CONCEPT PAPER HIV PREVENTION AMONG YOUTH

Theme: “Improving Access to HIV Prevention Service to Young People in Rwanda”
I. Context and justification

From 18th - 20th November 2009, CNLS in partnership with partners will convene the 5th Annual National Paediatric conference on children infected and affected by HIV and AIDS. The overall theme is “Count Down to 2015 for Children and HIV- Achieving Millennium Development Goal (MDG) 6-”. In the programmatic area of HIV prevention among youth, the theme that will be focuses on is   “Improving Access to HIV Prevention Service to Young People in Rwanda “. The theme is an echo to the government of Rwanda, development partners, implementing partners and youth themselves to place the primary prevention at the forefront of debating and provides an opportunity to review the status and define way forward toward achievement of MDG6 for children and youth and HIV in Rwanda.

II. Rationale

In Rwanda, young people make a majority of Rwanda population. 52% are young people aged between 0-18 years; 49% of population is aged less than 15 years and 60% aged less than 20 years. HIV/AIDS is having a devastating impact on the children and adolescents in Rwanda: The prevalence rate in the age group of 15-19 is 0.5% including 0.6 % among girls and 0.4 % among boys. This shows that almost 2 girls are infected against 1 boy (DHS 2005). In 20-24 age groups HIV prevalence is five times much higher for women than men. The previous data underlined the fact that women in this age group are particularly at risk for HIV infection. The overall prevalence rate for this age group is 1.6%. It means that 5 young female are infected against 1 young male.

It is also the age group where young women are having babies and therefore contributing to increasing transmission of HIV to their infants. According to the report on HIV sites Sentinel surveillance

among pregnant women in antenatal care, the HIV prevalence rate among young women aged 15-19 in Kigali is 16.8%


Furthermore most of the Commercial Sex Workers are young people (Rwandan HIV/AIDS synthesis project final report 2008).

Above all, the access of young people to HIV prevention services is one of the Bottlenecks that are especially challenging in the implementation of HIV prevention program. In the age group of 15-19 years, 3.5% of female utilize the condom with spouse or cohabiting partner; 29.4% utilize the condom with non cohabiting partner and 16.3% of female utilize the condom with whomever. In the age group of 20-24 years 1.2% of female utilize the condom with spouse or cohabiting partner, 26.2% utilize the condom with non cohabiting partner and 3.6% of female utilize the condom with whomever. In the age group of 10-25 years 3% of female utilize the condom and 5% of males. In general, the use of condoms with non cohabiting partners is 20% for female and 34% for males (DHS 2005). Youth are still encountering series of issues which, in absence of rapid and ongoing interventions, can lead to increasing spread of HIV among them.

The most important are the following:
 
      Inadequate understanding of behaviour change for young people. To ensure success we have to clearly be informed by current data and then use results based approach to programme and scale up best practices.

     Inadequate access to Prevention services: this will require ensuring availability of all HIV preventive services in a youth friendly way; including HIV testing and counselling, IEC/BCC, condoms, male circumcision and safer sex education.

     Inadequate guidance – parental and social - A focus on reproductive health education at community level, within health facilities and other social points using youth friendly and innovative methods.


     Inadequate integration of HIV/AIDS into health services- HIV testing should be available and offered at all health services point – family planning, outpatient clinics, emergency services etc.

     Insufficiency of a comprehensive HIV prevention services for the most disadvantage groups, most vulnerable and most at risk, youth out of schools, orphans, young commercial sex workers…

It is time to explore the status on programming for youth in HIV prevention area and also learn about international and regional experiences, what have worked well, what to improve and what new initiatives and recommendations for achieving of MDG6 among children, young people and HIV in Rwanda.

III. Achievement in the sector of youth HIV prevention

Within the context of HIV prevention among youth, it was put in place some mechanisms to deliver qualitative services. In this regard, the basic is the political of the Government of Rwanda in partnership with development partners. The Ministry of youth has been established with mandate to HIV mainstreaming in youth sector among other thing.

The different development partners are supporting youth friendly centres with component of Sexual and Reproductive Health with focus on HIV/AIDS. To this point, some activities were curried out such as sensitization with different means such as media, sports event,…

The above mentioned initiative was strengthened by the Joint Youth Program set by UN families. They are aiming at establish 15 new Youth Friendly Centres with HIV prevention among their services.
 
It was also set a National Youth steering Committee with Miniyouth as Chair and CNLS as Co-chair. Among its aim, we can mention the coordination, monitoring and evaluation for all interventions targeting youth including HIV prevention.

It has been conducting an evidence based campaign to fight against the Cross Generational Sex in Rwanda. The campaign is known as SINIGURISHA campaign.

Particularly, in schools, it was created the anti HIV-Clubs. There is opportunity for young people in school to discuss about HIV/AIDS as one way to protect against young people. At the level of high learning institutions and universities, a part from the anti-HIV clubs, some of them are offering VCT services and the condoms are accessible for all.    
IV. Purpose and expected result of HIV prevention among youth programmatic area
     Purpose of the HIV prevention among youth programme is to ensure that addressing issues related to quality service access to HIV prevention by youth is a priority in the 5th national paediatric conference at all levels. Experiences on how youth can access to adequate HIV prevention services will be shared by people from other countries and national levels, then recommendations will be formulated for immediate consideration during planning.   

Expected result for the conference are as follows: (a) Youth concerns in accessing services in HIV prevention are heard, (b) International and regional experiences on best practices are shared (c) Recommendations and way forward for achieving of MDG6 for youth and HIV in Rwanda are defined. (d)Recommendations are taken into account in national prioritisation, and planning process tackling issues related to youth and HIV and AIDS considered as other HIV programmatic areas.
IV. Methodology
     The conference will be organised in three parts: (1) Key note speakers: UNFPA will be in charge of identify one International Key note speaker and Rwanda National Youth Council will help the

team in the identification of a National Key note speaker. The terms of reference of the International key note speakers will be developed according his/her experience in regional and international  adolescent’s health and HIV prevention program management, experience in presentations development on youth and HIV for international conferences and workshops. The terms of reference for the national key notes speaker will be defined including the age of key note speaker ranging him/her in youth category, experience in HIV program, already had opportunity to address a talk publicly. (2) Abstracts development and presentation: A template that was issued by CNLS will be disseminated by the members of the primary prevention Technical Working Group to the identified organisations by ensuring that the guidance on the abstract template use is given to users. They will also be in charge of collecting the abstracts after they are filled. The quality of abstract will enable the team identify those which will presented orally while the other will be posted in the abstract book for the conference. Each organisation that will have the poster will appoint a person to provide explanations to the visitors. Flyers for exhibition will be prepared and availed for exhibition. The request for the table for exhibition will be done early to CNLS according to the quantity of material for exhibition. Also, every organisation will appoint someone to look after the materials, to provide explanation, etc.  
V. Moderator and reporters
The Technical Working Group will propose to CNLS one moderator and two reporters for the whole session on primary prevention. The role of the moderator will be for leading the session by inviting presenters, by motivating the discussions by highlighting the key points raised during the whole session. The role of reporters will be taking notes and recommendation that will be compiled in the global report at the end of the day and in the conference report.