HIV prevalence ↑ from ages 10-15 on
South Africa (2012)
Uganda (2011)
12.1%
11.0%
11.0%
9.8%
36.8%
11.3%
10.7%
31.0%
10.5%
10.2%
9.1%
26.6%
25.5%
23.1%
24.2%
21.4%
7.1%
17.9%
16.8%
15.7%
16.2%
40-44
45-49
4.0%
3.0%
2.8%
1.7%
<5
15–19
5.2%
3.7%
2.1%
0.7%
20–24
25–29
30–34
35–39
40–44
45–49
5.6%
1.2%
0-14
15-19
20-24
25-29
AGES
Females
Males
Females
1.3%
1.2%
?
0.1%
<5
15–19
0.6%
1.3%
0.5%
0.8%
0.7%
0.6%
0.7%
25–29
30–34
40–44
45–49
<5
0.3%
0.2%
0.2%
0.2%
0.1%
0.0%
15–19
20–24
25–29
Males
Females
0.5%
0.4%
30–34
35–39
AGES
AGES
Females
35–39
0.5%
0.4%
?
0.3%
0.2%
20–24
Males
India (2006)
1.0%
0.6%
35-39
AGES
Cambodia (2005)
1.3%
30-34
Males
0.2%
0.2%
40–44
45–49
YMSM Incidence: Bangkok MSM Cohort Study
(4762 MSM attending HIV VCT during 2005-2011)
Cumulative probability of HIV infection (%)
18-21 yrs
31.3%
30
22-29 yrs
26.3%
23.9%
All
20
15.2%
≥30yrs
10
N=4762
0
10
Source: van Griensven et al
Figure 3.2.1.2.1
20
30
40
Months of follow up
50
60
Estimated number of AIDS-related deaths among
adolescents (ages 10-19), Asia-Pacific, 2001-2012
7000
6513 (2012)
6000
Number
5000
4000
3000
2000
1000
AIDS-related deaths among adolescents in Asia-Pacific are
growing
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Children under 18 at higher HIV risk
• Epidemiological definition of children/adolescents as key
population is not clearly established – by age and by risk
behaviours (classified as “other populations”) - Often
excluded from surveillance
• Legal age of consent to test
• Face cumulative risks
• Extremely vulnerable to sexual abuse and violence
• Excluded from HTC/STI/SRH/OST services
• Diagnosed and treated too late
Legal age to consent independently to an HIV test
Country
Cambodia
Age
18 (Law on the Prevention and Control of HIV/AIDS)
Fiji
Child who is capable of understanding the nature and consequences
of the test (HIV/AIDS Decree 2011)
Lao PDR
14 (HIV/AIDS Law 2010)
Marshall
Islands
14 (Communicable Disease Prevention and Control Act)
PNG
13 (HIV/AIDS Management and Prevention Act 2003)
Philippines
18 (Philippine AIDS Prevention and Control Act)
Vietnam
16 (Law on HIV/AIDS Prevention and Control of 2006)
Source:
Young people and the law in Asia and the Pacific: A review of laws and policies affecting young people’s access to sexual
and reproductive health and HIV services- UNESCO 2013
Not leaving adolescents behind…
Routine programme data
Time to revive routine data/reporting data monitoring, disaggregated by age and
gender (currently requires additional abstraction from health facility registers for
analyses)
Surveillance/surveys
Current surveys are not designed for adolescents – most population surveys (MICS,
DHS) start from age 15; not 10-14
Time to redesign survey questions by testing knowledge of services instead of
knowledge on correct route of HIV transmission. “Do you know where to obtain HIV
test? Where to get condoms? Where to get HIV treatment?”
Programme response
Time for open dialogue on ethical, policy and programmatic issues - to improve
adolescents’ access to information and services
A multi-sectoral approach – collaboration between NAP, SRH, child/social welfare,
juvenile justice, law enforcement and civil society
THANK YOU
Wing-Sie Cheng
Regional Adviser, HIV and AIDS
UNICEF East Asia and Pacific Regional Office
Emerging research
33% of boys working on beaches reported adults sexual
33% of boys working on beaches
touching them; 56% first sexual experiences
qualify
as
reported adults sexual
touching
them; 56% first sexual
abuse; 66% forced;
experiences qualify as abuse; 66%
Help seeking: 82% feel guilty, 40%forced;
numb compared to
12% of boys not abused
Help seeking: 82% feel guilty, 40%
Feelings: Shame, guilt, self blame.numb compared to 12% of boys
not abused
Boys who were sexually touched 4 times more likely to
Feelings: Shame, guilt, self blame.
feel suicidal
Boys who were sexually touched
are 4 times more likely to feel
suicidal
*Source: UNICEF EAPRO (2012), Systematic Review of Child Maltreatment
‘I Want to be Brave’ Davis, J. and Miles, G. 2014
The LingaBoys of Siem Reap (Davis, J. 2013)
• 25% report never having used a condom
• 58% report never having received sexual health
services
• Almost half –47% report being forced to have sex
• Trans-gender individuals face high degree of
discrimination and marginalisation (‘Listening to the
Demand’ ,Havey, J. 2014)