Experiences of violence too often occur early in life. Violence in childhood has been linked to increased risks of: HIV and other sexually transmitted infections; mental health problems; delayed cognitive development; poor school performance and dropout; early pregnancy; reproductive health problems; communicable and noncommunicable diseases; and injury.

Among the 11 countries with available data between 2016 and 2020, violence (physical, sexual and/or emotional) experienced within the past 12 months by children (aged 13 to 17 years) ranged from 19.2% in the Republic of Moldova and Zimbabwe to 65.4% in Uganda among males, and from 17.7% in the Republic of Moldova to 57.5% in Uganda among females.

The percentage of young people (aged 18 to 24 years) who experienced one or more types of violence during childhood (before the age of 18) is high across all 11 countries with available data between 2016 and 2020, ranging from 26.3% in Zimbabwe to 75.6% in Uganda among males, and from 26.5% in Zimbabwe to 75.3% in Uganda among females.

Health systems and communities have been pushed to the breaking point by the COVID-19 pandemic, a pandemic that the world was woefully unprepared for. Two years on, networks of key populations and people living with HIV are still at the forefront of the COVID-19 response, working to ensure that communities have access to timely and undisrupted HIV services. Among them is Youth LEAD, the network of young key populations in Asia and the Pacific, which in 2020 established the YKP COVID-19 Emergency Relief Fund to support initiatives led by young people in Asia and the Pacific.

One of the beneficiaries is Ya_All, an organization for young lesbian, gay, bisexual, transgender and intersex (LGBTI) people based in Manipur, India. “The second COVID-19 wave hit north-east India really hard, as it did across the country. We saw health-care systems collapse in front of our eyes. This greatly affected our work as we saw more and more young key populations experience delays in accessing HIV prevention services and saw an increase in mental health issues,” said Sadam Hanjabam, the founder and Chief Functionary of Ya_All. Thanks to the YKP COVID-19 Emergency Relief Fund, Ya_All supported 300 young LGBTI people and members of other key populations to access telecounselling services in five districts to help them with depression and other mental health issues.

Since the outset of the COVID-19 pandemic, the YKP COVID-19 Emergency Relief Fund has helped organizations led by and serving young people implement programmes that ensured young key populations and people living with HIV were not left behind in the HIV and COVID-19 responses. This included providing essential food and supplies of personal protective equipment, information on HIV and COVID-19 prevention and continued access to HIV prevention and treatment services, including mental health services. It also included establishing harm reduction programmes, distributing seed funding for businesses led by transgender people, providing housing and supporting digital and peer-led initiatives.

Funded through the Robert Carr Fund, the AIDS Health Care Foundation and the UNAIDS Regional Support Team for Asia and the Pacific, the YKP COVID-19 Emergency Relief Fund has supported more than 20 projects from 15 organizations led by young people across the region, and has made a considerable difference to the lives of young key populations.

The Viet Nam Young Key Populations Network is one of the beneficiaries of the fund in Viet Nam. Even though the country was in complete lockdown for a substantial period, with a seed grant the network managed to produce HIV and sexual and reproductive health and rights digital educational content for young people at risk of HIV, distributing harm reduction materials to 15 provinces across the country.

Similarly, YPEER Pilipinas, another beneficiary of the fund, trained 1000 young people on HIV combination prevention strategies and screened more than 900 young people for HIV. With a small grant, they were able to scale up the #GetCondomPH Programme, which resulted in successfully distributing more than 11 000 condoms across the Philippines.

In Cambodia, KHANA has given mental health support training to more than 70 LGBTI leaders. The training accelerated ongoing mental health peer support to key affected populations who were experiencing mental health issues. “Online counselling sessions on how to cope with mental health issues were incredibly helpful. The YKP COVID-19 Emergency Relief Fund was an effective mechanism that allowed us to provide timely support to young people in need of HIV prevention and other health services,” said Phorng Chanthorn, Senior Coordinator at KHANA.

These few examples out of the many show that young people, communities and civil society play a crucial role in pandemic responses, helping HIV programmes rebound and adapt to COVID-19 rapidly. Still, these efforts have not been easy. “Youth networks are trying to find ways to recover, adapt and effectively lead in this new funding landscape that has resulted in greater competition for donor funding. Many programmes, including this one, showcase the impact and necessity of supporting youth-led HIV programmes and initiatives. However, it’s not enough,” said Vanessa Monley, Programme Officer at Youth LEAD.

In 2020, young people accounted for 26% of new HIV infections in Asia and the Pacific. In some countries, close to half of new HIV infections were among young people, and one in three members of young key populations do not know their HIV status.

“It is critical to find innovative ways to continue to scale up access to HIV services for young key populations in the context of COVID-19, ensuring that we do not give up achieved gains, and to respond to the additional issues that have come with the pandemic, such as mental health and social support issues. UNAIDS is fully committed to supporting responses led by young people and ensuring their sustainability as we work collectively to end AIDS by 2030,” said Taoufik Bakkali, Director, a.i., of the UNAIDS Regional Support Team for Asia and the Pacific. 

The UNAIDS Joint Programme and partners agree that a new initiative is needed to accelerate and support action at the global, regional, country and community levels to urgently end AIDS among children, adolescents and mothers. To meet the needs of all stakeholders and ensure the engagement of all partners, we are undertaking a global consultation survey to gather ideas and opinions on what the priorities should be for ending AIDS among children, adolescents and mothers.

Eliminating vertical (mother-to-child) transmission of HIV and ending AIDS among children are among the global priorities highlighted in the new Global AIDS Strategy 2021–2026: End Inequalities, End AIDS.

In 2020, there were 1.7 million children living with HIV globally, almost half (46%) of whom were not on life-saving HIV treatment. In the same year, there were 150 000 new HIV infections among children. Most of these new child infections could have been prevented if adolescent girls and women had universal access to HIV testing, prevention and treatment services and the support they need to stay in prevention care or on HIV treatment throughout pregnancy and breastfeeding.

Over the past decade the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, followed by the Start Free, Stay Free, AIDS Free 2016–2020 framework, helped to coordinate, accelerate, support and monitor the global response to HIV among children, adolescents and mothers. Significant progress was made from 2010 to 2020, with coverage of HIV treatment to prevent vertical transmission for pregnant women living with HIV increasing from 45% in 2010 to 85% in 2020 and with a 53% reduction in new child HIV infections over the same period. However, this progress was not enough to reach any of the global targets set for the end of 2020.

New targets have been set for ending AIDS among children, adolescents and mothers in the Global AIDS Strategy 2021–2026. Urgent and coordinated action is needed, from the global to the community levels, to reach these ambitious new targets, and we need your input on how best to accelerate action, especially at the community and country levels.

Please complete the online survey, which is available in English, French, Russian and Spanish, by 20 December.

• Consultation for English speakers - https://bit.ly/3DMkjJ2
• Consultation for French speakers - https://bit.ly/30MT7f7
• Consultation for Spanish speakers - https://bit.ly/3rBc27F
• Consultation for Russian speakers - https://bit.ly/3G13wm2

Ministers of education, health, gender, and youth in Eastern and Southern Africa (ESA), expressed overwhelming support to continue their joint efforts towards creating a brighter future for adolescents and young people in the region by empowering the youth and protecting their health and well-being to achieve the common goals.

A high-level Ministerial Meeting held virtually on Monday, as part of the International Conference on AIDS and sexually transmitted infections (ICASA) 2021 reaffirmed and expanded the commitment first made in 2013.

Eight years ago, Ministries of Health and Education from 20 countries - supported by the Southern African Development Community (SADC) and the East African Community (EAC) – joined forces with regional UN organisations to agree on a joint commitment, known as the ESA Commitment. They recognized the urgent need for more systematic scale up of sexuality education and youth-friendly SRH services in the region.

 While important strides have been made toward improving sexual and reproductive health and rights (SRHR) outcomes among adolescents and young people, significant gaps and barriers still exist to the realization of the ESA Commitment targets. An evaluation of the 2013 commitment revealed progress in reducing new HIV infections, increasing comprehensive HIV knowledge and creating a conducive policy environment. However, the evaluation also indicated that accelerated efforts are urgently needed to reduce early and unintended pregnancy, gender-based violence and curb the effect of humanitarian emergencies, such as the COVID-19 pandemic. This further underscored the need to renew the commitment, through expanding and aligning it with the SDG Agenda 2030.

Extensive consultations at national and regional level with governments, adolescents and young people, communities and development partners across sectors led to a new updated regional commitment and targets for 2022-2030.

This commitment by the ministers of Health, Gender, Education and Youth is expected to accelerate investments to the education, health and well-being of adolescents and young people in ESA.

By Prof. Sheila Tlou — Republished from Health Times

My years of work in HIV prevention have taught me a few things. Among them, one of the important things I have learnt is that if people do not know how to protect themselves or how to access treatment, they will not be able to prevent HIV or lead happy and fulfilling lives with HIV. Therefore, information and education is key. But its not the only thing needed. I might have the information that unsafe sex may expose me to HIV or other STIs, but I may still go ahead and engage in unprotected sex. This means that the motivation and means also have to be provided. The other thing I have learnt about imparting knowledge is that you have to do it before it is too late. People need to know how to prevent an illness before they come in contact with it or before they act in a way that allows their body to be vulnerable to it.

Children today are leading the charge on a number of global issues – be it girls’ education, be it climate change or HIV. We have at least two world leaders on the issue of girls’ education and of climate change – Malala and Greta – who began their leadership as children and made the world listen to them. Why is this possible in today’s day and age? Because we are all more and more connected, and children and young people are now growing up with the internet as well as other media.

But no one is born with the knowledge to handle this media or to know how to prevent illness. We all learn this. How to use a mosquito net to sleep in for avoiding malaria. How to wash our hands to prevent bacterial infection or COVID. How to use a condom to prevent HIV or other STIs. These are learnt behaviours and someone reliable and trustworthy needs to teach us or we are unlikely to listen.

All this to say that I know from my lifetime of experience, and the world knows through over a decade of evidence, that when you provide good quality, contextual and developmentally appropriate sexuality education to adolescents, it is effective. It results in less HIV infections, less early or unintended pregnancies and less unhappy couples!

Puberty, healthy relationships, and preparation for building a home and having a family are among those aspects of life that CSE teaches in schools. Addressing such topics can no longer be avoided because children are already being exposed through many, widely available channels. Unless a trusted source addresses it first, our children are at risk of taking wrong turns in life because of the things they read on the Internet, see on TV, or discuss with their friends. CSE offers comprehensive education – not just about puberty, healthy relationships, and preparation for starting a family. Indeed, the goal of is to support children in becoming well-rounded individuals. CSE teaches how to carefully think actions through and make decisions that are mature and healthy.

Here we are at the cusp of renewing our promise to our children and young people in east and southern Africa that we will give them the best possible education for their health and well-being, and access to the services they need. We are promising to them that we will do all we can for their brighter future. It tires me that there are still some people who want to rob our children of the education that gives them all the possible options and choices of protection, including abstinence, delaying sexual activity, condoms and other contraception. It tires me that there are some trouble makers spreading misinformation about sexuality education, when we know that CSE leads to healthier, happier and more fulfilled young people who have the information, attitudes and skills to make better life choices for themselves.

Let us reject this misinformation, trust our governments, and work together towards a better, healthier Africa.

Prof Sheila Tlou is the Co-Chair of the Global HIV Prevention Coalition, Former Minister of Health Botswana, distinguished advocate for human resources for health issues and a recognized visionary leader and champion through her initiatives on HIV and AIDS, gender, and women's health.

Current inequalities in HIV testing and treatment for children living with HIV and trends in historical coverage of services to prevent vertical (mother-to-child) transmission of HIV are driving year-on-year trends in AIDS-related mortality.

Reductions in AIDS-related deaths among children and adolescents are steepest among children aged 0 to 9 years (a 60% decline since 2010), reflecting both improvement in efforts to prevent new vertical infections and efforts to diagnose and treat children in the months following childbirth and during breastfeeding.

However, among adolescents (aged 10–19 years), progress is slower, with AIDS-related deaths declining just 37% over the same period.

The single biggest paediatric treatment challenge is to rapidly find children living with HIV who were missed at birth or during breastfeeding and link them to care. Scale-up of rights-based index, family and household testing and self-testing, and integrating HIV screening with other child health services, can help close this gap. 

“We are demanding that you step up and finally do your part,” said Yana Panfilova, a young female activist from Ukraine who is living with HIV, at the United Nations High-Level Meeting on AIDS in June 2021.

A leader of the regional adolescent-led movement Teenergizer, she emphasized the vulnerability of young people to HIV and the need to provide care and support to adolescents living with HIV and she called on world leaders to keep young people at the forefront of the AIDS response.

“If we are going to make real change, these four things must become a reality: comprehensive sexuality education in all schools, in all countries; psychosocial support and peer support for every adolescent with HIV and young key populations; community-led HIV services immediately as the reality, not the exception; and an HIV vaccine and a functional cure,” Ms Panfilova added.

All these recommendations are critical in eastern Europe and central Asia, which is facing the world’s fastest growing HIV epidemic. At end of 2020, there were 60 000 young people aged 15–24 years living with HIV in the region. Many young people remain unaware of their HIV status, and late HIV diagnosis remains a significant challenge in the region.

There are multiple barriers and obstacles in almost all countries in eastern Europe and central Asia for adolescents and young people to access HIV services and care. In many countries there is an absence of adolescent-centred HIV testing and counselling, there are requirements for parental consent for HIV services, there is a lack of access to modern contraceptives and there are confidentiality issues and stigma and discrimination. Harmful norms, taboos related to sexual and reproductive health, inequalities, gender-based violence, COVID-19-related obstacles and mental health problems are further barriers to access to HIV services.

Although significant progress has been achieved over the past 30 years in providing adolescents and young people in eastern Europe and central Asia with access to sexual education and other services, the level of knowledge about HIV prevention among people aged 15–24 years in the region remains low—as low as less than 3% in Tajikistan.

Different approaches have been used by civil society and community-led organizations to reach young people who are vulnerable to HIV. For example, the Dance4life project in Belarus, Kyrgyzstan, Kazakhstan, the Republic of Moldova, the Russian Federation and Ukraine reaches vulnerable young people with the Journey4Life Programme (J4L). J4L helps adolescents aged 14–18 years develop healthy interpersonal relationships that are free from violence and coercion and based on respect for gender equality and teaches them how to maintain their sexual and reproductive health, focusing on the prevention of HIV, unplanned pregnancy and sexually transmitted infections. It aims to reach 1400 young people by the end of 2021 in Kazakhstan and Kyrgyzstan, with support from UNAIDS and the United Nations Educational, Scientific and Cultural Organization.

A recent survey among adolescents run by Teenergizer showed that the availability of HIV treatment for adolescents is not enough to keep them alive. Treatment interruption is a significant reason why adolescents continue to die in the region. According to the survey, HIV-related fears, psychological vulnerability, treatment fatigue and stigma are significant risk factors for treatment interruption among adolescents. The survey noted that they need support from their peers, communities and doctors, and they often need professional psychological help. 

In her United Nations High-Level Meeting on AIDS speech, Yana Panfilova remembered Diana, who recently died of an AIDS-related illness. “This year, I was angry when we lost Diana. She was only 19, born with HIV. But she had pills that were impossible to take, no mental health support and no confidentiality. Like millions of people with HIV, she was killed by inequalities. Millions of people with HIV may have HIV pills, but they live in a world where their families and their societies do not accept them for who they are.”

Svetlana Izambayeva, who organizes It’s simple!  summer camps for children and adolescents living with HIV in the region, explained that adolescents living with HIV are often socially isolated and lonely—they are scared to talk about their diagnosis and fear for their future. The camp’s attendees receive psychological care and support, create networks and support others. 

“We need more political leadership, more data on adolescents and young people, more programmes to address the gaps and more funds for the youth response. But here in the region we already have a growing movement of adolescent and young leaders which we must nurture, fund and further support,” said Lena Kiryushina, the UNAIDS Youth Officer for eastern Europe and central Asia.

School-based comprehensive sexuality education plays a vital role in promoting the health and well-being of children and adolescents, both now and in their future. It improves sexual and reproductive health outcomes, including for sexually transmitted infections and HIV, promotes safe and gender equitable learning environments and improves access to and achievement in education.

In a preview of the upcoming global report on the status of comprehensive sexuality education, more than 700 people joined an online event opened by Stefania Giannini, the Assistant Director-General, Education, for the United Nations Educational, Scientific and Cultural Organization (UNESCO). While some progress has been made, she noted that there’s still a long way to go and underscored comprehensive sexuality education as one of the key priorities for action to achieve gender equality.

People attending the event heard the perspectives and recommendations of young activists for sexual and reproductive health and rights and case studies from Sweden, Tunisia and Namibia, together with engagement from policy-makers on how they are working towards ensuring quality comprehensive sexuality education for all young people. 

“Like all journeys, the road towards comprehensive sexuality education is long, and sometimes winding, but it is leading us on the path to brighter, healthier futures for our young people,” Ms Giannini said.

The panel of young people collectively called for the recognition of education as a fundamental right, the need for strong implementation with proper financing and sufficient monitoring and evaluation and truly comprehensive curricula that respond to the needs of all young people.

Shannon Hader, the UNAIDS Deputy Executive Director, Programme, addressed the meeting, referring to the new Global AIDS Strategy 2021–2026 and the 2021 United Nations Political Declaration on AIDS and the importance of comprehensive sexuality education to both. “Comprehensive sexuality education is a necessary core intervention—to prevent HIV among young people and also to empower young people to recognize and address issues of violence, sexual abuse and elements of their overall sexual health and well-being. Importantly, gaps in comprehensive sexuality education knowledge are not equal. Inequalities exist based on where young people live, levels of family income or education, digital access and degrees of gender inequality in the community. The global AIDS strategy recognizes we must end inequalities to end AIDS.”

The comprehensive sexuality education global status report is a collaboration between UNESCO, UNAIDS, the United Nations Population Fund, the United Nations Children’s Fund, UN Women and the World Health Organization (WHO), with support from governments and civil society. The report provides a snapshot of the status of school-based comprehensive sexuality education around the world, which can help to inform advocacy and resourcing efforts, as governments and partners work towards the goal of ensuring that all learners receive good quality comprehensive sexuality education throughout their schooling.

“For governments and international stakeholders, we want you to stand up, speak out, change the rules and allocate resources for comprehensive sexuality education,” said Reuben Avila, the Director of Sin Control Parental and a She Decides young leader from Mexico.

The event was held in the lead-up to the Generation Equality Forum (GEF), which will be held from 30 June to 2 July and which will launch a series of concrete, ambitious and transformative actions to achieve immediate and irreversible progress towards gender equality.

”Bodily autonomy and sexual and reproductive health and rights” is one of six Action Coalitions that will be established during the GEF. Among the three actions agreed to for the Action Coalition, the first is to ”Expand comprehensive sexuality education”, with the goal of increasing the delivery of comprehensive sexuality education in and out of school to reach 50 million more children, adolescents and youth by 2026. The goal is fully supported by the Global AIDS Strategy 2021–2026, which has a target to reach 90% of all young people with comprehensive sexuality education.

“For meaningful engagement of young people, we have to make sure they have ears, eyes and teeth. The ears mean that young people are aware of their entitlements, voice means that they can advocate for these rights and entitlements to be met by duty-bearers and the teeth means that young people can hold the duty-bearers accountable for doing so,” said Marina Plesons, a technical officer on adolescent sexual and reproductive health and rights at WHO.