IN EASTERN AND SOUTHERN AFRICA

JULY 2018

CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

INSIDE : 5 A GLOBAL CALL TO ACTION Case StuDIES

BLOGS - 14, 22, 30 Next steps 37 © UNICEF © UNAIDS This report brings together information and data from the All In process in Eastern and Southern Africa. The report was led by Anurita Bains, and compiled by Alice Armstrong. It benefited from reviews and editing by colleagues from the UNAIDS Regional Support Team for Eastern and Southern Africa and the UNICEF Eastern and Southern Africa Regional Office. The report incorporates contributions fromAll In country assessment reports and in-person and virtual interviews with over 40 government officials, UN partners and other organizations. The insights and technical contributions by all those interviewed were invaluable. Graphic design and layout by Edgar Mwakaba Cover image: © UNICEF/UN0145555/Schermbrucke CATALYSING THE HIV RESPONSE FOR ADOLESCENTS CONTENTS ALL IN FOR IMPACT FOREWORD Effects on HIV programming for adolescents 3 from the Regional Directors © UNICEF/UN070642/Hatcher-Moore 9

© UNICEF/Jasper J Van Zyl Van J © UNICEF/Jasper 5 10 Adolescent engagement A GLOBAL 11 Collaboration and partnerships CALL TO ACTION 12 Strengthening strategic information 6 All In to end adolescent AIDS – A collaborative platform 20 Informing national policy and plans All In in East and Southern Africa 6 21 Evidence-based programming 29 Mobilizing resources 7 CASE STUDIES

© UNICEF/UN025515/Schermbrucker KENYA Strengthening adolescent COUNTRY ASSESMENTS 16 strategic information Building blocks for change Botswana 24 Building capacity for sub-national data driven programming

Next steps NAMIBIA for adolescent HIV programming in 32 Leveraging resources for 37 Eastern and Southern Africa adolescent HIV programming BLOGS 14 22 30 © UNICEF/Julio Dengucho © UNICEF/Julio © UNICEF/Alessandra Silver © UNICEF/UN016830/Noorani

MOZAMBIQUE RWANDA United Republic of Tanzania Adolescent participation Developing an Adolescent Ensuring a healthy future for Operational Plan Tanzania’s adolescents 1 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/UNI157565/Ose

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from the Regional Directors, FOREWORD UNICEF and UNAIDS

The Eastern and Southern Africa Region take stock of the health and well-being (ESAR) is home to approximately 60 of adolescents. Through intensive per cent of the world’s adolescents data reviews and consultations at both aged 10-19 years who are living with national and district levels, policymakers HIV. Nearly half of the 254,000 new HIV and programmers identified critical data infections among adolescents globally in gaps on adolescent health and discussed 2016 occurred in the region. Yet, only a strategies to address the unique needs few short years ago, adolescents were of adolescents living with HIV and barely visible in the global HIV response. those at risk of infection. Central to All So, when data became available in In was the meaningful engagement of 2014 showing that HIV-related health adolescents. During All In consultations, outcomes had improved for other adolescents spoke of the challenges age groups but had worsened for they faced in being able to access HIV adolescents, we knew it was time to act. treatment, of wanting to take an HIV test but being afraid to, and the stigma they Building on the collaborative effort faced as a child of a parent living with that resulted in tremendous progress HIV. in scaling up lifesaving anti-retroviral treatment and preventing mother-to-child We are proud to launch this report, transmission of HIV in ESAR, UNAIDS which highlights how All In mobilized and UNICEF launched a campaign titled partners, engaged adolescents and All In to End Adolescent AIDS (All In) young people and influenced policies in 2015 in Nairobi, Kenya. The aim was and programmes. The report documents to inspire governments and partners to the progress made in a few short collaborate across sectors and accelerate years on adolescent HIV, and offers the HIV response for adolescents by suggestions and recommendations on reducing AIDS-related deaths and new how to strengthen strategic information, HIV infections among 10-19 year olds. apply evidence-based programming and mobilize resources for adolescents in the Since then much has been achieved. HIV response. In the 14 high-burden HIV countries in ESAR, UNAIDS and UNICEF have With this report, we hope partners in supported governments to convene ESAR will be better equipped to apply key stakeholders - including donors, and support efforts to end adolescent UN agencies, and young people - to AIDS.

Leila Pakkala Catherine Sozi Regional Director Director United Nations Children’s Fund UNAIDS Regional Support Team for Eastern and Southern Africa Eastern and Southern Africa

3 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/Gina Figueira

4 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/Shehzad Noorani

A GLOBAL CALL TO ACTION

our years ago adolescents were factors that contribute to HIV infection, or live positive, healthy lives with HIV. a forgotten population in the age- and sex-disaggregated data, modes This flurry of interest in adolescent health Fglobal HIV response. In Eastern of HIV transmission, barriers to treatment was welcome news to researchers, civil and Southern Africa and other regions, adherence and access to anti-retroviral society and adolescent activists who for programmes typically targeted either therapy and other services. Data for the years had been advocating for targeting infants and young children or adults, youngest adolescents (aged 10-14) was adolescents as a distinct population group. neglecting the needs of this unique group particularly limited, due to the challenges The new findings also spurred global of adolescents aged 10 to 19 years. of designing age-appropriate surveys leaders into action. Building on other and to age-related consent barriers. As a Adolescence is a critical life stage initiatives, UN partners initiated a series result, countries did not have a complete characterized by rapid biological and social of consultations with civil society groups, picture of how adolescents were affected changes. Adolescents require targeted youth-led organizations, researchers by HIV and how interventions could HIV programmes, but as recently as 2014 and governments to identify key address their needs.2 many adolescents had only limited access issues, gaps in the current response to information, services and testing. Then, in 2014, the HIV community was and urgently needed solutions. The Adolescents living with HIV often struggled confronted by new modelling indicating Global Strategy Consultation on All In to adhere to treatment regimens, due that AIDS was the leading cause of death to End Adolescent AIDS meeting held to lack of support and understanding of for the 10-to-19 age group in Africa, and in Geneva, Switzerland, in December their treatment. Uptake and coverage of the second most common cause of death 2014 highlighted several key problems, basic HIV prevention interventions – such among adolescents globally.3 While HIV- including the lack of adolescent-specific as comprehensive sexuality education, related health outcomes had improved health data. Other challenges noted were condoms and sexual and reproductive for other age groups, they had worsened the lack of adolescent engagement in health (SRH) services – among adolescents for adolescents. Suddenly everyone - policy and programmes, the absence was low in many places.1 from local-level programmers to national of sufficient resources and the need for policymakers - was discussing how to programme changes at all levels of the In addition, countries lacked critical do more for adolescents, so that young response. information and data on adolescent boys and girls could avoid HIV infection health, including the socio-economic

1,3 World Health Organization, Health for the World’s Adolescents: Second chance for a second decade, WHO, Geneva, 2014. http://www.who.int/maternal_child_adolescent/topics/ adolescence/second-decade/en/. 2 Idele P, et. al, Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014 Jul 1;66 Suppl 2:S144-53.

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A GLOBAL CALL TO ACTION

All In – a collaborative platform The result of these global deliberations was All In to End All In focused on four action areas: Adolescent AIDS (All In) – a joint initiative launched in February 2015 by UNAIDS and UNICEF that aimed to inspire actors to Engage, mobilize and support adolescents as collaborate across sectors to accelerate reductions in AIDS- 1 leaders and agents of social change related deaths and new HIV infections among adolescents. Aligning with the UNAIDS Fast-Track Strategy, the goal is to end Sharpen adolescent-specific elements of national the AIDS epidemic by 2030.4 Although All In was convened by AIDS programmes by improving data collection and UNAIDS and UNICEF, its approach depends on leadership and 2 analysis and using evidence to drive programming active engagement by countries at every step of the process, as well as on meaningful participation by adolescents.5 Foster innovative approaches that improve the reach of services for adolescents and increase the impact of Three years after its launch, countries in ESAR have experienced 3 prevention, treatment and care programmes far-reaching progress across multiple areas of adolescent HIV programming, laying the groundwork for improved adolescent Advocate and communicate at the global, regional HIV outcomes. and country levels to generate political will to invest in 4 eliminating adolescent HIV and mobilize resources4

All In in Eastern and Southern Africa The Eastern and Southern Africa region (ESAR) has been an important focus area of the All In initiative, since many countries in the region have significant adolescent populations and HIV burdens. Of the initial 25 All In priority countries, 14 are in ESAR: Botswana, eSwatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe. Many governments in the region have committed to taking action for adolescents’ health and rights, creating an enabling environment for addressing adolescent HIV issues. This report captures some of the major progress made in nine countries under the All In initiative, and how it has affected the lives and future of adolescents across the region.6 It incorporates a series of case studies, blogs and videos showcasing progress in individual countries. The impact of All In country it considers how All In influenced key programmatic areas such assessments was appraised through a desk review of All In as engagement and collaboration, strategic information, policies country assessment reports, country visits and both in-person and plans, implementation and resource mobilization. Data and virtual interviews with 43 key government officials primarily collated as part of the country assessments, which informed and from ministries of health and national AIDS coordinating councils supported programme changes are summarized in the 2016 All at both national and subnational levels and representatives of UN In Progress Report.7 Ultimately, the changes implemented should agencies, funding partners and implementing organizations. result in better HIV and related outcomes for adolescents and Qualitative in approach, this report sets out to explore will be measured through repeated country assessments or by implemented actions and changes in programming that came embedding the assessment into country programming. about as a result of the All In country assessments. In particular,

4 United Nations Children’s Fund and United Nations Joint Programme on AIDS (UNAIDS), ALL IN to End the Adolescent Aids Epidemic, launch document, UNICEF and UNAIDS, New York, 2016. https://childrenandaids.org/all-in-to-endadolescentAIDS. 5 United Nations Children’s Fund, Synthesis Report of the Rapid Assessment of Adolescent and HIV Programme Context in Five Countries: Botswana, Cameroon, Jamaica, eSwatini and Zimbabwe, UNICEF, New York, 2015. https://www.childrenandaids.org/synthesis-report-rapid-assessment-adolescents. 6 Information on All In countries in other regions can be found at: https://www.childrenandaids.org/UNAIDS-UNICEF_all-in-progress-report_2017 7 https://www.childrenandaids.org/UNAIDS-UNICEF_all-in-progress-report_2017

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COUNTRY ASSESMENTS: Building blocks for change

entral to All In is the promotion The country assessments adopted a and use of evidence to support three-phase approach: All In was a call to action. Much as Cthe development of more effective Phase I: rapid assessment of the adolescents were being talked about strategies, policies, programmes and adolescent programming context in the country, there was not a clear, services for adolescents living with or Phase II: in-depth analysis of bottlenecks structured way of looking at their affected by HIV. Many countries face needs. challenges in obtaining data to inform Phase III: evidence-informed planning Fabian Mwanyumba, UNICEF Rwanda the adolescent component of national The leadership role played by AIDS programmes. All In country governments (most often national AIDS assessments were designed to serve coordinating councils and ministries of as a first step toward addressing this health) in convening key stakeholders critical gap, providing - for the first time - a from across the country to contribute Standardized tools and guidance systematic way to identify performance to the assessments was key to All In’s supported the country assessment gaps affecting adolescent HIV success. Governments also provided process, including the Adolescent programming. The assessments facilitated strategic direction for the assessments, Assessment and Decision-Makers’ Tool the defining of adolescent target while UNICEF, UNAIDS and other UN (AADM). The AADM provided countries populations, interventions, geographic agencies (e.g. UNESCO, UNFPA, ILO, with the necessary platform and analytics areas and priority actions to improve WHO and UN Women, among others) to validate data, inform review and the effectiveness of national adolescent and strategic partners provided technical analysis of adolescent programming HIV responses. These assessments support. All In’s multi-sectoral approach gaps and facilitate the programmatic were centred around HIV outcomes, but provided a unique opportunity to look decision-making process (see page 40 for included a broad range of multi-sectoral beyond HIV-specific data and programmes key resources). Its interactive dashboard data and analysis to further contextualize and review the broader health, policy and enabled visualization of data, optimized HIV-related gaps for adolescents within development context for adolescents, data usage and provided a way to monitor the broader perspective of their holistic with the aim of addressing cross-cutting progress for adolescents across key HIV health, protection, education and overall structural drivers of the HIV epidemic. indicators. wellbeing.

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COUNTRY ASSESMENTS: A building block for change

Although all country assessments plan was prioritized before the phase of work plans and evidence-informed shared a structured, systematic II sub-national bottleneck analysis was planning. Perhaps most importantly, approach, individual countries adapted conducted. The focus on sub-national the assessment process and results the assessment process and tools to data allowed for in-depth analysis of generated significant momentum around meet unique disease, programmatic implementation and delivery-level adolescent health and rights – the results and geographic contexts. This approach challenges. Some countries that did not of which have been long-lasting across the empowered individual countries to take carry out the whole process used the region. ownership of their assessments. For AADM for programmatic assessment and example, to reflect its devolved health analysis on adolescents, such as Lesotho, system structure, Kenya’s entire All Malawi, and Zambia. In assessment used a sub-national The final phase of the assessments was approach. In Rwanda, after the phase I designed to transform available data rapid assessment, a national operational into action through the development

All In catalyzed a whole range of actions to put adolescents Government led much more firmly in the center of attention. Ulrike Gilbert, UNICEF United Republic of Tanzania Support with Action oriented guidance and tools

All In Country Assessment Subnational focus Approach Including implementation Adaptable & delivery

Comprehensive - including structural Multi - Sectoral drivers

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ALL IN FOR IMPACT: Effects on HIV programming for adolescents

cross ESAR, All In has increased basis for the HIV response in countries the visibility of adolescents, calling and serves as a critical advocacy Examples of political commitment Aattention to their risk for their tool to advance HIV programming to All In overall health and wellbeing. All In has for adolescents. Across the region, helped to ensure that adolescent HIV stakeholders supporting adolescent HIV Kenya: Launched by the president issues are now on the radar of prominent initiatives, health and rights now have Rwanda: Launched and supported by policymakers and health programmers, a mandate and the tools to do more to First Lady resulting in an improved response to reduce new HIV infections and ensure adolescents as a distinct population that adolescents living with HIV have group with specific needs. Political will access to treatment, care and support. and commitment were instrumental to the uptake and implementation of All In; prominent leaders across the region have United Republic of launched and promoted the initiative. It has been an eye opener. We need Tanzania: Key ministers to look at adolescents separately and publicly committed to All In country assessments set the the All In process target our programmes accordingly. stage for the collection and generation of sharper strategic information to inform Ketlaantshang Monyadiwa, adolescent programming. The All In District AIDS Coordinator, Botswana Namibia: Actively supported by First Lady assessments generated a significant amount of data, which now forms the

The following sections outline the impact of the All In country assessments on multiple areas: adolescent engagement, collaboration and partnerships, strategic information, policies and plans, HIV programming, resource mobilization and coordination in ESA countries.

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ALL IN FOR IMPACT: Effects on HIV programming for adolescents

Adolescent engagement dolescent engagement in the views on key interventions, such as Key achievements AHIV response provides policy- condoms. In Zimbabwe, adolescent makers and programmers with better representatives were crucial members • Adolescents as key technical understanding of how HIV programmes of the technical working group leading working groups members, including can respond to their particular needs. the country assessment process. At at sub-national level The country assessment process served the United Republic of Tanzania’s • Adolescent consultations, focus as an opportunity to strengthen existing national youth stakeholder meeting, groups and stakeholder meetings mechanisms for engaging adolescents in adolescents produced a declaration that • Leveraging partnerships between programme design. The majority of All outlined the key actions and programming the UN and governments with In countries in ESAR held consultations, requirements that they supported. existing youth networks focus groups or adolescent and youth In Kenya, the All In process continues stakeholder meetings and included • Strengthening of national to strengthen the response of networks adolescent representatives in technical adolescents living with HIV of adolescents living with HIV (known working groups (TWGs). networks as Sauti Skika); network members • Use of mobile technology to Botswana’s consultations generated lead programming efforts such as support programme research engagement by a diverse group of promoting demand for HIV testing and adolescents across the country – stigma reduction campaigns (see p 16). • Catalysed adolescent participation including those from rural areas, high-risk Consultations organized for All In in in other health and development populations and those with disabilities. Rwanda represented the first time that areas Ethiopia leveraged existing youth this group had engaged in policy and networks, including those for adolescents programming efforts at the national level. living with HIV, to actively engage in Key lessons learnt by countries the All In process, and facilitated the throughout the process can now inform involvement of younger adolescents longer-term engagement with this who are often overlooked. Likewise, age group. The momentum generated in Namibia, partnerships with active by All In has sparked and sustained youth networks supported consultative adolescent participation in both policy and processes, particularly during phase II of programming spaces; not only in relation the adolescent assessment. to HIV and SRH, but across other health Mozambique’s national youth meeting and development areas. brought adolescents together to identify core issues and interventions for improving the national HIV response (see p 14). Mozambique also utilized mobile technology (the U-Report platform) to They traveled so far to discuss HIV issues, and they were so gather and better understand adolescent engaged and involved – they really understood what they were talking about. The adults were the shy ones in the back and the teenagers were in front. There was a power in the air. Cecilia, youth advocate and meeting facilitator, Mozambique

We can’t talk about ending AIDS or getting to zero without including adolescents in every decision-making platform. Adolescents are the group most affected by HIV and they are tomorrow’s leaders. Consolata Opiyo, Y+, the Global Network of Young People Living with HIV

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ALL IN FOR IMPACT: Effects on HIV programming for adolescents

Collaboration and partnerships ll In aligned with and aimed to the formation of sub-national technical Key achievements Agalvanize existing efforts, specifically working groups. For most countries, All for adolescents, such as UNAIDS Fast- In technical working groups have evolved • Established or strengthened Track initiative;8 PEPFAR’s Accelerating into formal structures to support ongoing technical working groups on Children’s HIV/AIDS Treatment (ACT) adolescent programming and drive new adolescents at the national and sub- Initiative;9 and the Eastern and Southern initiatives. national levels Africa Ministerial Commitment10 The All In process further strengthened • Strengthened government on sexuality education and sexual governments, especially national AIDS coordination mandate on and reproductive health services for councils and coordinating committees adolescent health adolescents and young people. Since and ministries of health, as well as • Facilitated more effective national All In’s launch a number of global and ministries of social welfare, justice, youth, and sub-national work regional adolescent health and HIV-related gender and others - depending on the • Increased cross-sectoral initiatives have been implemented, country context - to lead and coordinate coordination including: the Global Strategy for on adolescent health. Particularly for Women’s, Children’s and Adolescents’ • Aligned with other adolescent and countries undertaking All In activities in Health;11 the PEPFAR DREAMS HIV initiatives priority districts, the processes facilitated Initiative;12 the Start Free, Stay Free, more effective working relationships AIDS Free Fast Track Framework;13 and between national and sub-national the Global Accelerated Action for the programming, and in Mozambique All departments. The assessments also Health of Adolescents.14 All In is working In led to a study of social norms. In both engaged and mobilized personnel in in support of these initiatives, leveraging, Kenya and Ethiopia, other departments monitoring and evaluation to support data informing and supporting them to achieve and sectors are now focusing on analysis and data-driven advocacy. further country-level progress toward adolescent programming. addressing the adolescent HIV epidemic. All In’s multi-sectoral approach led to the engagement of stakeholders beyond In countries, to prevent unnecessary HIV. For example, in Lesotho it built a overlap of efforts and address important strong advocacy case for cross-sectoral programming gaps, All In brought involvement when addressing adolescent multi-sectoral stakeholders together to HIV. Ethiopia saw the inclusion of coordinate efforts for adolescents. For adolescent HIV issues in social protection a number of countries, this was the first-time coordination had occurred in a structured way to accelerate adolescent HIV programming. Botswana, Kenya, Mozambique and Namibia established subnational technical working groups. Led by government, these mechanisms provided a platform © UNICEF/Alessandra Silver for partnership, strengthened knowledge and data sharing, joint planning and work plan implementation. In other countries such as the United Republic of Tanzania, partners are now strongly advocating for

8 http://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report 9 https://www.pepfar.gov/partnerships/ppp/234538.htm 10 http://youngpeopletoday.net/the-commitment/ 11 http://www.who.int/life-course/partners/global-strategy/en/ 12 https://www.pepfar.gov/partnerships/ppp/dreams/ 13 https://free.unaids.org/ 14 http://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/

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ALL IN FOR IMPACT: Effects on HIV programming for adolescents

Strengthening strategic information Key achievements ack of age disaggregation in the strengthen country HIV estimates through Lcollection and analysis of data estimation and projection package (EPP) makes it difficult to design or implement Spectrum modelling.15 • Changes to data collection tools to programmes for adolescents. Through allow for age disaggregation In Lesotho and Namibia, All In the country assessments, All In has accelerated advocacy efforts to ensure a • Strengthened HIV estimates helped to address this lack of strategic priority focus on collecting and reporting • Accelerated advocacy for information. The assessments brought age-disaggregated data, and to push adolescent specific data together available adolescent data and, for increased funding and capacity in several countries, generated new • Mapping of HIV and SRH services to strengthen data collection. All In data for the first time — including critical • New implementation science assessments in Botswana strengthened strategic sub-national information that was projects to inform scale up strategic information components of the used immediately to inform adolescent new national programming framework programme planning. The assessments for adolescents and young adults. In also highlighted data gaps that require Rwanda, data collection already allowed further attention, including important for age disaggregation, however the data aspects of programming such as supply was not analysed or reported accordingly. and demand. All In focused attention on the need for In Kenya and the United Republic of reporting adolescent data, which is now Tanzania, changes were made to key ongoing. We now have the data that speaks. data collection tools to ensure that We are able to utilise the data to To further understand which HIV services national data is disaggregated by age plan. It helps us to see what we need were available to adolescents, the United (see pp 14, 28). The revision of tools to do for adolescents Republic of Tanzania conducted a used by the national health management Caren Ayieko, Adolescent Focal Person, Kenya national mapping exercise. Botswana and information system, the United Republic Namibia are planning implementation of Tanzania’s health indicator survey and science research projects to monitor Kenya’s population-based HIV impact implementation of their All In work plans assessment will ensure routine availability and to understand the requirements for of adolescent-specific data to support scaling-up services for adolescents. targeted programming for this population. In addition, this data is being used to © UNICEF/Leitago

15 Further information on EPP Spectrum modelling can be found at http://www.unaids.org/en/dataanalysis/datatools/spectrum-epp

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The Operational Plan uses a multi- sectoral approach to addressing the HIV prevention and sexual and reproductive health needs of young people and adolescents in Rwanda. It demonstrates the power of partnerships and collaboration, with the involvement of young people at the centre. These are the principles that lie at the heart of the All In initiative. Betru Woldesemayat, UNAIDS Country Director, Rwanda

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BLOG MOZAMBIQUE Adolescent participation: The story of Cecilia © UNICEF Mozambique

There was a power in the air Catalyzing adolescent participation around HIV in Mozambique

oung people packed the conference meeting was convened as part of the All National AIDS Council, UNICEF, UNAIDS Yspace; an ‘electric current’ ran through In initiative. and others organized opportunities for the room. For the first time, adolescents adolescent dialogue. To kick off All In, institutions working on from across Mozambique, including some health in Mozambique – including the Twenty-eight adolescents from eleven living with HIV, had been provided with a government, international organizations provinces across the country gathered in platform to share their ideas on improving and civil society – conducted a rapid Maputo for the intense debate. the HIV response for young people with assessment to better understand how their government and UN officials. Cecília Dimande is one of the young HIV affects adolescents. As is the case leaders who participated in the consultation The consultation, which occurred in throughout ESAR, the data indicated that as the Mistress of Ceremony. Cecília first November 2015, was urgently needed. At from the age of 15, girls are significantly became involved with All In when she was the time, in Mozambique, an estimated more likely to contract HIV than boys of 18, but her contribution as a youth activist 110,000 adolescents were living with the same age. It also revealed a growing started much earlier. HIV. Adolescent girls are more than number of AIDS-related deaths among twice as likely to be living with HIV than adolescents aged 10 – 19, with 4,400 When she was 10, Cecília joined Radio adolescent boys. Half of Mozambican girls deaths in 2016, a 76 per cent increase Mozambique as a radio announcer and are married before their 18th birthday. The since 2010.16 After the assessment, the producer for children’s programmes.

16 UNAIDS Estimates 2017 http://aidsinfo.unaids.org

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in different health spaces around the country, including as members of provincial-level HIV working groups, particularly during the implementation of the All In phase II in 2017. © UNICEF Mozambique In the context of the national programme on adolescent sexual reproductive health called Geração BIZ, the Government, along with UNFPA, UNICEF and other key partners, continues to engage over 125,000 adolescents and young people on sexual and reproductive health topics through the mobile phone platform U-Report (or SMS Biz, as it’s known locally). Through U-Report, adolescents can be polled for their opinions on topics such as how to encourage condom use or make health services more youth friendly. Users As part of her work, she travelled to Committee; selected young facilitators can also direct questions about their health orphanages in Mozambique and met many and relied on local organizations to choose to one of 48 available peer counsellors. children whose parents had died of AIDS. participants. For Cecília, now 20, participation in the “When I saw how many children were During the meeting, adolescents and adolescent consultation has expanded her in the orphanages, I knew I needed to young people made recommendations for horizons. She recently traveled to Geneva, continue doing something,” she said. an improved national HIV response. These Switzerland as part of her country’s included appropriate health information delegation for the launch of the Global At the All In consultation, Cecília was one tailored to different age and key groups, Coalition on HIV Prevention, where she of the older participants – and meeting increasing the coverage of adolescent represented the voices of young people so many young adolescent activists was and youth friendly services at government in Mozambique. These kinds of linkages inspiring. health units, counselling on alcohol and are exactly what All In hopes to facilitate “They traveled so far to discuss HIV drugs, and improving the curriculum, through its support for meaningful youth issues, and they were so engaged and so that teachers provide high quality participation. involved – they really understood what comprehensive sexuality education. They Cecília says the consultation continues to they were talking about. The adults also shared personal stories, as well as motivate her to fight the stigma faced by were the shy ones in the back and the perspectives from their peers at home, young people living with HIV. “The way teenagers were in front. There was a providing critical context to the numbers we treat people affects their health,” she power in the air,” said Cecília. derived from the national assessment. said. “I want to do my part – whenever Mozambique’s National AIDS Committee The consultation sent a clear message to I have an opportunity to do something, I worked to make sure that the young government and partners: adolescents will.” people involved felt in charge of the participation must be taken seriously process. They fostered a safe space in order to see progress on preventing for adolescent participation including HIV among adolescents. It also helped the establishment of a youth Steering to spur the involvement of adolescents

ONLINE RESOURCES

To watch a video of the adolescent To find out more on U-Report in To find out more consultation in Portuguese, please Mozambique please use this link: information on All In click on the image below: http://mozambique.ureport.in/ please use this link: https://childrenandaids. org/all-in-to-end- To find out more about UNICEF’s work in adolescent-AIDS Mozambique please use this link: http://www.unicef.org.mz/en/

To find out more about UNAIDS’ work in Mozambique please use this link: http://www.unaids.org/en/regionscountries/countries/mozambique/ Link: https://bit.ly/2uebvsY

15 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY Strengthening adolescent strategic information: KENYA Revising tools/systems for disaggregation Background Responding to the challenge: enya is one of five countries – alongside How the process worked KIndia, Nigeria, South Africa and the Led by the Kenyan Ministry of Health and United Republic of Tanzania – that are home working with other partners, Kenya adapted to nearly half of all adolescents worldwide the All In process to the national context. living with HIV.17 Adolescents (10 –19-year- Given the country’s decentralized health olds) account for 22.4 per cent of Kenya’s system, the approach to All In focused total population of 44 million.18 An estimated directly on provinces, prioritizing six counties: 1.5 million Kenyans were living with HIV in Homa Bay, Kisumu, Mombasa, Nairobi, Siaya 2015, including some 133,000 adolescents.19 and Turkana. In recognition of both the large number Using the guidance materials and the of adolescents living with HIV and AADM tool specifically designed forAll the importance of their health and In, government and partners in Kenya 10,200,000 development to the larger society, Kenya decided to adapt the assessment process 10 -19 year olds population is committed to addressing the gap in by combining the data tool and key ( Ref: UNAIDS Estimates 2017 adolescent HIV programming. The All components of the analysis designed to http://aidsinfo.unaids.org ) In initiative convened by UNICEF and identify bottlenecks to scaling-up services UNAIDS provides a platform for doing so. that meet adolescents’ needs.20 Both The global All In initiative was launched steps helped to define target populations, in Kenya in February 2015 by President interventions and geographic settings for Uhuru Kenyatta. Since then, a key focus has priority actions to improve the effectiveness been on improving strategic information of the HIV response for adolescents. on adolescents living with HIV. In Kenya, The resulting sub-national adolescent this process revealed that information on assessments highlighted the limited adolescent health was incomplete. The way availability of disaggregated data for key in which data are collected and analysed indicators. Several data systems provided can mask differences for sub-populations age and sex disaggregation nationally, (especially by age and sex), and differences whereas others offered sub-national data across provinces within countries. This without age group or sex. Additionally, lack of data presents a major obstacle to while disaggregated denominators were designing and or implementing programmes readily available, numerators were not. For that are urgently needed to improve indicators that are not routinely collected outcomes for adolescents. – for example, correct knowledge of All In addresses this gap through country HIV - the number of adolescents was too assessments, which help to identify whether small to allow for age disaggregation. To 18,000 and where disaggregated data are available. produce sub-national age-disaggregated Once the gaps are highlighted, a plan can HIV estimates additional data was New HIV infections among extracted from health facilities using adolescents be created for addressing them, including sustained advocacy for more permanent electronic medical records and registers 21 measures to ensure ongoing availability of and EPP Spectrum modelling. granular data. Ref: UNAIDS Estimates 2017 http://aidsinfo.unaids.org

17 United Nations Children’s Fund, ‘ALL IN to End the Adolescent Aids Epidemic: A Progress Report’, UNICEF, New York, 2016. https://childrenandaids.org/UNAIDS-UNICEF_all-in-progress-report_2017 18 UNAIDS Estimates, July 2017 19 Ministry of Health, Kenya HIV Estimates 2015. 20 United Nations Children’s Emergency Fund, ‘Guidance on Strengthening the Adolescent Component of National HIV Programmes through Country Assessments’, UNICEF, New York, 2016. https://childrenandaids.org/guidance-on-strengthening- adolescent-component 21 For more information on EPP Spectrum modelling see http://www.unaids.org/en/dataanalysis/knowyourresponse/HIVdata_ estimates

16 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY Sub-national adolescent assessments Actions taken: Additional actions to address data gaps: 1. Established technical working groups to provide guidance and 4. Extracted data by age proportion from facility electronic support medical records and registers to estimate age-disaggregated 2. Decided which key indicators to assess across the HIV numerators cascade and within other sectors 5. Calculated sub-national adolescent HIV estimates using 3. Conducted desk review of reports to identify and map out EPP Spectrum modelling by using proportions from larger available denominators and numerators (for key indicators) (regional) geographical data to estimate smaller (county) area/ population data.

These additional steps were critical to gaining a clearer understanding of which adolescents are We didn’t have the data we needed – so we went and looked for it! We most affected, where service uptake and coverage utilized primary level data and tools. Knowing how to programme for gaps exist, which actions and interventions adolescents is critical, we couldn’t afford to be lazy need to be prioritized and where they should be Adolescent Focal Person, Kenya targeted.

New adolescent HIV infections by county, 2015

3,500 3,000 2,500 2,000 1,500 1,000 500 0

Kisii Kitui Siaya Meru Kwale Busia Narok Vihiga Lamu Wajir Nairobi Kajiado Bomet Laikipia Nyamira TharakaTurkana Samburu Homa Bay Kakamega Kirinyaga Uasin Gishu Tana River Elgeyo Markwet Source: UNICEF-NACC Analysis of Kenya HIV Estimates 2015

Outcomes The results highlighted an alarming These findings led to important government, in preparation for national increase in the number of new HIV discussions and a Government roll-out in 2018. infections among adolescents. Nearly a commitment to review and scale-up The adolescent assessments and changes quarter of all new infections were among targeted programming for adolescents, to the HMIS also served as a catalyst those aged 10 – 19 years, 62 per cent of and work to address the programmatic for disaggregating sub-national age and which occured in just in six of Kenya’s gaps that were identified. The process sex data in other data collection tools, 47 counties. The assessments also and results point to the critical need to including: indicated low uptake for HIV testing and strengthen and use strategic information low ART coverage. Only half (50 per cent) to better understand the needs of this 1. EPP Spectrum estimates of adolescents and young people aged population. As a result, the national Health 2. Kenya population-based HIV Impact 15 – 24 years had received an HIV test Management Information System (HMIS) assessment (KEN-PHIA) within the last 12 months.22 Nonetheless data collection tools for HIV were revised 3. New viral load monitoring systems. adolescent HIV-related deaths since 2010 to include age disaggregation. Training appear to have declined by 14 per cent in for sub-national personnel on the revised Kisumu and 40 per cent in Nairobi. tool was undertaken by the national

22 https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf

17 Since the All In meeting, I’ve learned so much and I have grown as a person. I’ve become more confident. I’ve become responsible for my

© UNICEF/UN0147063/Noorani health... My hope for the future is to empower adolescents living with HIV to live a healthy and a better life. Laura Adema, Kenya

To learn more about Laura’s inspiring story see https://bit.ly/2uz2LOg CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY

Lessons from Kenya’s All In process

Political will and leadership by the ministry of health is The AADM tool can be adapted to data availability and critical for driving the assessment process. country context. Conducting sub-national data assessments increases Aligning timelines with other data or programming ownership and accelerates the assessment process. processes provides opportunities to share and advocate Working with a range of stakeholders – local governments for robust data collection on adolescents. and facilities, partners supporting HIV efforts, adolescents Allocating time and flexibility to allow for competing and service providers – strengthens support at the sub- priorities is necessary when undertaking assessments. national level. The data have limitations, in particular regarding the use Collaboration between national and subnational HIV of estimates. However, future use of the newly revised programming, monitoring & evaluation and HMIS staff data collection tools, allowing age disaggregation, will builds capacity. reduce these limitations. Data gaps can be addressed by actively seeking data from Sharing assessment results is a critical advocacy tool for alternative sources to generate new, comprehensive data improving programmes and strategic information related sets. to adolescents.

The revised tools will ensure routine data. The revised data collection tools availability of adolescent-specific data to should enable responsive programming The closer to the ground the support targeted programming for this and tracking of implementation by assessment, the easier it is to obtain population. Many of the data challenges providing an ongoing mechanism to the information needed and to act and limitations experienced in the measure indicators and outcomes among upon it accordingly. assessments will now be mitigated, adolescents over time. County level adolescent focal person facilitating interpretation and use of the

Next steps for strengthening strategic information on adolescents in Kenya

Review progress with the data generated from the revised HMIS tools and the subnational adolescent To watch the Step Up for HIV Prevention video, please click on this image >> assessments Utilize HMIS disaggregated outputs to Link: https://bit.ly/2uz2LOg inform future EPP Spectrum modelling estimates for Kenya. Additionally, this data will help strengthen Spectrum outputs for adolescents in the region, and globally Support upcoming data quality assessments to ensure that they adequately cover adolescents Conduct special data reviews to generate new insights, focusing on the adolescent HIV/AIDS cascade Advocate for sub-national age and sex © UNICEF/UN0147076/Noorani disaggregation in other areas affecting adolescent health and well-being A significant gap area, both globally and in ESAR, is adequate information on adolescent HIV treatment, including the transition from paediatric to adult HIV treatment; adherence; disclosure of HIV status; and mapping of laws and policies that constitute barriers to access to health and HIV services for young people. Future country assessments will take these issues into account, where information is available.

19 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

ALL IN FOR IMPACT: Effects on HIV programming for adolescents

Informing national policy and plans dolescent-specific recommendations in Namibia, adolescents now feature Key achievements Aand activities are often missing from prominently in the National Strategic national health policies and plans. All In Framework 2017–2019, and the country’s • Informed adolescent -specific enabled the identification of adolescent policy on adolescents living with HIV programming frameworks and plans sub-populations, interventions and is being updated to account for the • Sparked development of separate geographic areas, dialogue on issues such new data and programme changes adolescent national and sub-national as age of consent, facilitating the inclusion generated by All In. Data produced by the work plans of adolescents in relevant policy changes country assessment in Zimbabwe was • Informed adolescent components and planning. instrumental in informing the Accelerated of national strategic plans Action Plan for the national scale-up of Botswana’s All In process informed anti-retroviral therapy for infants, children the development of the new National and adolescents. For Rwanda, the All In Programming Framework for Adolescents process led to development of the first and Young Adults, which in turn will play National Operational Plan for HIV and a vital role in the implementation of Sexual and Reproductive Health among the national HIV Strategic Framework Adolescents and Young Adults (see p 22). during the next five years. Likewise,

In Ethiopia, the country © UNICEF/UN074464/Lister assessment informed the national Adolescent Sexual and Reproductive Health Plan. The advocacy and attention to adolescents generated by All In also led to the inclusion of 10-to-14 year olds as a specific age group in the National Strategic Plan for HIV. Planning changes also occurred at the sub-national level. In Botswana, Kenya, Mozambique and Namibia targeted adolescent activities are now planned at the sub-national level, showing that change can devolve from the national to the local level.

20 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF Namibia

Evidence-based programming istorically, HIV programming has failed outcomes informed the development of a Key achievements Hto focus on different populations of national adolescent health training package adolescents through specific interventions and comprehensive sex education training • Creation of more targeted and service delivery approaches. Since All curriculum. In Ethiopia, All In facilitated adolescent programming In, countries have made an important shift the mainstreaming of adolescent HIV • Expansion and scale up of existing towards more targeted programming for programming in other sectors. adolescent programmes and adolescents. All In has also built the capacity of interventions In Kenya, significant programming changes service providers and others working • Multi-sectorial collaboration for have been seen across the HIV cascade. on adolescent health, improving their integrated adolescent interventions Priority counties – including Kisumu, Siaya understanding of targeted interventions • Increased understanding of and Nairobi – have increased outreach and of the importance of age and sub- adolescent programming and programmes to reach adolescents with HIV national data to inform adolescent importance of age disaggregated and SRH information, expanded HIV testing programming. In Botswana, the phase and subnational data beyond testing centres by training hospital II bottleneck analysis in priority districts • Increased capacity of subnational and clinic staff and increased the provision played a significant role in strengthening implementers of psycho-social support for adolescents the capacity of implementers at the living with HIV at facilities. Youth-friendly sub-national level (see case study, p 24). services have also been revitalized, and key Namibia further supported its bottleneck changes made to services for adolescents analysis by providing additional training living with HIV such as ‘adolescent only’ for both national and district teams on times or queues. adolescent HIV during phase II. If you approach something as a Since the All In country assessment, A number of countries increased capacity team you are able to complement Namibia has expanded psycho-social by appointing additional personnel to each other. support for adolescents living with HIV address adolescent issues. Kenya District Health Management Team through support groups and is moving appointed sub-national adolescent officers Coordinator, Botswana towards national scale-up. United Republic in priority counties. In Mozambique funds of Tanzania’s health sector, catalysed by were provided to the National AIDS Council the All In process, collaborated with other for technical assistance on adolescent sector partners to develop an integrated, programming, and in Namibia three new multi-layered intervention called Cash Plus positions were created at the national (see p 30). In Lesotho, All In assessment Ministry of Health.

21 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

BLOG RWANDA Developing an Adolescent Operational Plan © UNICEF/Alessandra Silver

Gearing up for success: Rwanda’s operational plan for adolescent HIV and sexual and reproductive health

ow does a country accelerate Adolescent AIDS (All In). The reason for these findings soon became improvements in HIV and SRH clear: low knowledge and utilization of H “All In was a call to action,” said Fabian programming for adolescents? We may sexual and reproductive health services, Mwanyumba of UNICEF Rwanda. “Much be drawn to think it is technological including HIV services, by adolescents. as adolescents were being talked about innovation or new ways of engagement The assessment identified coverage gaps in the country, there was not a clear, through celebrities and social media. But in key interventions including: condoms structured way of looking at their needs.” in fact, it is much simpler, calling mainly to prevent pregnancy and HIV infection. for proper analysis and planning. Through All In, the Government of family planning, voluntary medical Rwanda and partners conducted a rapid male circumcision, HIV testing and HIV Although Rwanda has high coverage of assessment to better understand HIV and treatment. Programming often took place HIV services, the government was aware sexual and reproductive health trends and in silos, with little collaboration within and that programmes were not adequately programme gaps related to adolescents. across different ministries, agencies and reaching adolescents aged 10–19 years. Although consistent with global trends, the providers responsible for adolescent health. At the same time, authorities lacked a results were alarming. They showed that thorough understanding of why that was The next step brought together Rwanda’s those aged 15 to 24 years accounted for the case and how coverage could be brightest minds to outline a clear plan more than one out of every four new HIV improved. for addressing these gaps. The result, infections,23 8 per cent of adolescents get the National Operational Plan for HIV and In response to these challenges UNICEF married before age 1824 and adolescent Sexual and Reproductive Health among and UNAIDS launched All In to end pregnancy rates were on the rise.25

23 UNAIDS, HIV Estimates. 2017 http://aidsinfo.unaids.org 24 https://www.unicef.org/infobycountry/rwanda_statistics.html 25 https://dhsprogram.com/pubs/pdf/FR316.pdf

22 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

whether enough trained health care In coming months, district level partners workers are present in each district. will start adapting the operational plan to their local contexts. In Rwanda’s capital, The operational plan breaks down Kigali, city officials, and relevant national © UNICEF Rwanda appropriate interventions by age, so that government colleagues will take the lead in the needs of younger adolescents can be overseeing the plan’s implementation and addressed differently from those of older ensuring that all adolescents gain access adolescents. And it includes targets for to the information and services they need. all interventions, which is key to tracking As new data emerge, the plan will be implementation progress. continually updated to ensure that it works The All In assessment and ensuing for adolescents. Operational Plan have now influenced implementation of the country’s National HIV Strategic Plan, helping to create a consensus about adolescent HIV and SRH. The plan also helped allocate domestic and donor funds (e.g., from the Global Fund) appropriately and served as a blueprint for fundraising efforts and partner coordination by the government.

Adolescents and Young Adults 2017- 2022,26 creates clear targets and indicators for scaling up the HIV response for adolescents across Rwanda. “This plan is unique for Rwanda because we went in deep to analyse the reasons © UNICEF Rwanda behind the service coverage gap,” said Dr Mpundu Ribakare, from the Rwanda Biomedical Centre, an arm of the Ministry of Health. “We also created the plan through a participatory process.” This process included representatives of adolescent and youth networks, since another key tenet of All In is to improve meaningful adolescent participation. When adolescents are involved from the beginning in shaping policies, they have greater ownership of the results. The resulting operational plan took into account programmatic challenges, often referred to as bottlenecks that prevent optimal service coverage. These include issues such as drug supply levels and

26 Republic of Rwanda Ministry of Health, Rwanda Biomedical Centre. National Operational Plan for HIV and SRH for adolescents and young people 2017-2022. Kigali, Rwanda

ONLINE RESOURCES

To find out more information on All In please use this link: To find out more about UNICEF’s work in https://childrenandaids. Rwanda please use this link: org/all-in-to-end- https://www.unicef.org/rwanda/ adolescent-AIDS To find out more about Rwanda’s All In assessment use this link: To find out more about UNAIDS’ work in Rwanda please use this link: https://www.unicef.org/rwanda/ http://www.unaids.org/en/regionscountries/countries/rwanda events_20676.html

23 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY Building capacity for sub-national data driven BOTSWANA programming Background Despite Botswana’s progress on HIV is required to ensure successful programming, adolescents – who implementation of the framework and form almost a quarter of the country’s outcomes for adolescents. To date, population – have been underserved by experience on targeting interventions the response. HIV prevalence increased to this population has been limited. alarmingly (up to three-fold) between Successful adolescent HIV programming 2004 and 2013 among adolescents and demands strengthening the capacity of young people aged 10-to-24 years.28 By the agencies and institutions planning and 2016 an estimated 17,000 adolescents delivering services, to ensure appropriate were living with HIV and an additional sub-national action. 1,400 were newly infected.29 There was an urgent need to strengthen targeting and Process programming efforts for this population. 506,000 The All In phase II in-depth bottleneck 10 -19 year olds population To better understand and improve analysis was fundamental to ( Ref: UNAIDS Estimates 2017 the HIV response for adolescents, strengthening sub-national adolescent http://aidsinfo.unaids.org ) Botswana commenced the All In country HIV programming in Botswana. Led by assessment in 2015. The initial rapid the Ministry of Health and Wellness assessment helped identify populations, through the National AIDS Coordinating interventions and geographic settings for Agency, with technical support provided priority actions. The assessment findings by UNICEF, phase II was carried out indicated national progress in terms of in collaboration with sub-national treatment coverage, which increased stakeholders: district AIDS coordinators, from 65 per cent in 2013 to 83 per cent district health management teams and in 2016, and viral suppression, which representatives from the Ministry of stood at 78 per cent in 2016.30 However, Youth and Ministry of Education. Strategic insufficient progress had been achieved in support on data was provided by UNAIDS. reducing new infections, which declined Four districts (Selebi-Phikwe, Goodhope, only from 13,000 in 2013 to 10,000 in Boteti and Ghanzi) were prioritized, 2016. This can be attributed in part to: low on the basis of: HIV prevalence, the uptake for HIV testing and services and presence of key HIV socio-economic and combination prevention, high incidence other contextual factors, the combined of sexually transmitted infections and geographic and demographic setting and lack of comprehensive HIV knowledge.31 past performance on priority interventions. The assessment also stressed the lack of Utilizing pre-defined standardized sub-national data and the need for better guidance materials, phase II identified 17,000 understanding of key HIV drivers among bottlenecks and performance gaps, adolescents. Adolescents living with HIV their associated causes and key actions Since the phase I rapid assessment, required to catalyse the sub-national Botswana has drafted a new National HIV response for adolescents. Priority Programming Framework for Adolescents interventions included: 1) HIV testing and and Young Adults, aimed at guiding and counselling; 2) anti-retroviral treatment; 1,400 coordinating the implementation of their 3) condom access and use; 4) voluntary New HIV infections among HIV programmes. Given geographical medical male circumcision; and 5) adolescents disparities across HIV, social, demographic addressing gender-based violence, alcohol and service delivery indicators, and drug abuse and other psychosocial strengthening sub-national programming issues. Data on key indicators related Ref: UNAIDS Estimates 2017 http://aidsinfo.unaids.org

28 Statistics Botswana, BAIS IV, 2013. 29 UNAIDS, HIV Estimates. 2017 http://aidsinfo.unaids.org 30 UNAIDS HIV Estimates, 2017 http://aidsinfo.unaids.org 31 National AIDS Coordinating Agency, Strengthening the Adolescent Component of National HIV Programmes through Country Assessments in Botswana: Preliminary Report of Rapid Assessment, 2015.

24 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY

to supply, demand and quality of these In-depth bottleneck analysis process interventions was collected and analysed utilizing the adolescent assessment • Select priority geographic areas and • Conduct key informant interviews and decision-makers’ tool. A causality priority interventions with sub-national stakeholders analysis was undertaken in collaboration • Mobilize sub-national partners and and focus group discussions with with sub-national stakeholders to further form a sub-national technical working adolescents in and out of school to identify and understand bottlenecks and group in priority geographical areas further explore causes of identified bottlenecks and gaps performance gaps. • Identify supply, demand and quality indicators for priority interventions • Hold a sub-national technical Outcome • Map different service delivery working group workshop to review platforms for data collection bottlenecks and gaps, further identify The in-depth bottleneck analysis provided their causes, synthesize findings and valuable evidence and insights to • Gather sub-national data available agree on key actions inform future sub-national and national through centralized databases • Document and present findings adolescent HIV programming. Not only did • Collect primary-level data from to national and district leaders, the analysis enhance strategic information selected sub-national services to undertake evidence-informed on adolescents, but it also strengthened • Utilize the AADM tool to analyse the planning during phase III. the capacity of planners, programmers data in order to identify bottlenecks and service providers to implement data- driven adolescent HIV programming. Focusing on capacity development, the National level outcomes presented below are based Strategic information • Further informed the draft national on a desk review of the All In country • Improved understanding of the programming framework for assessment, interviews with key national importance of age-disaggregated adolescents and young adults, as well and subnational level stakeholders in sub-national data to inform adolescent as the national strategic framework Botswana, and the findings of theAll programming and guidance on HIV and adolescent In phase II in-depth bottleneck analysis. • Provided district-level data on health The extent of the impact of the reported adolescents that was previously not • Informed proposal development for increase in capacity will be measured in available the Global Fund future country assessments. • Identified data availability and gaps, • Highlighted the diversity of challenges Capacity was developed in several areas: including important aspects of supply, experienced by priority districts demand and quality Understanding adolescents • Improved understanding of ‘on the • Stressed the importance of utilizing data ground’ realities of sub-national • Increased awareness of adolescents from other sectors, beyond HIV programming for adolescents as a distinct population group • Identified ongoing adolescent requiring targeted programmes and Adolescent programming programmatic technical assistance interventions District level needs at the sub-national level • Improved understanding of the need Partnership and collaborative for interventions and programmes working targeted to adolescents • Identified delivery gaps in adolescent “Having concrete data really helps us • Allowed structured, dedicated services and revealed implementation plan for this population.” opportunities for multi-disciplinary bottlenecks Hospital Matron and sectoral discussions focused on adolescents • Informed district-level planning; previous plans did not include • Established sub-national technical targeted adolescent programming or working groups, providing a platform interventions for partnership and knowledge-sharing across sectors to support decision making

25 © UNICEF/UNI103304/Nesbitt IEC chief,NationalAIDSCouncil,Botswana Nametsego Tswetla, addressit to theopportunity us with thisprovides for adolescents)... programming gap(inHIV isanotable thatthere It isevident CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF Rwanda

Lessons from Botswana’s sub-national in-depth bottleneck analysis

Scheduling the analysis prior to district Working collaboratively with a range of highlights programme needs and data planning maximizes programming national and sub-national stakeholders gaps. impact. ensures sufficient technical support for Data on key quality indicators are not Allocating sufficient time at the sub- capacity building. readily available, requiring a separate national level to undertake the analysis Engaging monitoring & evaluation and assessment process. facilitates joint work and capacity programme staff strengthens future data Adolescent programming capacity building. collection. is needed at the national level to Bringing together a wide range of Developing country-specific guidance adequately support both the sub- stakeholders from different departments on how to carry out the sub-national national analysis and ongoing adolescent and ministries improves understanding analysis (i.e., what data is available, programming. of the current situation and future work- where it comes from and potential Sharing data from sub-national findings plan needs. system challenges) will facilitate carrying is critical to improving programmes and Planning and national leadership are out the analysis in other districts. strategic information on adolescents. important to ensure that appropriate sub- Utilizing a variety of data systems and national stakeholders become engaged. sources – including primary data –

Next steps for strengthening adolescent Examples of key programming in Botswana indicators:

Launch the national programming Strengthen routinely collected data Supply framework for adolescents and for adolescent HIV by revising data o Commodities young adults tools to include age-disaggregation o Human resources Undertake the in-depth bottleneck and aligning M&E systems analysis in other districts to achieve Utilize new sub-national plans to o Accessibility nationwide results leverage domestic and external Demand Revise current HIV programming funding, in particular from the templates to include adolescents Global Fund o Utilization Provide ongoing technical support Improve understanding of targeted o Continuity of use at the sub-national level to ensure adolescent interventions through inclusion of adolescents in sub- implementation science Quality national plans and implementation o Trained providers of programme changes o Policies and procedures

27 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/UN075402/Kealey

28 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

ALL IN FOR IMPACT: Effects on HIV programming for adolescents

Mobilizing resources ince the launch of All In in 2015, Most significantly,All In leveraged Key achievements Sinternational and domestic resources within overall country funding resource investment in adolescent processes for the Global Fund to • Increased international and HIV programming has increased in the Fight AIDS, TB, and Malaria. Country domestic resource allocation countries that conducted assessments. assessments provided critical data • Informed concept notes and The All In process has assisted and direction to inform the adolescent proposals to the Global Fund programmes to be more targeted and components of concept notes and • Adolescent activities incorporated evidence-informed, facilitating funding proposals for special initiatives, such as into larger programming proposals requests and allocations for these on adolescent girls and young women, and other funding initiatives programmes. Resources have also been including in Kenya, Lesotho, Mozambique, • Resources allocated to leveraged to implement work plans Namibia, the United Republic of Tanzania implementation of workplans, scale generated as part of the All In process and Zimbabwe. In Mozambique, All In up of adolescent interventions and and for the expansion and scale- up of key contributed to improved understanding of dedicated adolescent personnel adolescent interventions. in-school and out-of-school health service needs among adolescent girls and young Across the region funds from partners and women, informing the revitalization of donors, including UNICEF and UNAIDS, these services through the country’s have supported key milestones of the Global Fund grant. With the generation All In country assessments. In Lesotho, of strategic information and changes to partners provided funds to further key policies and plans, further domestic strengthen strategic information on and international funds for adolescent adolescents. HIV activities are expected, including Kenya and Namibia were particularly resources for programme implementation. successful in integrating adolescent activities into larger international development partners’ operational plans and initiatives. In United Republic The Global Fund strives to make equitable funding decisions that prioritize of Tanzania and Ethiopia All In marginalized populations. But in order to do so effectively, we need to see assessment outcomes were instrumental data that illustrates the problem and outlines a clear case for investment. in mobilizing further funds for multi- When it comes to adolescents, getting the data is often challenging, but All In sectoral programme proposals. In Kenya, has sharpened country level data, leading to more strategic investment in a Mozambique and Namibia funds were number of countries. allocated to increase national and sub- Heather Doyle, Senior Gender Advisor, Global Fund national technical capacity on adolescents.

29 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

BLOG TANZANIA Ensuring a healthy future for adolescents: The story of Halima © UNICEF/Alessandra Silver

alima was still a child when she business and get more capital to start a transfer of Tsh10,000 per household Hbecame the primary breadwinner and new [business], which will help me and (US$4.50) – plus up to an additional caregiver for her family. my family live comfortably,” she says. Tsh28,000 (US$12.50) for households with children that regularly attend school Now a bubbly 19-year-old, Halima is Halima volunteered to be part of the pilot and get health check-ups. A recent from a village in Rungwe, in southeast phase of a new initiative, Cash Plus, to evaluation32 demonstrated the powerful Tanzania. When she was nine, her support adolescents as they navigate impacts of the PSSN on household grandmother fell ill, forcing Halima to drop the bumpy transition to adulthood. The well-being, including increased school out of school and start working. Government of the United Republic of enrolment. Nevertheless, this evaluation Tanzania, with support from UNICEF, Halima now runs a small-scale business, also highlighted that a significant number introduced Cash Plus last year in four rural purchasing bananas from local farmers of adolescents in PSSN households had districts in the Southern Highlands. and reselling them at a weekly market. already dropped out of school. In an effort Each month her total income is about Cash Plus provides tailored support to support this vulnerable population, Tsh40,000 (approximately US$20). to 2,500 adolescents (aged 14–19 the Adolescent Cash Plus pilot was layered on top of the PSSN. Implemented Although her dream is to complete years), who live in households enrolled through government structures, the secondary school, Halima says her in the Government’s social protection “Plus” provides training and mentorship main challenge is not earning enough to programme, the Productive Social Safety and facilitates linkages to HIV and SRH support her family. “I want to expand my Net (PSSN). The PSSN provides a cash

32 https://transfer.cpc.unc.edu/wp-content/uploads/2018/04/PSSN-Youth-Endline-Report-2018.pdf

30 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS services for adolescents. enrolling children in secondary school, forecast to more than double by 2050. creating a long-term benefit for young Governments across Africa now have While many programmes for adolescents people. Additionally, in some countries an opportunity to turn this increase in tend to focus on just one area of concern cash transfers have been linked to population into economic potential – but – such as health or livelihoods – Cash Plus delayed sexual debut, reduced teenage they can only do so if adolescents are is unique in bringing together different pregnancy and improved mental health for equipped for healthy futures. sectors to provide a comprehensive adolescents. package of support, recognizing that If evaluations demonstrate the adolescents require strengthened But cash alone is not a silver bullet. That’s effectiveness of Cash Plus, it could be capacities across multiple dimensions to why Cash Plus includes training on scaled-up across East Africa – putting safely transition to adulthood. livelihood and economic empowerment, more power and decision-making into the as well as education on SRH and referrals hands of adolescents to take charge of But the innovative programme didn’t to youth-friendly health services. their health and livelihoods. arrive in the country overnight. Two key factors laid the groundwork for Cash Plus. “The reason we’ve been focusing jointly Halima is already applying the new skills One was the All In initiative. on livelihoods, sexual and reproductive she learned during Cash Plus trainings, health and HIV knowledge is because the such as record-keeping and managing her “All In catalysed a whole range of actions evidence shows that youth need more savings. that placed adolescents much more than just economic empowerment,” said firmly at the centre of national attention,” Halima and others in the programme have Tia Palermo, a social policy specialist at said Ulrike Gilbert, HIV Chief for UNICEF also taken the initiative to form a peer UNICEF’s Office of Research-Innocenti Tanzania. support group, which meets regularly to Centre, in a recent podcast.33 “It’s not discuss business strategy, provide mutual All In also encouraged programmers to enough to economically empower an encouragement on savings goals and see adolescents as a distinct population adolescent if they’re not able to make swap advice on life in general. group, with different needs from children decisions about their lives – when to get and adults. As part of All In, the United pregnant and when to have a family. We Fostering these connections is an Republic of Tanzania conducted an want to simultaneously empower them important outcome of Cash Plus – a assessment that reviewed available data on the economic front and the social and programme worth following into the on issues affecting adolescent well-being health front.” future. – including social protection, education Cash Plus also links young people and health – and the programmes like Halima with a community-based available to meet their needs. mentor, who meets with them to build Research has shown that providing The other factor influencing the and strengthen their confidence and young women and adolescent girls introduction of Cash Plus was the connection with their community, support a modest cash transfer to stay in growing evidence that cash transfer their aspirations and help them to make school, works. And we know that programmes have multiple, overlapping decisions affecting their health. Mentoring staying in school is a protective benefits, including the potential to involves connecting young people to factor against early marriage, reduce the risk pathways of HIV infection education, vocational training, financial unintended pregnancy and HIV among children and adolescents. For counselling and other opportunities. infection. example, cash transfer programmes can The United Republic of Tanzania, like other Léopold Zekeng, reduce poverty and improve access to countries in the region, has a growing UNAIDS Country Director, Tanzania food and nutrition. Families that receive population of adolescents, which is cash transfers also have higher rates of

33 https://soundcloud.com/unicef-office-of-research/cash-plus-tanzania

ONLINE RESOURCES

To listen to the CASH Plus podcast, please To find out more information onAll In use this link: please use this link: https://soundcloud.com/unicef-office-of- https://childrenandaids.org/all-in-to- research/cash-plus-tanzania end-adolescent-AIDS

To find out more about CASH Plus in Tanzania, please use the link: To read more about Halima’s story, To find out more about HIV in Tanzania https://www.unicef.org/tanzania/ please use this link: please use this link: resources_21267.html https://www.unicef.org/tanzania/ http://www.unaids.org/en/keywords/ PDF: https://bit.ly/2xNqd9O media_20638.html united-republic-tanzania

31 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY Leveraging resources for adolescent HIV NAMIBIA programming Background Process Adolescents represent almost one quarter The three-phase assessment utilized the of Namibia’s population and face unique All In guidance materials and tools. Phase needs for HIV prevention, treatment, care I called for a rapid assessment of the and support. In 2016 in Namibia there was adolescent programming context, which an estimated 1,300 new HIV infections was conducted under the leadership of occurred among adolescents. While the Ministry of Health and Social Services prevalence is equal among adolescent (MoHSS) through consultations with a females and males in the 10-to-14 age technical working group. The technical group, gender disparity increases with working group included representatives age; the rate for females aged 20–24 (67 of adolescent and youth groups and per cent) is twice as high as for their male adolescents living with HIV were key peers (33 per cent).34 participants in both assessments. Phase I consolidated available data from various Adolescents in Namibia do not have national sources using the adolescent adequate access to HIV-related assessment and decision maker’s interventions. Uptake and coverage of 534,609 (AADM) tool to identify priority adolescent key HIV prevention interventions among groups, high-impact priority interventions 10 -19 year olds population adolescents is low; for example, only and high-burden geographical areas. 28.5 per cent of females and 13.9 per A review of the adolescent policy and cent of males aged 15–19 were tested for programme environment was also carried HIV during the last 12 months. Although out, highlighting the need to strengthen significant progress has been made resource allocation and mobilization.36 among those who test positive, this age group also lacks universal access Phase II involved conducting an in-depth to HIV treatment, ART coverage among analysis of bottlenecks in the seven adolescents aged 15-19 years is at 61 per high-burden regions for adolescent cent among girls and 76 per cent among HIV identified during the assessment. boys.35 Workshops, focus-group discussions and in-depth interviews with key stakeholders Namibia’s HIV response needs to be including adolescents living with HIV based on a better understanding of why led to the identification of bottlenecks, adolescents are falling behind, and to their associated causes and key actions adapt existing programmes to meet their for overcoming them. One of the key needs. findings across the seven regions was the Adolescent HIV programming in Namibia presence of large data gaps – most of the was challenging before 2015. Adolescent- interventions lacked data for 10 – 14 year specific components within national and 13,000 subnational plans were lacking, making it difficult to target adolescents and All In Country Adolescents living with HIV allocate funds essential for adolescent HIV Assessment Phases: programming. These gaps were further compounded by a lack of adolescent- Phase I: Rapid assessment of the specific data to inform policy development adolescent programming context and programming. In response to these Phase II: In-depth analysis of 1,300 challenges, in 2015 Namibia carried out an bottlenecks New HIV infections among All In assessment. Phase III: Evidence-informed adolescents planning

34 UNAIDS Estimates 2017 http://aidsinfo.unaids.org 35 https://www.unicef.org/namibia/na.Namibia_ALL-IN_Adolescent_HIV_Programme_Summary_Report_Phase_2_2017.pdf 36 MoHSS, Report on Phase 2 of the Namibia All In Country Assessment 2016-2017

32 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

CASE STUDY © UNICEF Namibia

olds, as well as for intervention indicators. to advance adolescent HIV programme Global Fund to Fight AIDS, TB, and Malaria The bottleneck analysis signalled that planning and implementation. agreed to fund the expansion of support adolescents were not accessing health groups for adolescents living with HIV The outcomes and gaps highlighted in the care and that urgent action was required and plans for national scale-up. Key All Phase I assessment served as a catalyst to train health workers on adolescent In assessment findings also informed prompting key members of the technical issues, provide adolescent-friendly health the Global Fund’s allocation decisions on working group to contribute funds to services and improve data collection. programming for adolescent girls and ensure that Phase II was prioritized. young woman, as well as reprogramming Based on the outcomes of the rapid and National adolescent HIV technical of funds for older adolescents from key in-depth assessments, Phase III involved capacity was also strengthened through populations. evidence-informed planning to address the creation of three new positions at the programming gaps. Based on the the MoHSS. Domestic funds secured The All In country assessment also assessment findings, regional workplans the recruitment of an adolescent HIV served as a critical catalyst for ensuring were developed, in which different focal point, while international donors that adolescents feature prominently partners took on responsibility for future provided funding for technical advisors in the National Strategic Framework adolescent HIV programming efforts. on programming for adolescent girls and 2017–2019, Namibia’s blueprint for HIV The MOHSS and other stakeholders also young women, as well as adolescent and programming. With this renewed focus, worked to ensure that these work plans paediatric testing, treatment and care. further domestic and international funds fed into ongoing national efforts and for adolescent HIV activities are expected, International development partners have existing mechanisms. including resources to sub-national actors. integrated priority districts’ work-plans, developed during Phase III, into their Outcomes development and operational plans. Through its unique approach, All In has Funding to implement the activities was Resources supported: helped Namibia’s adolescents to gain allocated to designated implementing recognition as a distinct population group partners and through co-working All In assessment that requires tailored programming. agreements for special activities (mainly All National technical capacity on also set the stage for the collection the first violence against children and In adolescents and generation of sharper, better targeted adolescent survey, which includes HIV Implementation of national and and more strategic information to inform indicators). Additionally, UNICEF’s HIV sub-national work-plans future programming. As a result, Namibia team received additional funding to Expansion and scale-up of key has been successful in leveraging support implementation of the work- adolescent activities international and domestic resources plans. Since the All In assessments, the

33 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

Namibian First Lady Monica Geingos launched the #BeFree movement inspired by the drive to © UNICEF Namibia ensure an AIDS-Free generation. It is through the leadership of advocates such as First Lady Geingos that we will be able to improve the health of adolescent girls and young women.

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CASE STUDY

Lessons from NAMIBIA’s All In process

Engaging a wide range of government and non- Aligning advocacy efforts among multiple stakeholders government partners from the very beginning of the increases impact and the probability of a successful assessment process is essential to securing broad response. ownership and commitment. The development of work-plans is crucial to guiding the Leadership from the national ministry of health is critical allocation of resources, particularly at sub-national levels. to driving the assessment process Collaboration between national and sub-national Technical support from other UN organizations increases stakeholders enables the effective review of relevant political commitment and supports advocacy efforts policies and their implementation. throughout the process. The clearly established three-phase All In process, Building on existing technical working groups strengthens including supportive guidance tools, lends credibility leadership and collaboration. to the initiative and provides greater confidence for Analysing existing adolescent-specific data offers a stakeholders invested in its outcome. powerful advocacy tool for leveraging resources. Coming together as partners around data and advocacy Advocating for the inclusion of adolescents during during key decision-making meetings increases the strategic funding and programming discussions ensures impact and likelihood of a focused response. that adolescents are recognized as a priority population.

Next steps for Namibia

Develop a comprehensive national plan of action on adolescent girls and young women focused on HIV, sexual and reproductive health, violence and comprehensive sexuality education © UNICEF Namibia Support adolescent components of the national combination prevention strategy Review and update relevant guidance on adolescent HIV including adolescents living with HIV Develop tools to facilitate implementation of support groups for adolescents living with HIV Strengthen routinely collected data on adolescent HIV by revising data tools for age disaggregation and aligning M&E systems to improve understanding of targeted adolescent interventions through modelling for possible scale up

35 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/Till Muellenmeister

36 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/UN043563/Lister

FOR adolescent HIV Next steps programming in ESAR

hile All In has contributed importance of the country assessments adolescents affected by HIV. Championing to remarkable progress in for forging alliances to examine the ongoing dialogue with adolescent and Wa short amount of time for data and evidence, and for raising youth networks in policy dialogue with adolescents across the region, continuing awareness of the multi-faceted needs governments and key stakeholders will be targeted action for adolescents is crucial. of adolescents. In many countries, All In critical so that approaches to addressing Adolescents still face a number of translated into measurable investments adolescent HIV are responsive to their barriers to accessing the HIV prevention, in adolescents, yet adolescents at-risk needs. treatment and care they need. Adapting of HIV, including pregnant adolescents In order to build on the success of All health and other sectoral systems to be and young key populations, continue In in ESAR, some key next steps are adolescent-responsive and putting in place to be left behind. Moving forward, All outlined below. Now is the time to adapt appropriate adolescent data collection and In will continue to sustain and expand the lessons learned across the region analysis demands sustained efforts. meaningful consultation and partnership and transform the HIV response for with a broad constituency – including In mid-2018, UNICEF, UNAIDS, UN adolescents. adolescents, programme practitioners, agencies and Youth PACT met to academics, and policymakers – in order discuss the way forward for All to ensure effective service delivery for In. Partners reaffirmed the critical

37 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS © UNICEF/UNI160392/Ose

38 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS Key Next Steps

Collaborations, Partnership and Engagement Continue and strengthen technical such as Technical Working Groups Continue to engage adolescents on working groups, to advance collaboration Support the technical, financial and whether their views and ideas are being and further facilitate emerging initiatives human resource capacity of adolescent heard, and how to ensure meaningful Facilitate opportunities and platforms and youth networks to engage in policy adolescent participation for adolescents to remain engaged in and programming ongoing decision-making structures,

Strategic information Continue to advocate for routine adequately address adolescents Enhance processes and platforms for data collection on adolescent HIV, Undertake in-depth bottleneck analyses documenting case studies and results and through revision of data tools for age- in additional districts to obtain nationwide for facilitating intra- and inter-country peer- disaggregation and aligning M&E systems results; ensuring that sub-national data to-peer learning capacity Adapt the All In country assessment as and analysis inform national planning and Harmonize health and other sector an embedded, systematic practice that programming is critical indicators and data systems to ensure informs ongoing HIV programming for Improve understanding of targeted comprehensive programming adolescents and young people adolescent interventions through Include additional important indicators for Utilize disaggregated outputs to inform implementation science, including the measuring prevention interventions and future EPP Spectrum modelling estimates examination of quality, feasibility and community participation. Support data quality assessments to sustainability

Policy and plans Revise current national and sub-national other HIV, health or social protection guidance to include adolescent-specific HIV programming planning templates to strategies recommendation and considerations include adolescents Develop a separate national adolescent Coordinate advocacy around addressing Ensure the inclusion of adolescent- strategy and action plan, where age of consent barriers to essential HIV targeted interventions in newly appropriate and associated services developed national strategic plans and Review and revise relevant HIV

Programme implementation Implement national and sub-national work protocols, training, educational materials) Expand the adolescent health focus plans developed through All In Address programming and data gaps for beyond HIV to issues such as mental Provide ongoing technical support at the adolescents from key populations health, substance abuse etc. sub-national level to ensure inclusion of Continue to explore the use of innovative Utilize the outcomes and impact of All adolescents in sub-national plans and strategies to improve coverage, access, In as an opportunity to advocate for implementation demand and monitoring of adolescent HIV increased attention to health during the Develop implementation tools to support interventions second decade new targeted adolescent interventions (i.e.

Resources Utilize new sub-national plans to leverage Work with partners to strategically domestic funding allocation, thus domestic and external funding allocation advocate for inclusion of adolescent ensuring that adolescent programmes are Ensure ongoing coordination with key interventions with larger national funding embedded in government investments funding partners – sharing new data, processes rather than ad-hoc external funding programming progress and funding gaps Advocate for national ownership through initiatives

39 CATALYSING THE HIV RESPONSE FOR ADOLESCENTS

Key resources ON All In

Guidance on strengthening the adolescent component of national HIV programmes through country assessments, UNICEF, 2015 This guidance document and its accompanying tool, the Adolescent Assessment and Decision- Makers Tool (AADM), were devised to facilitate country assessments aimed at strengthening the adolescent component of national HIV programmes. The purpose of the country assessments are to: (1) support country teams in the identification of equity and performance gaps affecting adolescent HIV programming; and (2) define priority actions to improve the effectiveness of the national adolescent HIV response. https://childrenandaids.org/guidance-on-strengthening-adolescent-component

Collecting and reporting of sex- and age-disaggregated data on adolescents at the sub- national level, UNICEF, 2016. This document guides countries through the process of collecting and reporting sub- national data on adolescents to inform programme planning and implementation efforts. It was developed with the specific aim of identifying data gaps for adolescents and informing immediate programme planning needs at the sub-national level. https://childrenandaids.org/collecting-reporting-sex-age-disaggregated-data

UNAIDS, Ending the AIDS epidemic for adolescents, with adolescents: A practical guide to meaningfully engage adolescents in the AIDS response, 2016. This document provides guidance to programme designers, implementers, policymakers and decision-makers on how to meaningfully engage adolescents in the AIDS response and in broader health programming. It also demonstrates why adolescents and youth are critical in efforts to end the AIDS epidemic by 2030. http://www.unaids.org/en/resources/documents/2016/ending-AIDS-epidemic-adolescents

Government of Kenya, Ministry of Health, Kenya HIV estimates report, 2015. This 2015 HIV Estimates Report is a document published biennially by the Ministry of Health, Government of Kenya. Its aim is to provide an improved understanding of the HIV epidemic in the country amongst various sub-populations. The estimates are derived from several data sources including the Kenya Demographic and Health Surveys, Kenya AIDS Indicator Survey, HIV Sentinel Surveillance among pregnant women, programmatic data and the national census. http://nacc.or.ke/kenya-hiv-county-profiles/

Namibia ALL IN reports (phase I & phase II), MOHSS, UNICEF & UNAIDS, 2015. These reports highlight the findings of the ALL-IN End Adolescents AIDS assessment reports on generating and utilising data to sharpen the focus of adolescents and HIV programming within the National HIV/AIDS Response. https://www.unicef.org/namibia/na.Namibia_ALL-IN_Adolescent_HIV_Programme_Summary_ Report_Phase_2_2017.pdf

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© UNICEF/Julio Dengucho