Inclusion of Adolescents with Disabilities: Towards an AIDS-Free Generation

2. Inclusion of Adolescents with Disabilities: Towards an AIDS-Free Generation All In! Rosangela Berman Bieler Senior Adviser, Children with Disabilities, UNICEF

3. Towards an AIDS-Free Generation • Adolescents are the only age group in which AIDS-related deaths have increased. • Globally, AIDS-related deaths overall fell by 30 per cent between 2005 and 2012, but increased by 50 per cent among adolescents aged 10-19 years during that same period. • An AIDS-free generation, in which all children are born free of HIV and remain so for the first two decades of life, is within reach. An AIDS-free generation cannot be achieved without adolescents.

4. ALL IN! A GLOBAL INITIATIVE TO END ADOLESCENT AIDS GOAL: Halve new infections and close the treatment gap for adolescents by 2020 HOW: Increase investments in high-impact interventions that target adolescents most at-risk to avert an estimated two million new infections among adolescents between now and 2020 ALL IN! To achieve results for all youth, this initiative may reach out to and include adolescents with disabilities

5. DISABILITY IN NUMBERS More than one billion people – about 15% of the world's population (WHO/WB, 2011) In sub-Saharan Africa, the estimated proportion of people with disabilities is as high as: • 36% in Swaziland • 20-24% in Namibia and South Africa • 14-17% in Zimbabwe, Kenya, Zambia, Malawi • prevalence expected to grow due to longer life expectancy in some countries

6. ADOLESCENTS WITH DISABILITIES • Young people with disabilities are at similar or higher risk for HIV transmission: • they are just as likely to be sexually active and use drugs and alcohol as their non-disabled peers • they may be at higher risk due to the lack of access to sex education, HIV prevention information and services • high rate of sexual and gender-based violence against children, adolescents and youth with disabilities • greater poverty, less access to education and protection • extreme exposure to stigma, discrimination and bullying • high risk ofsocial marginalization and exclusion

7. VOICES OF YOUTH WITH DISABILITIES “There are radio and TV campaigns aimed to people living in rural areas but are not accessible for the deaf. They would need to be reached through interpreters (sign language).” “I am HIV-positive since 2008. HIV stigma is strong, but when the community discriminates (against) the disabled this is the biggest challenge.”

8. ADOLESCENT GIRLS AND YOUNG WOMEN Adolescent girls and young women with disabilities may be at increased risk for HIV infection due to their vulnerability to sexual abuse, lack of appropriate HIV prevention education, poor access to health care services, and widespread discrimination related to the double burden of both gender and disability. “I know of a deaf woman that goes to the clinic to get her medicines and she spends hours waiting. They just skip over her name…”

9. ACCESS TO SERVICES Despite national policy and legal frameworks to support disability rights and scale-up of HIV programs, implementation of policies is poor and access to PMTCT and other HIV services remains very limited. In order to eliminating new HIV infections among children by 2015, countries need to address prevention, care and treatment services for adolescent girls and young women with disabilities. “When I was pregnant I heard many comments from the nurses, like what kind of man did this to you? They think that you are going to make a lot of extra work for them (as a wheelchair user)”.

10. ISSUES TO BE ADDRESSED • large gap between policy and legal frameworks and access to health/HIV services for adolescent with disabilities • need to integrate disability concerns into HIV-related laws, policies and programmes using inclusive approaches • continued vulnerability of girls and women with disabilities to sexual abuse and inability to negotiate safer sex • lack of sensitivity among police as well as health care staff

11. ISSUES TO BE ADDRESSED • challenges accessing basic HIV prevention information at health centres and national campaigns • health infrastructure and services are not accessible to adolescent girls and women with disabilities • they are invisible to tracking mechanisms within the Maternal Child Health system

12. GENERATING DATA AND EVIDENCE • There is limited information on the prevalence of HIV and access to HIV services for persons with disabilities---and little solid evidence base upon which to build policy and programming. • Lack of high quality, population based evidence to estimate the size of the population of youth with disabilities at risk for HIV • it is time to define the epidemiology and risk factors for HIV in order to effectively advocate for resources for those who are left behind.

13. ALL IN! ADOLESCENTS WITH DISABILITIES • Improve strategic information to monitor program inclusion and HIV service accessibility for adolescents with disabilities • estimate the population size of adolescents with disabilities who are at risk for HIV, and those who are HIV infected in high burden countries.

14. OUTREACH STRATEGIES • invest in outreach and family-based approaches to make Maternal and Child Health programmes more inclusive; • Ensure access to service facilities and to information and communication campaigns; • use innovations to assess stigma and discrimination and include adolescent with disabilities in campaigns to combat stigma; • involve persons with disabilities as health agents and map capacities to increase the use of community resources; and • introduce zero tolerance to discrimination in health services.

15. AIDS DOES NOT DISCRIMINATE ALL IN! TO END ADOLESCENTS AIDS

16. THANK YOU! Follow us @unicef_aids www.childrenandaids.org www.unicef.org/disabilities Contact: RoseangelaBurman-Bieler rburmanbieler@unicef.org