Introduction and Description of Problem
HIV/AIDS in adolescents is a dire global problem and has resulted in millions of adolescent deaths (young people from 10-19 years old). HIV is a virus that attacks the immune system, and if it is not properly treated, can completely destroy it. HIV can lead to Acquired Immune Deficiency Syndrome (AIDS) which refers to the illness that occurs and the last stage of HIV. The disease can be transmitted via sexual activity, breast feeding, and sharing needles (or other equipment) used to prepare an injection for someone with HIV.
The aim of this paper is to describe the Joint United Nations Program on HIV/AIDS (UNAIDS), the United Nations Children's Education Fund (UNICEF), and some of their partner's efforts to reduce Human Immunodeficiency Virus (HIV) infection, deaths, and associated stigmas among adolescents through direct engagement with adolescents and engagement with national governments. This engagement has come through initiatives including ACT!2015, PACT, YouthEngage Teenergizer, UReport, the Fast-Track Cities initiative, and the Text to Change initiative.
HIV's impact on adolescents is startling and it is crucial to find a cure to honor the 39 million people who have died from the illness. In 2015, an estimated 41,000 adolescents died due to AIDS related illnesses—this is more than double the number of AIDS related deaths in the year 2000 (UNICEF,__). HIV/AIDS in adolescents is second largest cause of death in the world and are the only age group in which deaths due to HIV are not decreasing—all other age groups combined had a decline of 38% in HIV-related deaths between 2005 and 2013 (__,_). Conversely, between 2005-2012 there was a 50% increase in adolescent HIV related deaths leading to over two million adolescent deaths from the virus. With 2.1 million adolescents living with HIV, it is extremely difficult and unlikely for them to receive any treatment. In 2016, according to UNICEF, there were an estimated 260,000 new HIV infections in adolescents aged 15-19 globally (__,_). At this rate, there will be hundreds of thousands of more infections if there is still a lack of awareness and conversation around the disease.
The most effected regions are in sub-Saharan Africa where 85% of HIV affected adolescents live (__,__). Half of the effected 15-19 year olds live in six countries: South Africa, Nigeria, Kenya, India, Mozambique and Tanzania (__,__). While this is important to note, it is also critical to understand how this disease affects both men and women. For men who have sex with men, young people who use drugs, transgender people, and sex workers, in Asia, 95% of adolescents diagnosed with HIV fall into one of these groups (__,_). Women in general are twice as likely to have HIV than males (_,_). Further, it it is extremely common for people to be sexually active during their adolescent years, yet condom use among them remains low for reasons ranging from lack of education to lack of affordability. Demographic and Health Surveys show that between 2010 and 2015, less than 60% of young women (ages 15-24) with multiple partners used a condom during their last intercourse in 19 of 23 countries. The results were similar for young men in 15 of 23 countries (__,__).
There have also been thousands of cases in which adolescents with HIV refused to seek help solely due to the fact they felt discriminated toward. There is a stigma that deteriorates self worth, inflicts embarrassment, and results in poor emotional well-being. According to a study by the National Institute of Health, coping only appears to be self taught, and is modestly helpful in managing the perceived stigma (__). Clearly, there is a lack of education on this topic on a global scale which leads to people fearing help, even though it could save lives. However, there is work being done to ensure that the amount of fatalities and infections drop.
Direct engagement with adolescents is crucial to spreading a positive and informative message to who is directly affected by the disease. Active, informed, and voluntary involvement in adolescents is instrumental to how they process information and carry it with them for the future. It is vital for adolescents to have policies and programs that fit their needs thorough collaboration and cooperation with government programs and United Nations programs.
As a part of the ACT!2015 Initiative, UNAIDS, PACT, and adolescents met and received feedback that most of the strategy that they had for reducing adolescent AIDS was short term. The PACT is a coalition of more than 80 organizations collaborating and responding to the global HIV response. There was a lack of long term communication with communities amongst issue based priorities—making long strategy for conquering adolescent AIDS a significant weakness, according to the International AIDS Conference in 2012. To address the weakness, youth organizations indicated it was necessary for them to come together to strategize on their own terms and to articulate their shared ambition and priorities in advancing the AIDS response. This process created shared goals both by the IGO and on a local level to also create goals and define how to reach them.
In May 2013, the problem was address at a meeting called Youth and UNAIDS: A Pact for Social Transformation. The meeting was in Tunisia between 15 key youth groups and the UNAIDS Youth Advisory Forum in a hope to come up with common goals and strategies to expanding the movement. The main result of the conference and collaboration between the groups, were elaborated on the vision to, “create solidarity across youth organizations to work strategically and collaboratively in the HIV response towards ensuring the health, well-being and the human rights of all young people.” The four priorities discussed at the conference were: promoting youth-led accountability for sexual and reproductive health services and policies (like sexual education), mobilizing decision makers and young people to increase access for prevention and treatment, strengthening adolescent capacity to change HIV policy, and advocating for young adolescent participation in global, regional, and national decision making processes. As a result of the strategic initiative, UNAIDS is committed to informing the youth movement about political processes relating to HIV, discussing steps needed to disaggregate data and share it with youth organizations, and map which laws have age, parental, and marital status related restrictions on providing services by country. Not only are these critical to reducing numbers and the affect of adolescent AIDS, but they are also strong indicators of what is to come.
Based on these goals, PACT launched a global survey of people under 30 to ask about how insights, laws, and policies effect access to sexual and reproductive health services. After, results the findings of the survey were announced at the 2014 AIDS conference. It was found that there was an advocacy of discussing parental consent created by the PACT. Future work includes creating advocacy on age of consent laws and how that affects AIDS in young people. This engagement is crucial to continuing the progress of finding the most effective steps to take to evaluate the future of adolescent AIDS.
Further, UNAIDS supported an initiative led by the PACT and was co-convened by Youth Engage Zimbabwe called ACT!2015 Zimbabwe. Zimbabwe had one of the highest HIV rates in the world with 74,000 living adolescents in 2014. The Youth Engage Zimbabwe initiative is a membership network for young people with the focus of drawing members to challenge HIV stigma, silence, denial, discrimination, action, and “misaction” through the empowerment of young people who were/are effective my HIV/AIDS (Youth Engage Tumblr, 2014).
Youth Engage has inspired vast action in the HIV space for adolescents since 2014. As a part of their strategy, they increase public pressure on political leaders about reproductive and sexual health and rights and partnered with over 60 organizations who serve youth and key populations. As a result of the relationships created due to the Initiative, in 2014 and 2015 Youth Engage was able to participate in determining and enforcing governmental sustainable development goals. This not only raised awareness, but Zimbabwe had a __% drop in adolescent HIV rates as of 20__.
Their efforts also led to the creation of a technology initiative called iCount to directly engage with adolescents in an application to report on HIV adolescent statistics, access to youth friendly services, and sexual education (UNAIDS, 2015). In order to get effective data for the fight against HIV, the way iCount would best be implemented was left up to the adolescents themselves in 12 countries.
To gain adolescent engagement for iCount there was a competition with the winner providing the best idea winning $15,000 while honorable mentions win $2,000 each. The requirements for the competition is that not only does the tool have to be simple, easy to use, interactive, and “empower young people to share their experiences through knowledge of sexual and reproductive health rights, services, education, and build self confidence around these issues and using youth empowerment to lead the change on ending the AIDS epidemic” (Funds for NGO's, 2016). Due to their strategy of partnering up with key organizations to engage adolescents, they have become an imperative force in reducing infection, death, and stigma.
Both UNAIDS and UNICEF support Teenergizer, an online platform for teenagers to address discrimination in all areas, including HIV. Together their goal is to create a world where every teenager can realize their potential (Teenergizer, 2017). One of their main events in engaging with adolescents was by creating the first Tennergizer strategic planning conference amongst adolescents in Eastern Europe and Central Asia (UNAIDS, 2017).
Teenergizer consists of a group of 80 adolescents born to mothers living with HIV from Georgia, the Russian Federation, and Ukraine. The uniting factor amongst these adolescents are not only their connection to the disease, but also support for engagement, tolerance, and for human rights.
The issues discussed include avocation for sexual rights, promotion of age-appropriate information on adolescent prevention, and engaging teens with HIV to use their voice in response to the disease. After hearing what the concerns were of the adolescents living with the disease, they discussed another initiative--#questHIVtest. The goal was to to hear about the barriers to testing adolescents faced—this included stigma, parental consent, and the lack of HIV testing and information available (UNAIDS, 2017). As a result of how adolescents felt about those three barriers, a map was developed showing 63 testing locations along with reviews of personal experience and fun places for adolescents to meet after. This message is crucial in engaging adolescents by creating a social and fun testing environment where people can both go with their friends and hang out with them afterwards. As of September 2017, 1925 adolescents from 5 cities have been tested due to the initiative showing incredible progress has been made (UNAIDS, 2017).
Lastly, UNAIDS has worked on The Fast Track Cities Global Partnership. The partnership is an initiative between the City of Paris, International Association of Providers of AIDS Care, UNAIDS, the UN Human Settlements Program in collaboration with local, national, regional, and international partners and stakeholders. The partnership was finalized at the World AIDS Day conference in 2014 where there were 27 cities and 50 countries in attendance and committed to ending adolescent AIDS. Clearly, this is a major way in which organizations like UNAIDS directly engage with governments to respond to the illness (Fast Track Cities Global Partnership, 2014).
The main targets are to ensure that 90% of people now their HIV status, improve treatment access to 90%, and have 90% of all people receiving therapy have viral suppression, as well as zero discrimination. Within this initiative, there are three activities. One is task force planning meetings. At these meetings they bring together a group of stakeholders responsible for leading the given cities AIDS response to work for a city-wide consultation. The forces usually have 5-10 stakeholder including the mayor, NGO leadership, and the city health director. The objectives of the meetings are to create introductions between members, define roles and the cities current actions, understanding what the initiative is, and planning the next steps (like the city-wide consultation).
Another activity that is used for engagement is the city consultation meeting. The purpose of this is to bring together stakeholders to coordinate an AIDS response. This is a more general form of participation like that of city representatives, healthcare providers, and private and public sector stakeholders. The objectives of this part of the Fast Tracks Cities Global Partnerships is to establish baselines for actions and strategize a collaborated response and draft an action plan surrounding 5 implementation points. The five points addressed are process and oversight, monitoring and evaluation, program interventions, communications, and resource mobilization. The purpose of these are to help facilitate a coordinated response, develop a consensus on indicators to measure progress discuss potential gaps across the HIV are continuum optimization, create a communications plan to inform and engage communities, and finally, develop a plan for financing these activities.
To go over what occurred in the meetings and recap the consultations and action items, there is a working group/post- consultation meeting. The participants come from working groups, divided based on implementation programs or stakeholder categories. The objectives of this meeting is to gather and get an update on the gaps and accomplishments, address goals that were not reached, revise the action plan, and drafting a quarterly report discussing progress. These meetings may take place either quarterly or monthly to spark conversations and facilitated discussions regarding these objectives.
A place where this strategy has been implemented and worked is in Dakar. Although the city average is lower than the national average of Senegal, the effect of HIV is crucial on its citizens. The governmental strategy was had the goal to reduce AIDS by 50%. As a result of the program, key programs have resulted in prevention of mother to child transmission of HIV and integrating sexual education programs. Further, they have put an emphasis on the infections amongst children. In particular, all public health facilities have HIV counselling and testing services, including counseling centers for adolescents that provide services. Between 2001 and 2013, the new infection rate in HIV dropped 60%, and the Dakar government continues to keep the HIV rate as low as possible, while providing vast treatment options (Fast Track Cities Global Partnership, 2014). The results of the initiative have yet to be released, but in general, with help from the initiative, HIV levels have dropped and much more work is necessary in order to reach the 90-90-90 target.
To effectively connect with adolescents and governments, UNICEF is using two major forms of communication in an effort to reach out to adolescents and end adolescent AIDS. The first is through social media and creating campaigns to spread the word about the issues with AIDS. UNICEF specifically focuses on young people and their most common problems within the disease. Two initiatives they have used to directly engage with adolescents and government is U-Report and Text to Change.
U-Report is a social media polling tool (via Facebook and Twitter) used to let adolescents around the world talk about issues that affect them. Polls are sent via direct message in real time and results are posted to the U-Report website. With 2.4 million users in over 25 countries, this is crucial in gaining information about how adolescents feel about HIV as well as their fears of testing and their preferences. The benefits of this tool is countless whether it be speaking about what is going on in a given community, creating awareness, participating in nationwide campaigns for change, and comparing a given countries progress with another's.
In 2015 U-Report polled adolescents from 10 countries around the and in 2016 they asked poll questions to a broader audience in over 16 countries and to an extra 410,000 diverse group of young people (including adolescents from Brazil, Ireland, Mexico, and Chile). They found that two out of three of the over 75,000 adolescents and young people polled said that “fear of an HIV positive test” is their biggest barrier to getting tested—a breakthrough result that greatly changes the approach and landscape of ending AIDS.
Out of the nearly 40,000 total responses to the the question about what the biggest fears would be if given a positive result, 48% said social stigma while 34% of adolescents said death. This information solidifies the fact that although there are vast initiatives with the goal of ending stigmatization (even though it's unlikely), it is still a global problem. Going off that, when asked about where adolescents would like to most get tested for HIV, only 2% said they would like to do it through a school nurse. Out of the near 80,000 responses to this question, 38% of people felt that proximity was the most important factor of determining where they would take the test followed by anonymity and a health facility with youth friendly services. Interestingly, when self testing was an option, 59% of over 70,000 respondents said that they would be extremely likely to take that route. If self-testing options become available, based on these results, testing rates and self-awareness are likely to sky rocket.
With the results gathered from U-Report from this vast database, UNICEF and other agencies have used data to create reports for distribution to come up with suggestions on how to adapt to the adolescent environment based on gender, age, and geography. Results were also shared at the largest HIV/AIDS conference in the world (AIDS 2016) by the Director of UNICEF to ensure young people and their struggles were heard. This would inspire adolescents to continue participating, and made them feel even more validated when the Director tweeted, “Hey U-Reporters! U R great. Your responses to the HIV poll will be used in a new global report, and will help UNICEF & governments in our fight to prevent & treat HIV and end stigma. Thank you from all of us at UNICEF.”
Another initiative supported by UNICEF is the Text to Change initiative. This initiative is essential for spreading the message about HIV and stigma that follows it. The initiative is technology based and uses surveys, quizzes, and polls combined with marketing and promotions to connect with adolescents and over 750 million users to gain insight on stigma on a variety of issues. Their services are used in several sectors including health, agriculture, social and economic, consumer goods, and education.
An example of the use of this initiative is in the Democratic Republic of the Congo— the country with 4th largest population in Africa. The estimated number of people living with AIDS is 440,000 people and there has been a growing number of people with technology and infrastructure (in 2013 there were around 29 million cell phone subscriptions covering 40% of the population). The Text to Change initiative is taking care of the technological resources that people of the Congo have through their first interactive SMS campaign used to motivate people to get tested.
Their awareness campaign was though the Vodacom phone network to establish, assess, and improve knowledge about HIV/AIDS. The overall results of the awareness campaign were successful in that they were able to reach over 100,000 people with information on HIV. Not only was this taken up by SMS/phone companies, but it was able to spread across three different languages and regions via radio campaign as well. To incentivize people, at the end of the survey, they were given an airline credits.
The questions in the survey included “do you think a healthy looking person can have HIV” or “donating blood or blood transfusions put you at risk for contracting HIV” with answers being “yes” or “no” or “true” and “false” along with nine other questions. The results of the initiative were extremely informative: 77% of respondents in the key areas were males. This shows that their cell phone ownership could be extremely high amongst males and also that they are more likely to participate in mobile/interactive quizzes. More than 33% of respondents were unaware of the risk to get HIV having sexual interaction and about 25% of the respondents believed that they could not get HIV from oral sex. Lastly, almost 50% of respondents did not know that to be declared HIV positive there are 3 series of tests rather than one. This information not only encouraged people to get tested, but it also allowed for a different demographic to be reached then the traditional route of getting information.
Although UNAIDS and UNICEF are two different organizations, they are really similar as they collaborate on many projects for the same common good. UNICEF advocates for protecting kids and helping them meet their need to expand and reach their full potential. While this is rather vague, UNAIDS supplements their mission by having a more specific approach which is an innovative partnership that leads the world in achieving universal access to HIV treatment, prevention, care and support. They often sponsor each other's projects and initiatives and work off each other to see what has already been done and partner up on projects that specifically focuses on the topic of HIV in children. They work together to find the extent by which to monitor certain demographics of people with HIV. Also, if UNAIDS is working on a report to analyze youth and adolescent statistics and ideas regarding HIV, UNICEF will often be consulted on the results to evaluate next steps and initiatives.
All in all, personally, I learned a great deal from my research on adolescent AIDS supplemented by my research on UNAIDS and UNICEF. Firstly, I learned how global of an issue AIDS is. As an adolescent, I could not imagine living with a disease as debilitating as AIDS and not having the support system necessary to treat the disease. Of course, I am fortunate to live in New York City and get a great education at George Washington University, so I could only imagine what it is like to live in sub-Saharan Africa and not have resources available at my fingertips to respond to the virus. Resources are extremely hard to come by in low income countries and it continues to be a large problem that numerous organizations around the world are attempting to solve. To not know about the disease and how it's spread as well as the other basic fundamentals about the illness is unacceptable. The magnitude of this disease is something that I feel as though should be more discussed, which is why I decided to write about the topic in my paper.
Also, I was surprised how effective direct interaction is whether it be between the government or other the people effected in general. Social media is truly the foundation to doing good and making people aware of issues in the world. I did not realize the effectiveness that came with these type of campaigns because I would not fill out most surveys via the internet. The influence that these surveys, hashtag campaigns, and links have is immense, and if these initiatives are any indication, it is the most effective way to get information on a global level.
In Washington D.C., students and citizens are often unaware of the threat HIV/AIDS has on their daily lives. Washington D.C. is amongst the highest HIV rates per capita. According to the CDC, youth from 13-24 were nearly ¼ of all new HIV diagnoses in the United States—81% of diagnoses among gay and bisexual men. Despite different economic statuses between countries and regions, the core problem still remains the same. Perhaps we can start the mission here in the United States and continue to spread information not only to young people, but students on college campuses and people living in the D.C., Maryland, and Virginia area. Whether this be through initiatives like Text to Change or putting up statistics around the area that address the magnitude that HIV has, it is bound to be an effective method of limiting stigma, and creating conversation around infection and deaths.
I plan on getting involved to end the HIV epidemic as a whole. As someone who has done the HIV/AIDS walk in New York City in the past, I will continue to do it. However, now that I better understand the magnitude, I will not only continue to do the walk, but I will try and get sponsored to do the walk in an effort to raise money. Further,
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