International Workshop on HIV & Adolescence 2019 Abstracts Oral Presentations Abstract 1 Reviews in Antiviral Therapy & Infectious Diseases 2019_10 Abstract 2 1 Results: Among 1851 adolescent girls initiating PrEP, 1266 (68.4%) self-identified as FSW. Those identifying as FSWs were slightly older than those Risky sexual behaviors: a from the GP (Mean age 18.1, SD=1.0 vs 17.5, SD=1.3) (p<0.001), and a majority (72.3%) of the comparative analysis between older adolescent girls were FSW. A majority (72.4%) of the adolescent FSW were single, while a large adolescent female sex workers proportion (62.1%) of the GP were married. The (AFSW) and adolescents from AFSW sought PrEP services predominantly from the DICES (92.5%), while the GP from public health the general population (GP) in facilities (80.1%). Most (77.8%) of the adolescent ten Jilinde-supported counties FSWs were linked to PrEP services through their peers. On comparison of risk behaviors, the AFSWs in Kenya. had higher odds of having had a sexually transmitted infection in the last 6 months(OR=6.56, Ong'wen P1, Were D1, Mutegi J1, Wakhutu B1, Musau A1 CI=3.17,13.54), recurrent use of Post- exposure 1Johns Hopkins Program for International Education in Gynecology Prophylaxis( PEP)( OR=2.89, CI=1.29,6.46), and and Obstetrics( Jhpiego)- Kenya, Nairobi, Kenya engaging in sex under the influence of alcohol or drugs( OR=7.66, CI=5.62,10.45). They, however, had lower odds of having a known HIV positive sexual Background: Young people aged 10–24 years partner (OR=0.12, CI=0.07, 0.21) and using condoms constitute one-quarter of the world's population, inconsistently (OR=0.25, CI=0.12, 0.56). All the and are among individuals most affected by the differences were significant at P<0.05. global HIV/AIDS epidemic. Adolescent girls are more vulnerable, and those who engage in sex work There have been limited concerted experience compounded vulnerabilities. Despite Conclusions: efforts to focus on or address the health needs of this concern, many young KPs (YKPs) do not access adolescent girls engaging in sex work, as they are health services to receive prevention interventions considered underage. Data from Jilinde shows that because they do not perceive their risk, experience preventing HIV infection in adolescent girls need to stigma and discrimination, and due to lack of include interventions for those engaging in sex work appropriate tailor-made interventions. Jilinde is a due to the hire burden of risky behaviors, and harm large-scale project, which provides oral PrEP to key reduction for those from the GP who do not use and vulnerable populations including female sex condoms consistently. workers (FSW) and adolescent girls and young women (AGYW) in Kenya. PrEP for AGYW is delivered in public clinics, private clinics, and drop- in-centers (DICEs). We investigated the prevalence of self-reported risky sexual behaviors comparing between AFSW and adolescents from the GP. Materials & Methods: We report demographic and reported risky behaviors of adolescent girls, ages 15 - 19 years, initiating PrEP from February 2017 to May 2019. The adolescents received either static or outreach services from 93 Jilinde-supported clinics. We used data on risk behaviors in the client encounter form as documented by providers during eligibility assessment for adolescents accessing PrEP for the first time. Retrospective analysis was conducted on de-identified client data sourced from the PrEP medical record form approved by the Ministry of Health of Kenya. Chi square and t-tests were conducted to evaluate inter-group differences and odds ratio for the risk factors between the two groups. All analyses were conducted using SPSS 25.0. Reviews in Antiviral Therapy & Infectious Diseases 2019_10 Abstract 3 2 Counselling teachers, and 110 were referred to out- of-school-based support (for post-abuse, health, HIV testing and counseling, and social welfare Reducing HIV Risk, Retaining support). 25 adolescent girls self-reported experiencing sexual abuse, 84 reported being at-risk Girls In-School, and sexually active and 5 reported as engaging in transactional sex. WEI/Bantwana retained 91% of Linking Girls to Services in these highly vulnerable girls in school through the Eswatini through School-based EWS and its response protocols. Early Warning Systems Conclusions: Results suggest that teachers may be less likely to identify girls at risk of drop out due to Chirume S factors other than financial needs; deeper training 1World Education, Inc., Boston, United States is required to capacitate teachers to see the ABC warning signs. Girls were surprisingly candid about being at-risk, self-reporting gender-based violence, Background: Young women who attend more transactional sex and being sexually active, among school days and stay in school have a lower risk of other indicators. The EWS tool needs to be revised incident HIV and HSV-2 infection. Research shows to be a less sensitive instrument, as high numbers that interventions to increase frequency of school of girls were identified as at risk, which could easily attendance and prevent dropout should be overwhelm a nascent EWS and the ability of the promoted to reduce risk of infection. However, school community to implement effective response nearly 50 million school-aged girls in Africa are not protocols. Capacity of teachers to fully implement in school, and are at risk of engaging in numerous the response protocol, and link girls to services is drivers of HIV. Further, while vulnerability required. The EWS is a promising approach to assessments successfully identify many girls at-risk, identify and retain girls in school, and decrease their a large number are missed. Early Warning Systems risk to HIV. WEI/Bantwana has won onward funding (EWS) can identify girls at risk of drop out and to pilot a digital version of the EWS self-assessment provide robust response protocols and supports to tool to be delivered directly to girls via mobile retain them in school and reduce their risk to HIV. phones. Materials & Methods: EWSs are grounded in the “ABCs” of risk behavior: Absenteeism, Behavior, and Course failure. The Bantwana Initiative of World Education (WEI/Bantwana) piloted two versions of the EWS: a teacher-administered tool, and a student self-administered tool. In collaboration with the Ministry of Education and Training in Eswatini, WEI/Bantwana piloted the teacher-administered EWS tool with 24 Guidance and Counselling teachers across six schools. With the support of Peer Educators, WEI/Bantwana piloted the self-administered EWS tool with 517 adolescent girls, who self-assessed their risk of dropping out within a school club-based setting. Results: The teacher-administered EWS tool identified 36 adolescent girls as at risk of dropping out of school. The student self-administered EWS tool identified 175 adolescent girls (34%) as at risk of dropping out of school. The teachers’ assessment tended to focus on financial risk factors (girls who had outstanding fees and balances), whereas the girls’ self-assessments better tapped into the three risk factors of absenteeism, behavior, and coursework. Of the 175 who met the at-risk criteria, 65 consented to meet with Guidance and Reviews in Antiviral Therapy & Infectious Diseases 2019_10 Abstract 4 3 Exclusion: Some donors’ focus on adolescent girls and young women leads to exclusion of younger Politics or evidence: whose children (5-9), of adolescent boys and young men, and of older men and women including caregivers, perspectives count? Key from Stepping Stones processes. Discrimination in favour of adolescent girls unfairly places challenges experienced in responsibility for changing social norms on them, scaling-up Stepping Stones instead of involving the whole community, including those with more power, in learning about and programmes practising equality and negotiating change together. It also discriminates against the excluded Kusiima S, Bajenja E, Birungi F3, Chizizia N4, Gatsi J5, Gordon G1, sectors of the population, and crucially misses the Holden S1, Kemunto M7, Kiwia P6, Manyama W6, Opondo M7,9, opportunity to work with younger children, despite Oron B8,2, Tholanah M10, Welbourn A1 UNESCO’s evidence-based CSE guidance. 1Salamander Trust, London, United Kingdom, 2Communicating for Action and Results, Wakiso District, Uganda, 3American Refugee Committee, Kampala, Uganda, 4Pastoral Activities and Services for Short-term results-driven policies: Limited funding People with AIDS Dar es Salaam Archdiocese (PASADA), Dar es and timelines have resulted in poorly adapted Salaam, Tanzania, 5Namibia Women's Health Network, materials with fewer sessions, abridged schedules Windhoek, Namibia , 6Kimara Peer Educators, Dar es Salaam, Tanzania, 7Stepping Stones Kenya Network, , Kenya, 8Network of and inadequately delivered training, with Stepping Stones Approaches (NESSA), , Uganda, 9Love and Hope insufficient detail or insight. These factors severely Centre, Nakuru, Kenya, 10Independent consultant, , Zimbabwe affect the outcomes of these programmes on communities. Background: Stepping Stones (1995, 2016) and The described censorship reflects that Stepping Stones with Children (2016) are holistic, Conclusions: experienced more widely by many key populations; gender-transformative programmes working not unique, but still challenging. The programme respectively with older adolescents and adults, and shows caregivers and facilitators that children are with children and younger adolescents living with already familiar