a time when AIDS-related deaths are declining rapidly in other population groups, AIDS-related deaths among adolescents aged 10–19 are not declining and AIDS remains the second leading cause of death in adolescents globally. It is the leading cause of adolescent deaths in Africa.”
This report was developed by the United Nations Children’s Fund (UNICEF) HIV Programme to support the ALL IN agenda to end adolescent AIDS, which was launched in February 2015 by UNICEF and the Joint United Nations Programme on HIV/AIDS (UNAIDS), along with governments, international partners, and adolescent and youth networks. The aim of ALL IN is to accelerate reductions in new HIV infections and AIDS-related death among adolescents. The report looks at the process and results of rapid assessments conducted in five countries (Botswana, Cameroon, Jamaica, Swaziland, and Zimbabwe). These assessments sought to better understand the adolescent and HIV programme context within these countries, specifically the demographics, HIV epidemiology, HIV programme delivery, and the overall health and well-being of adolescents aged 10-14 and 15-19. This synthesis report focuses on documenting the rapid assessment process, lessons learned from the process, as well as the actual findings that emerged from this first phase of the assessments in the five countries. It is intended to support government technical specialists, development partners, civil society organisations, and adolescent and youth groups considering or planning similar ALL IN country rapid assessments.
As explained in the report, the publication aims to help readers:
- “Understand the data-driven planning process that was used in Botswana, Cameroon, Jamaica, Swaziland and Zimbabwe to help prioritize adolescent populations, programme interventions and priority geographic areas to accelerate HIV results in adolescents.
- Identify and discuss key programmatic and other contextual and cross-sectoral challenges and coverage gaps in the delivery of results for adolescents in HIV and related sectors.
- Understand the cross-sectoral opportunities and linkages to health, education, protection and other relevant areas identified in the five countries as strategic platforms for leveraging improved HIV results in adolescents.”
The report outlines the objectives and strategies of the ALL IN agenda, explaining that the three ALL IN targets for 2020 include a) reducing new HIV infections among adolescents by at least 75 per cent, b) reducing AIDS-related deaths among adolescents by at least 65 per cent and c) eliminating stigma and discrimination. In order to achieve these targets, the following four key action areas have been identified:
- “Engaging, mobilizing and supporting adolescents as leaders and agents of social change.
- Sharpening adolescent-specific elements of national AIDS programmes by improving data collection and analysis and using to drive programming and results.
- Fostering innovation in approaches that improves the reach of services for adolescents and increases the impact of prevention, treatment and care programmes.
- Advocating and communicating at the global, regional and country levels to generate political will to invest in adolescent HIV and mobilize the necessary resources.”
The report goes on to explain the objectives of the rapid assessments, which are are to 1) Collect, review, and validate data on selected indicators related to HIV and adolescent well-being from multiple data sources; 2) Assess the national programme enabling environment with partners and adolescents; 3) Synthesise data into a dashboard report; and 4) Identify adolescent sub-populations, interventions, and geographic focus areas for programme acceleration.
Following a discussion on the rapid assessment process and the methods used to review, synthesise, and validate the research findings, the report outlines the findings of the research. These include: demographic information on adolescents in each country; the HIV epidemic in adolescents and young people, including projections into the future and a focus on adolescent key affected populations; the state of HIV testing, treatment, and care among adolescents; coverage of different combination HIV prevention interventions such as condoms; cross sectoral programmes; and child protection, gender-based violence, social protection, education, and lifeskills. Overall, it was found that data on adolescents are lacking in many countries, as national surveys seldom disaggregate by age, and where adolescent data is collected, data for younger adolescents (aged 10-14) is often unavailable in sentinel surveillance, monitoring systems, surveys, and programme and research data.
Findings that hold particular relevance to media and communication are those related to social and programmatic enablers in adolescent populations, which include comprehensive, correct knowledge of HIV, access to media, and health care decision-making. The findings showed that:
- Coverage of HIV-related social and programmatic enablers of adolescents was poor in all the five countries.
- Rates of comprehensive, correct HIV knowledge were low, with slightly higher levels among girls than among boys.
- In all five countries, there are connections between secondary school attendance and HIV knowledge gaps, with increased attendance at school resulting in better HIV knowledge.
- All countries but Jamaica were below national targets for adolescent access to media.
- Countries did not have data on mobile phone use and access to the internet, but noted that such data would be useful.
- Only Cameroon collected data on adolescent participation, and it showed extremely low levels of participation.
As stated in the report, “as a whole, data on social and programmatic enablers in the five countries highlighted challenges in adolescent participation in decision-making and in comprehensive, correct knowledge of HIV among adolescents. These data also highlight the need to enhance correct, comprehensive HIV knowledge through traditional and innovative forms of media and through schools.”
Findings related to child protection, gender-based violence, social protection, education and life skills also hold significance for media and communication. Here, the rapid assessments explored country progress in relation to selected measurable social norms (child marriage and gender-based violence), education, and social protection – all areas that influence adolescent health, well-being, and HIV risk. Findings showed the following:
- High rates of child marriage were reported in Cameroon and Zimbabwe.
- High levels of sexual violence in relation to girls and boys were reported in all five countries.
- Given the links between child marriage and HIV risk as well as between and sexual violence and HIV risk, these findings point to areas that require urgent action.
- School attendance was moderate to high in all five countries. This provides an opportunity to reach adolescents and complement school and education-sector programmes with initiatives that empower, build social networks, engage adolescents in social change, and build health-seeking behaviour.
- The proportion of schools with teachers trained to deliver life-skills-based and comprehensive sexuality education was extremely low in all countries.
As stated in the report, “data on child protection, gender-based violence, social protection, education and life skills from the five countries reveal challenges in the adolescent HIV response related to social norms, child and social protection systems and monitoring. They also point to opportunities for response.... Education and empowerment of children and adolescents as well as community engagement are key to mobilizing collective action to challenge and change social beliefs that maintain the practices of child marriage and gender-based violence. Opportunities to act on this exist through the moderate-to-high secondary school attendance rates and in programmes in place in multiple sectors that reach out to and engage communities and adolescents themselves.”
Based on the rapid assessment results, the report identifies the following:
- Opportunities to advance focus on adolescents - Four core opportunities were identified in the majority of the rapid assessment countries: 1) Fostering political will to ensure continued prioritisation of adolescents and to meet commitments; 2) Using findings from assessments to inform and influence laws, policies, and guidelines; 3) Strengthening national M&E systems and data on adolescents; and 4) Strengthening adolescent programming and response through improved coordination and innovative partnerships.
- Innovative ways to enhance adolescent participation - Country teams recommended the following approaches to enhance adolescent engagement: 1) Complement the use of traditional media sources with the use of mobile and internet technology to improve communication and engagement and to improve programme quality; 2) Create space and support for engaging adolescents and define active roles for them related to programme planning, monitoring, communication, and service delivery; 3) Harness the full potential of the education sector to complement opportunities for learning with initiatives to mobilise and drive social change; and 4) Strengthen the capacities of family and community networks to engage and support positive adolescent outcomes.
- Priorities for addressing the adolescent HIV epidemic - following the assessment, all five countries identified priorities for in-depth exploration for the Phase 2 assessment with agreements on WHO (which populations), WHAT (which interventions), and on how to determine WHERE (geographic locations). These are summarised in the report.
With regards to the actual assessment process, the report outlines eight key lessons based on an analysis of global and country-level stakeholder interviews and country rapid assessment reports. These include, among others, early engagement and preparation with countries, multi-sector and donor participation, the important role of champions (either government, United Nations, or prominent non-governmental organisation, or NGO), adolescent engagement, and gaps in data on adolescents.
The final section in the report offers the following eight overall programme recommendations:
- Prioritise adolescents in efforts to end the HIV epidemic.
- Use data on the adolescent HIV epidemic to tailor the response to the epidemic.
- Strengthen data collection in relation to adolescents and adolescent key affected populations.
- Improve HIV knowledge, awareness, and capacity to make health-related decisions among adolescents by using school programmes, the media, and community-based approaches.
- Scale up integrated and multi-disciplinary health service delivery for adolescents.
- Use innovative strategies (such as those that harness mobile technology and media) to scale up accessible quality interventions for adolescents, and to generate demand for and monitor coverage of these key interventions.
StopAIDS Now website on October 13 2016.