HIV PREVALENCE REDUCTION AMONG YOUNG PEOPLE THE ZIMBABWEAN EXPERIENCE

TUDOR HOTELNEW YORK CITY26 OCTOBER 2009

 

PRESENTED BYSIBUSISIWE MARUNDA

ZIMBABWE NATIONAL AIDS COUNCIL

PRESENTATION OUTLINE

Background InformationWorking Definition Policy EnvironmentIdentified drivers of the epidemic What is working well BarriersWhat can we do better

Background Information

Zimbabwe is a landlocked African country with a total land area of 390 757 square kilometers with a total of 12,121,565 people of which 5, 870,088 are males while 6,251, 477 females

Youth PopulationWomen (15-24) 1,337,816

Women (15-49) 2,994,457

Men (15-49) 2,735,461

Men (15-54) 2,882,213

Children (0-14) 4,981,963

HIV Historical trend

2007 2008 2009

Adult prevalence 15-49 years

14.7%(12.8-16.0)

14.1%(12.1-16.0)

13.7%(11.9-15.0)

Prevalence males15-24 years

3.4%(2.6-4.0)

3.4%(2.7-4.0)

3.5%(2.8-5.0)

Prevalence females 15-24 years

7.5%(6.2-10.0)

7.3%(6.0-10.0)

7.5%(6.1-10.0)

Prevalence children0-14

2.1%(1.3-3.0)

2.1%(1.3-3.0)

2.1%(1.3-3.0)

The estimate of HIV incidence peaked in 1993 at 4.6%. In 2008 it is estimated at 0.98% and in 2009 at 0.96.

Zooming on 2009 Statistics

2007 2008 2009

HIV Adults + Children 1,131,384959,762 – 1,281,486

1,103,988937,339 – 1,254,194

1,102,864934,143 – 1,249,673

HIV Adults 15+ 1,022,209862,611 – 1,155,22

996,600840,668 – 1,131,292

997.123845,507 – 1,134,403

HIV 15+ female 609,942479,083 – 701,805

595,181467,273 – 685,459

594,847469,071- 688,140

HIV population- Children 109,175142,197 – 66,635

107,38865,934 - 139,188

105,74066.126 – 136.898

Prevalence Adult 14.712.75 – 16.0

14.1%12.1 – 16.0

13.71%11.9 – 15.0

Prevalence- Males aged 15 to 24

3.372.63 – 4.0

3.392.66 – 4.0

3.542.77 – 5.0

Prevalence- Females aged 15 to 24

7.466.2 – 10.0

7.336.03 – 10.0

7.456.07 – 10.0

Summary of HIV Estimates 2007, 2008 and 2009

Estimation Method

Data Inputs ANC Sentinel Surveillance

ZDHS+ 2005-2006

Census and Inter-censal Demographic Data

Monitoring and Evaluation Data

African Youth Charter 10-35United Nations 10-24Zimbabwe National Youth Policy 10-30

African Youth Charter 10-35United Nations 10-24Zimbabwe National Youth Policy 10-30

Working Definition of Youth

Zimbabwe adopted a multisectoral response Zimbabwe adopted a multisectoral response to HIV and AIDSto HIV and AIDSResponse is underpinned by 3 Ones, i.e.Response is underpinned by 3 Ones, i.e.#One national Coordinating Authority (NAC)#One national Coordinating Authority (NAC)#One national M & E system #One national M & E system #One agreed Strategic Plan (ZNASP)#One agreed Strategic Plan (ZNASP)Three ones create order, harmony and Three ones create order, harmony and accountability in national responseaccountability in national response

The Response

HIV Policy Environment

Zimbabwe national policies Draw from International and regional policies:Millenium Development GoalsUNGASSRegional policiesSADC Business Plan 2010-2015SADC Strategy on OVCYAbuja DeclarationMaseru Declaration

Policy Environment Contd

Regional Policies and Commitments inform the national umbrella policy:

The Zimbabwe HIV and AIDS Strategic Plan(ZNASP)-2006-2011.Provides bases for advocacy, resource mobilization and programming. Informs the following sector policies:•National Behavior Change Strategy 2006-2010

Policy Environment Contd

•The Zimbabwe Health Sector HIV Prevention Strategic Framework 2007-2010•Zimbabwe National Plan of Action on Women & Girls and HIV & AIDS 2006-2010•National Adolescent Sexual and Reproductive Health Strategy 2009-2015 (Draft)

•National Female Condom Strategy 2006 – 2010•The National HIV Testing and Counselling Strategic Plan 2008-2010•Plan for the Nationwide Provision of Antiretroviral Therapy 2008-2012•PMTCT and Paediatric HIV Prevention, Treatment and Care National Plan 2006-2010

Policy Environment Contd

Policy Environment Contd

•National Action Plan for Orphans and other Vulnerable Children 2004-2010•National Youth Policy- seeks to proffer guidelines with regards to concerns of young people in Zimbabwe like ASRH, HIV and AIDS

Sex workers

Multiple Concurrent Partnerships

Combined with:

• Low risk perceptionin long-term relationships

• Low condom usein long-term relations

•Low levels of malecircumcision

Identified key drivers of HIV:The ‘Highway of HIV Transmission’

“Dry sex”?

STIs (HSV-2)

Early debut

Cross-generationalrelations

Unprotected casual sex

MTCT

Gender imbalances Stigma Mobility

Underlying vulnerability factors:

How has the Reduction in Prevalence rate been Achieved?

Prevention of new infections has constituted the cornerstone of the national response. The ZNASP acknowledge the importance of:

o Maintenance and adoption of safe behaviors among young people

o Adolescence sexual and reproductive health programs including community based, peer education & youth friendly services

o Trained lecturers to teach life skills based on HIV&AIDS in teachers and technical colleges

Conti…

Improved support for individuals, families and communities, Through: support to OVC, the infected and affected by HIV and AIDS, livelihoods support, etc

Effective management and coordination of the national HIV and AIDS response (including resource mobilization).

Conti…

o Vulnerable Groups. The Young People are explicitly noted as a vulnerable group that requires innovative strategies, focusing on their empowerment & inclusion in decision making as well as allocation of resources

o Universal Access. The principle of UA will include deliberate targeting of the vulnerable groups including the young

o Evidence and Result-Based Strategies. These includes programs targeting youth which are tailored to meet their specific needs

o Adherence to International Goals and Principle.

What is working well

1.National Young People’s Network on HIV and AIDS ( launched in 2007 by NAC facilitates youth involvement in the national response )

2.Social Transformation Empowerment Project's (STEPS) Screening Program“Tariro”

3.Global Fund supported Youth friendly centres providing youth friendly reproductive health services

4. The Nation wide campaign on the Zero Tolerance of Child Abuse which has created increased awareness and triggered an increase in reported cases of rape

5.The Young People We Care mulit-partner program

6. Pooling of resources to create basket funds eg ESP , POS-multi-partnerships

7. The National AIDS Trust Fund

What is working Well contd

What is working well contd

8. Multi-partner Behaviour change Strategy role out- there are plans to scale out

9.Structured Coordination at all levels10.Livelihoods programs for older OVC

as an HIV prevention strategy11. Use of the media to promote

monogamy and fight stigma

Barriers

The legal age of consent for testing is 16-leaving out the 12-15 sexually active adolescents

Children living outside the family

The Ministry’s refusal to consider the option of condoms in schools

Barriers Contd

Implementation gaps for legislation eg Domestic Violence Act and the Criminal Law Codification and Reform Act

The economic environment continues to create conditions conducive to transactional and intergenerational sex

Limited Linkages between programmes e.g mitigation should have stronger linkages with prevention

What can we do better

1. Decline is encouraging but one in seven people among the 15-49 age group is infected

2. Support should therefore continue to focus on behavior change, scale up of prevention strategies and care and treatment to decrease incidence and mortality specifically:

Make Participation of Young people in policy formulation and advocacy more meaningful

The Young People’s Network on HIV should scale out to all districts and have clear linkages with other programs

What can we do better Continue Public education including law enforcement officers on relevant legislation Scale up livelihoods programs to encourage economic independence for women and girls Programmes for children on the streets should aim at reintergration.There is room to build on Global Fund Youth Programmes-the UN could partner with NAC and the Family Planning Council Continue use of the media and revive the Zero Tolerance of Child Abuse Campaign

Thank you…