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UNDP Youth Policies and Strategies in the Context of the MDGs. George Ionita [email protected] Regional HIV Advisor UNICEF MENA. Harvard Study: Young People’s Sexual Reproductive Health and Rights. Unicef-UNFPA-UNAIDS-IFRC-WHO Started in 2003 Almost completed

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Undp youth policies and strategies in the context of the mdgs l.jpg

UNDP Youth Policies and Strategies in the Context of the MDGs

George Ionita

[email protected]

Regional HIV Advisor UNICEF MENA


Harvard study young people s sexual reproductive health and rights l.jpg
Harvard Study: Young People’s Sexual Reproductive Health and Rights

  • Unicef-UNFPA-UNAIDS-IFRC-WHO

  • Started in 2003

  • Almost completed

  • 20-21 June 2005, Cairo, League of Arab States


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Harvard Study: Methodology and Rights

  • Desk-based review of published & unpublished literature

  • Telephone interviews (N = 33) with key experts across region and internationally

  • Face to Face interviews by research assistants in Egypt Lebanon, Jordan, and Tunisia (N = 29)

  • Collection of data in above countries

  • Email survey to UNFPA, UNICEF, IFRC country offices


The youth bulge l.jpg
The “youth bulge” and Rights

  • Unique demographic moment: unprecedented numbers of young people 10 to 24 Arab region (roughly 1/3 of population)

  • What are some of the implications of the “youth bulge” for young men and women and families?

  • How have young people themselves experienced these changes?

  • Problem: very little research on Arab youth (other than from sectoral perspective)


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Considerable Unmet Need in the Region and Rights

  • Rapid social change:

    • urbanization;

    • rising unemployment;

    • breakdown of social networks;

    • exposure to global media;

    • migration;

    • rising educational levels;

    • widening generation gaps;

    • changing gender roles etc.

  • Rising age of marriage

  • Few policies/services dedicated to age group

  • Youth centres tend to exclude girls for various reasons


Need for positive youth development approach l.jpg
Need for Positive Youth Development Approach and Rights

  • Need to integrate various interventions for youth within broad approach

  • Need for positive approach (not seeing youth as deviant or politically dangerous): Youth are part of the Solution, not a Problem

  • Importance of understanding perspective of young people

  • Arab Human Development Report: high desire for emigration among young people – need to address their concerns


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Social Context and Rights

Protective factors:

  • Strong family solidarity but in flux

  • Intra-regional shared heritage

  • Rising levels of education

  • Increasing age at marriage

  • Greater communication/access to electronic media

  • Religious values that in some instances positively promote youth development and SRH


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Economic Context and Rights

  • Sharp class differences in vulnerability and outcomes (e.g. education; high risk behaviour in terms of HIV/AIDS)

  • Rising unemployment among youth

  • Higher costs of living/housing

  • Higher material aspirations (media etc.)

  • Above - Reasons for deferral of marriage (little research except for Egypt)


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Political Context and Rights

  • Conflict creates vulnerability:

    • Palestine (first intifada led to earlier marriage),

    • Sudan (HIV/AIDS driven by civil war) and

    • Iraq (violence against young women increased)

  • Reluctance to address sensitive issues/ risk behaviors by both government and NGOs

  • Political participation of youth limited, particularly young women


Marriage patterns l.jpg
Marriage Patterns: and Rights

  • Rising age at marriage for both males and females

  • Early marriage still a problem in pockets of all societies

  • High incidence of consanguineous marriages

  • Higher numbers of unmarried women in 30s

  • Resurgence of forms of non-conventional marriage


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Maternal Mortality and Rights

  • Maternal deaths concentrated in

    • Djibouti, Egypt, Morocco, Sudan, Yemen,

  • Risks among young high, but number of deaths may not be known (few studies on age group)

  • Early marriage a factor

  • Anaemia in pregnancy high across region

  • No data on relationship between induced abortion and maternal mortality


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Unwanted Pregnancy and Abortion and Rights

  • Young girls who marry early face strong pressure to bear children

  • Unsafe induced abortion known to occur with often severe health consequences but little data on age group

  • Survey of suicides in Algeria (1980s) showed 30% were unmarried and pregnant


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Female Genital Mutilation (FGM) and Violence and Rights

  • FGM in four countries:

    • Djibouti, Egypt, Sudan, Yemen and

    • Also reported in Iraq, Oman, Saudi Arabia,

  • Sexual violence, abuse and incest reported, but little reliable data

  • “Honour killings” reported across region, but much more data in some countries


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Reproductive Morbidity and Rights

  • Giza study:

    • Prevalence of reproductive tract infections

      • 45% among 14-19 year olds,

      • 55% among 20-24 year olds

    • Genital prolapse was 24% for 14-19 year olds in Giza study

  • Vasico-vaginal fistulae and prolapse in Yemen and Sudan (early marriage and poor nutrition)

  • Poverty, lack of access to water, and inadequate IUD screening


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Sexually Transmitted Infections and Rights

  • WHO: 600,000 new infections per year but underreporting (esp. women and youth)

  • Most reported:

    • trichomoniasis, gonorrhoea and syphillis

  • Around 74,000 STIs in 5 countries reported 2002

  • Study in Morocco: 40% of reported STIs among young adults 15 – 29 years


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HIV Epidemic Levels in the MENA/EM Region and Rights

Type 1: Consistently low rates but no consistent testing of high risk groups:

 Egypt, Syria, Jordan, possibly Saudi Arabia and Iraq

Type 2: Accumulating levels of infection; some rapid increase in identified high risk groups:

 Algeria, Iran, Libya, Morocco, Tunisia, Lebanon, Oman, Bahrain, Kuwait, Yemen and possibly UAE and Qatar

Type 3: High levels of HIV in general population, although solid epidemiological data are lacking:

 Djibouti, Sudan and possibly Somalia


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HIV/AIDS and Youth and Rights

  • Very little data on AIDS related knowledge and behaviour

  • Wide reports of premarital sexual activity at least in urban areas but little research

  • Main modes of transmission: Heterosexual and IDU

  • Most women develop AIDS at younger age (25 – 29) than men (35 – 39)

  • Globally: Married young women more at risk for HIV than sexually active un-married young women


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HIV/AIDS: WHAT DOES IT MEAN? and Rights

Human

Immune Deficiency

Virus

Acquired

Immune

Deficiency

Syndrome


People living with hiv l.jpg
People Living with HIV: and Rights

  • 1980s: 100,000

  • 2004: 39,400,000

    (36-44 million)

    Damascus, May 3-5-2005, Joint WHO-UNESCO-UNICEF Workshop on School Health, Peer ED


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Orphans: and Rights

  • 1990: 1,000,000

  • 2003: 11,000,000

  • 2010: 25,000,000


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Regional HIV/AIDS statistics and features, end of 2004 and Rights

% of HIV-positive adults who are women

Main mode(s) of transmission for those living with HIV/AIDS **

Adults & children newly infected

with HIV

Epidemic

started

Adults & children

living with HIV/AIDS

Adult prevalence

rate *

25.4 million

440 000

1.4 million

1.0 million

1.7 million

7.1 million

540 000

610 000

35 000

1.1 million

39.4 million

late ’70s

early ’80s

late ’80s

late ’80s

late ’80s

late ’70s

early ’80s

late ’70s

early ’80s

early ’90s

late ’70s

early ’80s

late ’70s

early ’80s

late ’70s

early ’80s

3.1 million

53 000

210 000

44 000

240 000

890 000

92000

21 000

5000

290 000

4.9 million

7.4%

2.3%

0.8%

0.6%

0.6%

0.6%

0.3%

0.3%

0.2%

0.1%

1.1%

57%

49%

34%

25%

36%

30%

48%

25%

21%

22%

47%

Hetero

Hetero, IDU

Hetero, IDU

IDU, Hetero, MSM

MSM, IDU, Hetero

Hetero, MSM

IDU

MSM, IDU

MSM, IDU, Hetero

MSM

Sub-Saharan Africa

Caribbean

Eastern Europe&Central Asia

North America

Latin America

South and South-East Asia

North Africa & Middle East

Western and Central Europe

Australia & New Zealand

East Asia & Pacific

TOTAL

* The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2004, using 2004 population numbers

** Hetero: heterosexual transmission – IDU: transmission through injecting drug use – MSM: sexual transmission among men who

have sex with men


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+ 1 300% and Rights

+ 20%

+ 20%

+ 160%

+ 300%

+ 60%

+ 40%

HIV prevalence in adults, end 2001

+ 30%

15 – 39%

5 – 15%

1 – 5%

0.5 – 1.0%

+ 20%

0.1 – 0.5%

0.0 – 0.1%

not available

The global view of HIV, end 2001

Recent trends in HIV infection, 1996–2001

Source:UNAIDS/WHO July 2002

outside region


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HIV in High Risk Groups- and Rightsad hoc surveys, reports-#1

0.59% in MSM;12% in FSW;

12% in STD patients (1998)

12% in IDUs (in-treatment) up to 69%(in one prison) (2001)

0.3% in 291 IDUs (2000)

0.22% in 458 FSW (registered)(2001)

0 in 945 prisoners

2.3% in 217 FSW (2001)

0.86% in 815 MSM (2001)

Qatar

Bahrain

5% in 2240 STD

patients (1999)

571 new HIV infections, 98% IDUs, (2000)

3% in 139 FSW; 2% of sex workers in Oran and 9% in Tamanrasset , 1.7%STD clinic in Oran (2000)

5% in 135 arrested IDUs (1999);

8.3% in 60 IDUs (2000)

North:

10% in tea sellers, 4% in sex workers, 4% among refugees

South:

17% in VCCT centers

7% in FSW (2001);

1.8% in 248 STD patients (2000)

*FSW = Female Sex Workers

*IDU = Injecting Drug Users

*MSM =

*STD = Sexually Transmitted Disease

28% in bar girls,

>50% in street FSWs

(1996-98)

0.14% in 2102

IDUs (1997)


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HIV in General Population and Rights

0.06% in blood donors,

0.6% TB patients (2000)

.0015% in blood donors

1.5% ANC (2000)

0 in 108 ANC ;

0.03% in blood donors (2000)

Tunisia

Syria

0 ANC (1999);0.03% blood donors (1999);

0.36% in 281 TB patients (2000)

Jordan

Morocco

Kuwait

1.7% in 275,307 screened (2000)

Algeria

0.2% in 627 ANC (1998)

Bahrain

Libya

Egypt

Qatar

0 in 2,464 blood donors

Oman

0.4% in 1.984 ANC;

0.9% at ANC sites in south (Tamanrasset)

Yemen

4.8% TB patients (2000)

Sudan

Djibouti

0.7% in 11,070 low risk persons (1998); 0.04% up

to 0.28% in blood donors(1998-2000);

sex ratio:4:1(M:F) in 1995 to 2:1 in 2001

2.5% general population (2000)

*ANC = Ante Natal Clinics

2.9% general population (2002)


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Do Services Meet Needs?: HEALTH and Rights

  • Respondents report service providers often judgemental, young people not welcomed

  • Few scaled up programs:

    • Egypt Ministry of Health HIV Hot-Line

    • Oman Ministry of Health HIV Hotline + Outreach to High Risk Groups

    • Morocco NGO services


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Do Services Meet Needs?: EDUCATION and Rights

  • Lack of life skills and sexuality education programs

  • Gender disparities in access/outcomes

  • Generational differences in education

  • Rural migrants to university often at risk

  • E.g. Tunisia “Double Protection” Project in Tunisian university dormitories


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Quantitative Research and Rights

  • Exists DHS, PAPFAM and Gulf Family Health among others

  • BUT lack of consistent data across region makes comparisons difficult

  • Lack of dis-aggregation or secondary analysis of surveys for relevance to youth

  • Certain questions never asked

  • Limited info on unmarried

  • Need more youth development surveys (PAPFAM Youth Module good opportunity but optional and new)


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Till Recently little population based data on youth because:

1) Preoccupation fertility/family planning (so only ever married women)

2) It is sensitive to interview unmarried

3) Adolescent policy received little attention


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Qualitative Research Gaps

  • Perceptions of young people (of services, social norms etc.)

  • Perceptions of adults re youth Reproductive Sexual Health (service providers, parents etc.)

  • High quality and in-depth research (many KAP)

  • Key linkages between development/social trends and RSH (much anecdotal)


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CONCLUSIONS

  • Lack of access to public Sexual Reproductive Health

    • Information,

    • Education,

    • Counseling and

    • Services for young people – married and unmarried

  • Knowledge gaps huge

    • e.g. Need for understanding of this stage of life-cycle in cultural context

  • Most programs small-scale and not sufficiently evaluated

  • How to build on protective factors?


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Moscow Ballet, Jerash Art Festival 2004

Photo by Dr. George Ionita


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