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XIII International AIDS Conference, Durban, July 2000

Involvement of young people in the Conference

During the International AIDS Conference in Durban, Carol Bellamy, UNICEF Executive Director launched the UNICEF publication "Progress of Nations" (PON) with a focus on the HIV/AIDS essay of the Report. At the press conference, Ms. Bellamy was joined by Professor Coovadia, Chair of the International AIDS Conference, and adolescents from LoveLife, a youth-driven multi-media initiative focussing on peer education and counseling. Later that day, the Executive Director participated in a panel encounter on the "Power of Girls in Confronting HIV/AIDS", organized by UNICEF.

Click here for a statement by Carol Bellamy

The panel involved a frank exchange among five young women, Carol Bellamy and the Communications Director of LoveLife on the realities of the pandemic on the youth of today. The Conference went further than earlier global AIDS conferences in involving youth and adolescents. UNICEF was praised by a number of media and NGO representatives for highlighting the importance of youth involvement in "breaking the silence" during the PON launch and subsequent youth encounter.

Prevention for young people

This remains a top priority for UNICEF with and for young people.

New Findings

A constant high profile theme was the need to work with/for young people. This was done in ways that strongly reinforce the programming approaches that UNICEF has been developing and promoting (a focus on information and skills, access to education and health services, the creation of safe and supportive environments, and adolescent participation). Increasingly people are speaking of adolescents as a resource, not simply as presenting problems to be solved - they are a central consideration for community capacity development, they are right holders and agents of change, not simply beneficiaries, they are key resources and partners to prevent this pandemic.

It was notable that there has been a shift from a focus on information and services for young people, to the importance of the contexts in which adolescents live and learn indicating growing appreciation that an unacceptable number of adolescents do not have access to either, particularly in rural areas. Also that many young people become infected with HIV not because they do not know about AIDS but because of the social values and norms that surround them, the power imbalances, the exploitation and abuse, the poverty, the boredom and, for many, the lack of hope in the future. There is a growing appreciation that we need to focus on socio-economic and cultural environments as much as individual behaviours on the right holders of course, also on the duty bearers. There is also growing appreciation that AIDS provides an opportunity to enhance the role of "front line" workers to fulfil and protect adolescents' rights - to develop the information and skills of teachers, NGO/CBO staff, health workers and of course parents (which will have an impact on a much wider range of problems than HIV/AIDS).

Furthermore, there is growing recognition that girls are particularly vulnerable, but it will be very important to focus on boys as well if we are to decrease this vulnerability, not that the rights of adolescent boys aren't also frequently undermined. In addition, there is increasing attention being given to issues such as violence, the gender inequities and relationships (between the sexes and the generations) that underlie this pandemic, and other causal risk behaviours that are linked to HIV/AIDS vulnerability such as drugs and alcohol.

There was strong consensus that "prevention works", that the most important decreases are taking place among young people, and that the reason that the previous prevention programmes have been handicapped inadequate resources and priority.

Clearly there are no silver bullets for prevention (a vaccine seems far away, despite the optimism - although specific attention will need to be given to adolescents in vaccine trails and we need to ensure that adolescents have access to any vaccines that are developed). We must be careful that vaccination trials and effective drugs do not lessen the top priority resources and energy being committed to prevention.

Finally there seems to be less competition between organisations, and much greater focus on collaboration between sectors and organisations, with an increasing focus on the need to partner with NGOs that work with/for young people, religious groups, the private sector, mass organisations, organisations of people affected and the media.

Unresolved Issues

Documentation, monitoring and evaluation: There remains a continuing need to document, monitor and evaluate policies and programmes. For example, peer programmes continue to have strong support although it is clear that these are not always effective in reaching out to the majority of young people, and it is not always evident that they are being effective. Creating a safe and supportive environment for adolescent: This remains a challenge, whether in their homes, schools or communities. Insufficient attention is paid to the commercial, interactive and audience researched media, despite the important potential role it plays in breaking the silence, informing young people and influencing social values and norms.

Fulfilling and protecting the rights of the most disadvantaged adolescents: remains a challenge, including adolescent heads of households (it is important to focus on children orphaned by AIDS 0-18 years) and adolescents living with HIV/AIDS - there is agreement on the need to focus on both the general population and at-risk groups, particularly if we are to take advantage of the opportunities that HIV/AIDS presents us with to do those things with/for adolescents that we have failed to do in the past - AIDS is, after all, symptomatic of our collective failure to fulfil and protect the rights of adolescents. Short term and long term action: It is important to develop both short term (access to information, life skills and services) and long term (education and livelihoods) strategies. While broad strategies and principles of programming are common to many different situations, there cannot be a cookie-cutter approach to programming with/for adolescents.

Scaling-up: Taking effective interventions to scale is not sufficiently happening, and generating adequate resources for adolescents remains a major challenge - we are often not clear enough for policy makers, and there is a need to make a compelling case and also provide examples of the activities that are promoted actually being implemented to a reasonable scale. Reaching Youth and Access to services: Providing young people with access to health services, including treatment for STIs and condoms and harm reduction programmes for injecting drug users remain a challenge, both from a policy and a programme perspective. While there is in general support for VCCT for young people, many questions remain - the availability of treatment for those people who are HIV positive (at a minimum access to treatment for opportunistic infections), counselling and support, ensuring confidentiality and, countering discrimination. It will be particularly important to focus on the CC aspects of VCCT by increasing adolescents' access to relevant/quality counselling/psychosocial support, using new approaches - including hotlines, the internet, and indigenous counsellors.

Schools as a focus: Even though many children are still not in school, particularly girls, schools provide an important focus for action - however designing and implementing activities remains a challenge (e.g. Life-skills, decreasing violence and abuse) Dealing with the heterogeneity of adolescents remains a challenge, in terms of age, sex, schooling, marital status, rural/urban domicile, etc., as does dealing with the diversity of settings. There are often insufficient efforts to disaggregate data or explore the different needs/expectations of boys and girls -- adolescence is a period when gender roles are set in concrete, when damaging aspects of masculinity can be explored, when we can help to ensure that adolescents develop relationships that are responsible, respectful and consensual (and mutually satisfying and fun!).

Other entry points: There is a need to explore the use of entry points other than HIV for reaching and working with young people (even in countries with high HIV prevalence) - adolescents get tired with being bombarded with HIV/AIDS information, and they need to deal with a range of related issues. Much more attention needs to be given to confronting violence and to developing livelihood skills and opportunities for adolescents. It is important to use the right language (eg. adolescents or young people, not youth; children and adolescents affected by AIDS, not AIDS orphans or victims)

Implications for UNICEF

  • Continue programming approaches that we have been developing during the 90s in all regions - we are clearly on the right track.
  • Continue to give a high priority to primary PREVENTION among young people, be clear about our niche/strategic advantage, and ensure that in all our programming with/for adolescents we give adequate attention to the unresolved issues raised above.
  • Use/promote rights-based programming approaches (we need to continue to focus on adolescents' rights, but we need to direct our programme efforts both to adolescents as rights holders and also to the significant adults in their lives as duty bearers) - we need to be more up-front in using the CRC to create a supportive policy environment;
  • Mobilise, involve, empower young people, in the situation assessment and analysis, in advocacy, in policies/programmes (eg. peer programmes), etc. This is perhaps the greatest challenge for UNICEF. If young people are at the centre of this pandemic and are the force for change, how are we really involving them in what we do, how are we leading by example, how are we listening to them and acting on their ideas, how are we helping to develop their capacities and create opportunities for their involvement, particularly younger adolescents? There are many opportunities.
  • Ensure that situation assessment and analysis give adequate attention to HIV and adolescents/young people, help to set national targets, and help to monitor and evaluate what is being done - who, for example is not being reached with information, what are the important contextual causes of HIV transmission among young people, what do we know about adolescents beliefs and sub-cultures, and their health-seeking behaviours.
  • Give more attention to the socio-economic and cultural contexts in which adolescents live, in the home (working with parents), in schools (creating adolescent-friendly schools) and in the community (creating safe spaces and challenging social norms and the behaviours of adults that undermine young people's rights to health and development) - including the use of a range of media to reach young people, to reach adults, and to foster inter-generational dialogue;
  • Develop more effective partnerships with religious organisations, the private sector and the media, and be more NGO/CBO/mass organisations friendly/respectful.
  • Increase the availability of long-term sustained resources for primary prevention among young people (both UNICEF's own resources and those that are allocated by governments, bilaterals, Foundations, and other donors), and support development of national capacity to respond to this aspect of programming and take successful projects to scale.