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					Mapping of Children, Young People and HIV/AIDS Activities in the Middle East and North Africa Region:

Potential Good Practices and Lessons Learned

July 2006

Middle East and North Africa Regional Office Amman, Jordan

Mapping of Children, Young People and HIV/AIDS Activities in MENA

Acknowledgements

This compilation of Children, Young People and HIV/AIDS Activities in the MENA region was prepared by a team led by George Ionita, UNICEF/MENARO Regional HIV/AIDS Advisor, who together with Monica Isabel Larrieu, UNICEF/MENARO consultant, conceptualized and compiled the collection. Colleagues from UNICEF Headquarters, UNICEF MENA Regional Office and UNICEF MENA Country Offices were consulted and generously gave their feedback and input into the process and documentation. The team would like to thank each and every one of them for their contributions: Rick Olson, Krishna Belbase, Buthaina Al-Iryani, Solofo Ramaroson, Suad Nabhan, Naseem Ur-Rehman, Wessam El-Beih, Severine Leonardi, Maisoon Ibrahim, Mitra Motamedi, Renato Linsangan, Najin Yasrebi, Joumana Haj Ahmad, Ahmed Laabid, Sheila Mangan, Omar Habib, Mhd Imad Al-Daker, Alexander Malyavin, Shoubo Rasheed and Amal Obeid. Colleagues from other organizations were also consulted and provided helpful feedback and inputs: Iris Semini (UNAIDS), Chokri Ben Yahia (UNFPA), Ashraf Azer (UNHCR), Najwa Kefaya (Save the Children), Basma Khraisat (Family Health International), Rana Kabalan and Darine El-Sabeh (IFRC), Sany Kozman and Youssef Aziz (Caritas-Egypt/RANAA), Elie Al-Aaraj (SIDC) and Jocelyn DeJong. Special thanks go to Laila Younes, for her dedicated and indefatigable research support, and Rana Taher, for her constant support and reliability.

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Abbreviations and Acronyms
AFS AIDS ARV ASRH BSS CO CSW EVA FGM/C FHI FP FSW GFATM GIPA HIV HQ IDU IFRC KAPB MCH MDG MENA MENARO M&E MoE MoH MSM MTCT MTSP NAP NGO NSP OPT OVC PED PLWHA PMTCT PPTCT PO PSA RANAA RO Adolescent-friendly services Acquired immunodeficiency syndrome Anti-retroviral Adolescent sexual and reproductive health Behavioral surveillance surveys UNICEF country office Commercial sex worker Especially vulnerable adolescents Female genital mutilation or cutting Family Health International Focal point Female sex worker Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Involvement of People with AIDS Human immunodeficiency virus UNICEF headquarters Injecting drug user International Federation of Red Cross/Red Crescent Societies Knowledge, attitudes, practices and behavior Maternal and child health Millennium Development Goals Middle East and North Africa Region UNICEF Middle East and North Africa Regional Office Monitoring and evaluation Ministry of Education Ministry of Health Males who have sex with males (or men who have sex with men) Mother-to-child transmission Mid-term Strategic Plan National AIDS Program Non-governmental organization National HIV/AIDS Strategic Plan Occupied Palestinian Territory Orphans and vulnerable children Peer education People living with HIV/AIDS Prevention of mother-to-child transmission Prevention of parent-to-child transmission Program officer Public service announcement Regional Arab Network Against AIDS Regional office
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SD SIDC SPO SRH STI SW TB ToT UNAIDS UNDP UNESCO UNFPA UNGASS UNHCR UNICEF UNODC UNTG USAID VCCT VCT WB WHO

UNICEF Supply Division Soins Infirmiers et Developpement Comunautaire (Lebanese NGO) Senior program officer Sexual and reproductive health Sexually transmitted infection Sex worker Tuberculosis Training-of-trainers Joint United Nations Programme on HIV/AIDS United Nations Development Programme United Nations Education, Scientific and Cultural Organization United Nations Population Fund United Nations General Assembly Special Session on HIV/AIDS United Nations High Commissioner for Refugees United Nations Children‟s Fund United Nations Office on Drugs and Crimes United Nations Theme Group on HIV/AIDS United States Agency for International Development Voluntary and confidential counseling and testing Voluntary counseling and testing World Bank World Health Organization

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Table of Contents
Acknowledgements.................................................................................................. 2 Abbreviations and Acronyms ................................................................................... 3 I. Introduction ........................................................................................................... 6 HIV/AIDS, Young People and Children in the MENA Region ............................. 7 II. Children, Young People and HIV/AIDS Projects/Programs in MENA ............... 10 Purpose................................................................................................................. 10 Methodology ....................................................................................................... 10 Children, Young People and HIV/AIDS Activities in MENA by Priority Area ........ 12 Children, Young People and HIV/AIDS Activities by Country ALGERIA ....................................................................................................... 15 DJIBOUTI ....................................................................................................... 17 EGYPT ........................................................................................................... 21 IRAN .............................................................................................................. 29 IRAQ ............................................................................................................. 36 JORDAN ....................................................................................................... 37 LEBANON ...................................................................................................... 40 OCCUPIED PALESTINIAN TERRITORIES ........................................................... 43 SUDAN .......................................................................................................... 46 SYRIA............................................................................................................. 49 YEMEN .......................................................................................................... 55 III. A Way Forward to Future Programming of Children, Young People and HIV/AIDS Activities............................................................................................. 59 IV. Appendices ................................................................................................... 61 Appendix 1: Matrix of Children, Young People and HIV/AIDS Activities in MENA by Priority Program Area and Country .......................................... 62 Appendix 2: Global Good Practices in Children, Young People and HIV/AIDS Programming ................................................................................. 66 Appendix 3: References ..................................................................................... 81

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I. Introduction
The global impact of HIV/AIDS has reached alarming and worrisome proportions, having killed more than 20 million people all over the world since it was first detected in 1982 and afflicted an estimated 34 to 46 million currently living with HIV/AIDS. Figures for the MENA region indicate lower prevalence and incidence compared to sub-Saharan Africa but are comparable to other parts of the world. The 2004 Report on the Global AIDS Epidemic1 estimates indicate that MENA has 480,000 adults and children living with the disease, and a regional estimated prevalence rate of 0.2%. It is important to note that accurate and true prevalence rates in the MENA region are virtually unknown and difficult to survey due to (1) poor biological and behavioral surveillance, (2) inadequate availability of testing services, and (3) stigma and illegal nature of high risk behaviors associated with the disease. Table 1: Regional HIV/AIDS Estimates for 2003
Region Middle East/North Africa Africa (Sub-Saharan) Caribbean South and South-East Asia Eastern Europe Latin America East Asia HIV Prevalence Rate (range) 0.2%
(range: 0.1-0.6%)

Estimated Adults and Children Living with HIV/AIDS 480,000
(range: 200,000-1,400,000)

AIDS Deaths (adults and children) 24,000
(range: 9,900-62,000)

7.5%
(range: 6.9-8.3%)

25,000,000
(Range: 23,100,000-27,900,000)

2,200,000
(range: 2,000,000-2,500,000)

2.3%
(range: 1.4-4.1%)

430,000
(range: 270,000-760,000)

35,000
(range: 23,000-59,000)

0.6%
(range: 0.4-0.9%)

6,500,000
(range: 4,100,000-9,600,000)

460,000
(range: 290,000-700,000)

0.6%
(range: 0.4-0.9%)

1,300,000
(range: 860,000-1,900,000)

49,000
(range: 32,000-71,000)

0.6%
(range: 0.5-0.8%)

1,600,000
(range: 1,200,000-2,100,000)

84,000
(range: 65,000-110,000)

0.1%
(range: 0.1-0.2%)

900,000
(range: 450,000-1,500,000)

44,000
(range: 22,000-75,000)

Source: UNAIDS Report on the Global AIDS Epidemic, July 2004

Despite seemingly low prevalence rates in the region, it must be emphasized that this low prevalence does not, by any means, indicate low risks for the region and therefore, justify lack of attention and a false sense of security. It is critical to recall the lessons learned from once low prevalence countries whose disease profile changed dramatically in a short time, only to be faced with an epidemic that they could have been better prepared to curtail with timely planning and forecasting.

UNAIDS and UNICEF coverage of countries vary slightly in that UNAIDS excludes Sudan but includes Somalia and Israel.
1

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According to the World Bank‟s report on HIV/AIDS in the Middle East and North Africa: The Costs of Inaction, the epidemiological profile of HIV/AIDS in the MENA region can be categorized into three epidemic types (see Table 2 below). Table 2: HIV/AIDS Epidemic Profiles by Type in the MENA Region2 HIV/AIDS Epidemic Profiles in the MENA Region
Type
Low Prevalence Epidemic

Description
Repeated testing; consistently low rates; no consistent systematic testing or reporting of high risk groups (<5% in high risk groups; <1% in general population) Gradually accumulating levels of infection; some rapid increases in identified high risk groups (>5% in high risk groups; <1% in general population) Generalized epidemic levels with a HIV/AIDS prevalence rate greater than 1% for the general population.

Countries
Egypt, Jordan, Syria Possibly Saudi Arabia and Iraq

Concentrated Epidemic

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

Generalized Epidemic

Djibouti, Sudan

Additionally, many countries in the region are exhibiting the risk factors that merit proper investment and planning for the timely prevention of HIV/AIDS3. Risk factors witnessed in the region that demonstrate vulnerability to the disease include: (i) rising incidence of sexually transmitted diseases, (ii) existence of risk groups [commercial sex workers (CSW), men who have sex with men (MSM), refugees], (iii) gender inequality, (iv) large young population, (v) high unemployment rates, (vi) urbanization and migration, (vii) rising incidence of injecting drug use (IDU), and (viii) region‟s proximity to other high prevalence regions. Given these risk and vulnerability factors, the MENA region should therefore keep the global experiences in mind and become more engaged in fighting the spread of HIV/AIDS. HIV/AIDS, Young People and Children in the MENA Region As evidenced globally, HIV/AIDS is increasingly affecting youth and the most vulnerable. In 2003, young people and children under 25 years of age

Jenkins, C. and Robalino, D., “HIV/AIDS in the Middle East and North Africa: The Costs of Inaction.” World Bank, 2003. 3 Jenkins, C. and Robalino, D., “HIV/AIDS in the Middle East and North Africa: The Costs of Inaction.” World Bank, 2003.
2

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accounted for over half the 4.8 million new HIV infections throughout the world4. Evidence has consistently shown that young people are particularly vulnerable to becoming infected with HIV, because of biological and psychosocial development vulnerabilities, sexual initiation, curiosity, unfavorable socioeconomic situation, lack of access to education and youth-friendly health services, and lack of accurate information about health and HIV/AIDS. Youth who are already socially and economically disadvantaged are generally at highest risk of infection - girls, young people in the sex trade or who have been sexually exploited, injecting drug users, men having sex with men, and children and adolescents orphaned by AIDS or caught in armed conflict. These are factors that exist in many parts of the MENA region. Recent data for MENA show that at least 160,000 young people between the ages of 18 and 245, and an estimated 35,100 children under the age of 14 are living with HIV/AIDS6. Although there is little country-specific data on youth and HIV/AIDS infection in the region, what is available indicates that 21% of HIVinfected people in Tunisia are between 15-24 years of age, and 3.8% of recorded AIDS cases have occurred among young people between the ages of 15-19 years7. When factoring in MENA‟s large and growing young population, which is a risk factor in itself, and in conjunction with the region‟s vulnerability and epidemiological potential for HIV/AIDS, there is a high probability that the epidemic could increase in the region. Although population rates have slightly decreased recently, MENA‟s young population will continue to grow as population growth rates remain high. (See Figure 2 below). In Egypt, Jordan and Morocco, it is estimated that one-third of their populations are between the ages of 15-29 years8.

“Youth and HIV” website, based on UNAIDS 2003 data www.youthandhiv.org/index.php?p=B_young_people
4

“Youth and HIV” website, based on 2003 UNAIDS data. (http://www.youthandhiv.org/index.php?p=B_facts) 6 “The State of the World‟s Children.” UNICEF, January 2004. 7 Jenkins, C. and Robalino, D., “HIV/AIDS in the Middle East and North Africa: The Costs of Inaction.” World Bank, 2003. 8 Ibid.
5

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Figure 1: Population Growth Rates for MENA, 2000-20159

OECD Tunisia Lebanon Iran, Islamic Republic Morocco Algeria Egypt, Arab Republic Djibouti Bahrain Iraq Qatar UAE Syria Oman Jordan Kuwait Yemen, Rep. Saudi Arabia Palestinian Administration

0.6 1.2 1.3 1.5 1.6 1.6 1.8 1.8 2 2 2.1 2.4 2.4 2.4 2.6 2.8 3 3.3 3.7

0

0.5

1

1.5

2

2.5

3

3.5

4

Average Annual Population Growth Rate

Source: World Bank projections on population data.

Coupled with the other risk and vulnerability factors that the region faces (i.e. conflict, illiteracy, poverty, gender disparities, migration, etc.), MENA‟s youth will be critical to determining the direction the HIV/AIDS epidemic takes in the region, particularly among high risk youth. In order to curtail the potential devastating spread of the epidemic, MENA‟s youth should be equipped with the proper knowledge, skills, tools and youth-friendly services in an enabling environment with which they can lead safe and healthy lives, as well as make positive decisions. HIV/AIDS programming must therefore address this critical population in the MENA region. Unfortunately, such programming for young people and children is in an embryonic stage, if even existent, in many of the region‟s countries. As such, the region needs to identify early on existing HIV/AIDS programming that target youth, engage their participation, and that are rendering results as well as providing valuable lessons learned. With such examples, most countries in the region will be able to apply the lessons learned from experiences within the region to their individual country contexts that are still in development stages of programme conceptualization or development.

9

Presentation made by George Schieber, World Bank Senior Health Economist, 2004. 9 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

II.

Children, Young People and HIV/AIDS Projects/Programs in MENA

Purpose Having received requests from UNICEF MENA country offices for information on programming practices from other countries in the region, MENARO‟s Regional HIV/AIDS section embarked on compiling such information. Initially conceived as an exercise to identify good practices, too little information on such programming was identified, most of which had little or no evaluation elements with which to determine good practices. An initial exercise of taking stock of or mapping all programming with respect to young people and HIV/AIDS (and HIV/AIDS-related) activities must first be completed. As such, this mapping activity and review of existing programming was initiated – a virtual “yellow pages” of children, young people and HIV/AIDS activities in the MENA region. The purpose of such a document is to provide program managers and project implementers with a resource tool that will permit them to take stock of activities conducted in MENA addressing children, young people and HIV/AIDS to better plan, design and implement projects and programs in their countries. The information provided in this mapping document reveals basic project description information to help the reader determine which projects‟ experiences and lessons learned can be applied to their own particular contexts. Ultimately, the mapping document will help program managers and project implementers identify the following:
   

Who has done what, how and where; What approaches have been working and are possible in MENA, as well as what has not worked; Applicable methodologies, useful lessons learned and possible adaptations; Gaps in programming, over-programming, and areas of possible collaborations.

Additionally, this document can be used as a networking tool to help program managers and project implementers identify potential partners, promote peerto-peer or project-to-project technical exchanges, as well as facilitate the sharing of information and experiences in the region. Methodology Information included in this document was collected by means of a desk review of existing information from publications, reports, web searches, and best practices collections (WB, UNAIDS, WHO, UNICEF, Ministries of Health, etc). Additionally, UNICEF country offices and other partnering agencies, NGOs and GOs were contacted to solicit project documentation and information for
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submission (feedback to date was received from various UNICEF Country Office HIV Focal Points, UNFPA, UNHCR, IFRC, STC, FHI, RANAA). It is important to note that the projects included in this mapping document are by no means the only projects addressing, in some form or another, children, young people and HIV/AIDS. The projects included thus far are only the ones that have been either identified by the authors or were otherwise submitted from the country-level. It is expected that several more exist but have either not yet been properly documented or requests for project information have not yet been responded to. In presenting the project information, an attempt was made to standardize the format of the project descriptions. Given that submissions contained varied levels of detail, it was deemed important to include all projects identified, regardless of how much information was presented, rather than exclude projects because guidelines for submission were not followed. Program managers and project implementers will receive basic, but at least enough, information with which to make initial considerations and eventual follow-up with project contacts. Project information is laid out in three different ways in this mapping document. First, there is listing of projects by priority programming area. Second, project information is laid out by country and contains specific information (where available) for each project including project contact information; project/program purpose; objectives; main activities; outcomes; and lessons learned. Lastly, all projects are displayed in a matrix by country location and areas of priority programming – these are hyperlinked to the main project descriptions for quick reference to additional information. Examples of other programming in other regions of the world are provided as an appendix to the document.

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Children, Young People and HIV/AIDS Activities in MENA by Priority Area

Adolescent-Friendly Services/Youth-Friendly Services
   

HIV/AIDS Adolescent-Friendly Services – IRAN (MoH; UNICEF) HIV/AIDS, Malaria and Tuberculosis Control Project – DJIBOUTI (GFATM Secretariat) HIV/AIDS Prevention in Vocational Training Schools – TUNISIA (ATPF; IPPF) Horn of Africa Corridor Project – DJIBOUTI (MoH; UNICEF)

Adolescent Sexual and Reproductive Health (ARSH)
     

HIV/AIDS Prevention among Refugees – SUDAN (SFPA; IPPF) HIV/AIDS Prevention in Vocational Training Schools – TUNISIA (ATPF; IPPF) Horn of Africa Corridor Project – DJIBOUTI (MoH; UNICEF) Palestinian Family Planning Association Hotline – OPT (PFPA; Ford Foundation) Prevention des IST/VIH/SIDA en Milieu Jeune (HIV/AIDS/STI Prevention among Youth) – ALGERIA (Association AIDS-Algerie; UNFPA) Youth and Reproductive Health Project – TUNISIA (MoH; L‟Office National de la Famille et Population; UNFPA)

Advocacy
  

HIV/AIDS Communication and Education Project – IRAN (MoE; MoH; UNICEF) HIV/AIDS Prevention through Outreach to Vulnerable Populations – LEBANON (SIDC; MoH) Religious Leaders and Advocacy Program – SYRIA (UNICEF)

Especially Vulnerable Children
   

Caritas AIU Intervention Program – EGYPT (Caritas; MISEROR) Community-based Interventions in Aden Governorate – YEMEN (Government; UNICEF) HIV/AIDS Prevention for Youth – JORDAN (NAP/MoH) HIV/AIDS Prevention through Outreach to Vulnerable Populations – LEBANON (SIDC; MoH)

Gender


ISHRAQ Project – EGYPT (Save the Children; PopCouncil; CEDPA; Caritas)

Harm Reduction/Drug Prevention and Treatment
  

Caritas AIU Intervention Program – EGYPT (Caritas; MISEROR) HIV/AIDS Prevention through Outreach to Vulnerable Populations – LEBANON (SIDC; MoH) Triangular Clinics – IRAN (MoH)

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HIV/AIDS in Conflict/Post-Conflict Situations
 

HIV/AIDS Prevention among Refugees – SUDAN (SFPA; IPPF) Right to Play (RTP) – SUDAN (UNICEF)

Information, Education and Communication (IEC)/Media
     

Caritas AIU Intervention Program – EGYPT (Caritas; MISEROR) Community-Based HIV/AIDS Education for Out-of-School Youth – SYRIA (NAP/MoH) Community-based Interventions in Aden Governorate – YEMEN (Government; UNICEF) HIV/AIDS Communication and Education Project – IRAN (MoE; MoH; UNICEF) HIV/AIDS Hotline – EGYPT (MoH; Ford Foundation; UNICEF) Palestinian Family Planning Association Hotline – OPT (PFPA; Ford Foundation)

Out-of-School Youth
   

Community-based HIV/AIDS Education for Out-of-School Youth – SYRIA (NAP/MoH) HIV/AIDS Prevention for Youth – JORDAN (NAP/MoH) ISHRAQ Project – EGYPT (Save the Children; PopCouncil; CEDPA; Caritas) Prevention of HIV/AIDS among Youth at the Workplace – EGYPT (NAP/MoH)

Outreach to Vulnerable Populations
 

HIV/AIDS Prevention through Outreach to Vulnerable Populations – LEBANON (SIDC; MoH) Horn of Africa Corridor Project – DJIBOUTI (MoH; UNICEF)

Peer Education
       

Community-based Interventions in Aden Governorate – YEMEN (Government; UNICEF) HIV/AIDS Peer Education Project – LEBANON (Lebanese Red Cross; IFRC) HIV/AIDS Prevention among Refugees – SUDAN (SFPA; IPPF) HIV/AIDS Prevention in Vocational Training Schools – TUNISIA (ATPF; IPPF) HIV/AIDS Prevention for Youth – JORDAN (NAP/MoH) Peer Education Initiative in Aden – YEMEN (Government; UNICEF) Peer Education Program - IRAQ (MoH; MoYS and UNICEF) Youth Peer Education – JORDAN (MoH; FHI/USAID)

Policy Development/Health Sector Response/Institutional Capacity Building


HIV/AIDS, Malaria and Tuberculosis Control Project – DJIBOUTI (GFATM Secretariat)

Prevention of Mother-to-Child-Transmission of HIV/AIDS (PMTCT)


Prevention of Mother-to-Child-Transmission of HIV/AIDS Project – IRAN (MoH; UNICEF)

Religious Leaders


Religious Leaders and Advocacy Program – SYRIA (UNICEF)
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School Health
   

Caritas AIU Intervention Program – EGYPT (Caritas; MISEROR) HIV/AIDS Curriculum Development – IRAN (MoE; UNICEF) Peer Education Initiative in Aden – YEMEN (Government; UNICEF) School HIV/AIDS Education – OPT (Jerusalem AIDS Project; Palestinian MoH; local NGOs)

Social Mobilization/Community-Based Interventions
    

Community-based HIV/AIDS Education and Communication for Out-of-School Youth – SYRIA (NAP/MoH) Community-based Interventions in Aden Governorate – YEMEN (Government; UNICEF) HIV/AIDS Communication and Education Project – IRAN (MoE; MoH; UNICEF) HIV/AIDS, Malaria and Tuberculosis Control Project – DJIBOUTI (GFATM Secretariat) HIV/AIDS Prevention through Outreach to Vulnerable Populations in Beirut – LEBANON (SIDC; MoH)

Voluntary Counseling and Testing (VCT)
 

HIV/AIDS Prevention through Outreach to Vulnerable Populations in Beirut – LEBANON (SIDC; MoH) Triangular Clinics – IRAN (MoH)

Young Refugees/Internally Displaced Persons (IDP)
  

HIV/AIDS Prevention among Refugees – SUDAN (SFPA; IPPF) HIV/AIDS Prevention and Impact Mitigation among Refugees in Cairo – EGYPT (Sacred Heart Church; UNHCR; UNAIDS) Right to Play (RTP) – SUDAN (UNICEF)

Youth Centers/Extracurricular
  

Horn of Africa Corridor Project – DJIBOUTI (MoH; UNICEF) In-School Adolescents Program – EGYPT (Save the Children) Peer Education Initiative in Aden – YEMEN (Government; UNICEF)

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ALGERIA
PROJECT/PROGRAM NAME: Prevention des IST/VIH/SIDA en Milieu Jeune (HIV/AIDS/STI Prevention among Youth) IMPLEMENTING ORGANIZATIONS: Association AIDS-Algerie UNFPA/Algeria TARGETED POPULATION: Young people between 15-30 years of age in eight wilayates, including drug users and commercial sex workers. PROJECT/PROGRAM CONTACT: Adel Zeddam, President Association AIDS-Algerie Service de Medecine Legale, CHU Alger Center Alger, ALGERIE Tel: +213.70.21.2628/Fax: +213.21.23.6301 Email: aids_algerie@yahoo.fr

Purpose: This project was designed to promote healthy behavior among young people and adolescents in eight wilayates in Algeria, deemed one of the most vulnerable groups with respect to STIs and HIV/AIDS. It was envisaged that the project would also support the Association AIDS-Algerie in operationalizing its fight against HIV/AIDS/STIs among vulnerable groups, including young people, commercial sex workers and drug-users. Another element of this project aims to address community mobilization in achieving the project goals. This is a cost-shared project between the two organizations, but implemented by AIDS-Algerie in the wilayates of Bejaia, Skikda, Tamanrasset, Tlemcen, Oran, Mostaghanem, Tizi Ouzou, and Alger. The interagency agreement was signed in July 2004 and has a project duration of 18 months. Objectives:  To increase young peoples‟ knowledge of HIV/AIDS/STIs, as well as reproductive health and family planning, among the eight wilayates covered by the project (target: 10,000 young people);  To train health and social workers in HIV/AIDS/STI awareness building (target: 25 professionals). Main Activities:  Training activities targeting health and social workers to increase their knowledge and awareness of HIV/AIDS/STIs and increase counseling capacity to best reach the target populations;  Awareness-building and educational activities in the areas of HIV/AIDS/STIs aimed at at-risk-youth in their settings of daily activities;
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   

Designing and producing HIV/AIDS/STI informational materials, such as brochures and a CD, aimed at the target population; Conducting a behavioral survey in order to obtain baseline data on sexual behavior of sex workers; Community mobilization activities to better involve community and institutional leaders in the response to HIV/AIDS/STI; and Monitoring and evaluation activities in order to evaluate activities carried out, measure results and estimate project impact.

Source: Project documentation provided by UNFPA/Algeria.

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DJIBOUTI
PROJECT/PROGRAM NAME: Horn of Africa Corridor Project IMPLEMENTING ORGANIZATIONS: UNICEF/Djibouti Ministry of Health TARGETED POPULATION: Young people and truck drivers PROJECT/PROGRAM CONTACT: UNICEF/Djibouti P.O. Box 583 Djibouti, Republic of Djibouti Tel: +(253) 35.12.74 or 31.41.11 Fax: +(253) 356.346 Email: unicef@internet.dj

In preparing a national strategy, studies identified the following at-risk and vulnerable groups in Djibouti: adolescents and young people; truck drivers; and sex workers. Five adolescent-friendly youth centers were established which provide sexual and reproductive health services. One of these centers is housed at Horn of Africa Corridor Project, a SRH and HIV/AIDS service project physically housed in a shipping container off of a highly-accessed roadway used to transport all of Ethiopia‟s exports via Djibouti‟s sea port. Horn of Africa Corridor Project offers the following services: condom distribution; SRH services; HIV/AIDS testing; HIV/AIDS/STI information and messages.

PROJECT/PROGRAM NAME: HIV/AIDS, Malaria and Tuberculosis Control Project IMPLEMENTING ORGANIZATIONS: Executive Secretariat, GFATM FINANCING ORGANIZATION: The World Bank

TARGETED POPULATION: General population including vulnerable groups, young people and students PROJECT/PROGRAM CONTACT: Mr. Omar Ali GFATM Executive Secretary Djibouti, Republic of Djibouti Fax: +(253) 356.346 Email: omaryabeh@yahoo.fr Dr. Sameh El-Saharty Senior Health Policy Specialist The World Bank Tel: +1 (202) 458-7014; Fax: +1 (202) 477-0036 Email: selsaharty@worldbank.org

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

Background: In 2002, the Government of Djibouti (GoD) requested the assistance of the World Bank through the Multicountry HIV/AIDS Program for the Africa Region (MAP). The GoD was able to meet the eligibility criteria including the development of a strategic approach to HIV/AIDS, the establishment of a high-level HIV/AIDS coordinating body, and the channeling of funds to nongovernmental organizations and the private sector. In 2003, the Djibouti HIV/AIDS, Malaria and Tuberculosis Control Project in the amount of US$12 million in grant funds became effective. The HIV/AIDS sero-prevalence rate was estimated at 3% percent for the whole population however, it was higher than 5% among persons aged 20-35, indicating that HIV infects the economically productive and sexually active persons. This required a particular emphasis in the project interventions on the younger population groups. Purpose:  To contribute to the change in behavior of the Djiboutian population in order to contain or reduce the spread of the HIV/AIDS epidemic;  To mitigate HIV/AIDS impact on infected and affected persons; and  To contribute to the control of malaria and tuberculosis. Objectives:  To prevent the spread of HIV/AIDS by reducing transmission among high-risk groups, particularly the young population;  To expand access to treatment of STIs, opportunistic illnesses, and tuberculosis;  To provide care, support, and treatment to People Living with HIV/AIDS (PLWHA) in Djibouti;  To support multisectoral, civil society, and community initiatives for HIV/AIDS prevention and care, particularly among high-risk groups, particularly the young population; and  To promote social communication as well as peer-education in order to prevent HIV infection and the mobilization of the young people from both sexes whether not enrolled in schools or dropouts. Main Activities:  Support for capacity building and policy development of the national coordinating structure including the Interministerial Committee (IC) chaired by the Prime Minister and includes eleven ministries, the Technical Intersectoral Committee (TIC), and the Executive Secretariat (ES) as well as the strengthening of public, private, and nongovernmental institutions;  Strengthening of the Public Health Sector Response to HIV/AIDS, STIs, Malaria and Tuberculosis including the prevention and management of these diseases through Voluntary Counseling and Testing (VCT); diagnosis and case management of STIs; distribution of condoms; strengthening TB screening and treatment; strengthening of the detection, prevention, and response to malaria; and strengthening of the health system;

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

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Developing Multisectoral Responses to reinforce health education, counseling, and prevention activities in eleven ministries to better target Priority Vulnerable Groups (PVG); and Reinforcing the Community Response to strengthen community-based initiatives, associations, and NGOs so that they can implement essential activities for the reduction of the vulnerability to HIV/AIDS, malaria and tuberculosis and mitigate the impact of the epidemic.

Achievements  The provision of integrated social, psychological, nutritional and clinical care for about 400 persons living with HIV/AIDS, including treatment with Anti-Retroviral drugs;  The provision of social support to the families of infected people;  The establishment of a distribution network of condoms that reached 300 sales points and distributed more than one million condoms yearly;  Most of the planned activities in the multisectoral component were successfully realized through different ministries, notably the Ministry of Youth;  About 75 community-based projects were successfully implemented in all the districts of the country;  The provision of training to the selected peer instructors in the „Information Centers for the Young”;  The establishment of 12 “Information Points for the Youth” at the national level, which raised the awareness of more than 25,000 young people within 2 years through information and chatting sessions;  The creation of 6 “Audio listening Cells” for young girls in difficulty which is taking in charge 1440 girls per year;  Assignment of 12 animators and 20 female instructors in different information and education sites for the young;  Conducting education and prevention sessions in schools and other educational establishments that reached about 18,000 students through the distribution of 12,000 notebooks and 3,000 handbooks containing informational messages for the young;  The creation of a network of “Health Clubs” in high schools and academic establishments; and  The establishment of a social communication program on HIV/AIDS for the instructors and the peer educators in the “Health Clubs”. Lessons Learned: The successful implementation of this project may be attributed to a number of key factors:   The importance of designing the program and its interventions based on an evidence-based situational analysis, which would help identifying the epidemiologic pattern, the vulnerable groups, risk behaviors, and needs; The importance of the political commitment at the highest level;

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

     

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The provision of an integrated package of care including medical, psychological and social support to the infected persons as well as their families and not only medical care and health education; The mobilization and the involvement of all relevant government sectors and not only the ministry of health; The mobilization and capacity strengthening of the community-based associations through umbrella NGOs; The importance of applying rigorous criteria in selecting the community-based projects; The establishment of a rigorous monitoring and evaluation system to track progress; Given the sensitivity of the subject of “sexuality” and “AIDS”, it was important to get the support of the community leaders and obtain the consent of parents before launching the “youth” program, particularly for the peer educators of the youth. The community and parents‟ support worked, in turn, as a source of motivation for the young people involved in the program; The creation of “Audio-listening Cells” and “Information Points” allowed a large number of young people to acquire information on VIH/AIDS and get condoms in a discrete manner; and There is continuous need to engage the religious leaders to make it politically and religiously acceptable to publicly talk about condoms. Source: Project Information provided by Dr. Sameh El-Saharty, the World Bank.

20 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

EGYPT
PROJECT/PROGRAM NAME: Prevention of HIV/AIDS among Youth at the Workplace TARGETED POPULATION: 1,500 youth working in tourism; 2,000 young men working in factories; 2,000 young women working in industrial cities. PROJECT/PROGRAM CONTACT: Dr. Nasr El-Sayed, NAP Manager Ministry of Health and Population 3 Magles EL Shaab Street Cairo, Egypt Tel: +202.792.1059/312.5803; Fax: +202.792.1059 Email: nasr_elsayed@hotmail.com

IMPLEMENTING ORGANIZATIONS: Egyptian National AIDS Program, Ministry of Health and Population

Purpose: Initiated in 1999, this project was designed to target young people working in tourism, factories and industrial cities – primarily in tourist areas, as well as at 50 factories in Mahalla, 6 th October and 10th Ramadan cities, and in the industrial cities of Helwan and Shoubra El-Khaima. Activities targeting the working youth population used different approaches that include seminars, workshops, focus group discussions, peer education, and surveys, as well as dissemination of printed materials on HIV/AIDS/STI prevention. Objectives:  To improve the understanding of Egypt‟s working youth of their vulnerability to HIV/AIDS/STI infection;  To increase youth‟s awareness of HIV/AIDS/STI prevention;  To encourage voluntary testing among youth; and  To change youth‟s attitude towards HIV/AIDS positive persons. Main Activities:  Conducting of a quantitative study for assessing working youth‟s knowledge, attitudes and beliefs about HIV/AIDS as well as risk practices;  Conducting of a condom needs assessment among this group;  Facilitation of focus group discussions to assess working youth‟s needs for understanding risk factors and vulnerabilities;  Training of trainers and peer educators, as well as conducting orientations for factory leaders and tourism mangers; and  Development and production of educational and training materials. Source: EMRO/WHO website (http://www.emro.who.int/asd/CountryNews-SpecialProjectsEGY.htm)
21 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

PROJECT/PROGRAM NAME: Caritas AIU Intervention Program

TARGETED POPULATION: Students, children in conflict with the law, street children, health and social care providers, parentteacher association members. PROJECT/PROGRAM CONTACT: Sany Kozman, Responsible for AIDS Program Caritas/Egypt Alexandria, Egypt Tel: + 203.4806306; Fax: + 203 4877332 E-mail: caritasalex@link.net or caritas@alexnet.com.eg

IMPLEMENTING ORGANIZATIONS: Caritas Egypt (primary) MISEREOR (support)

Objectives:  To increase HIV/AIDS/STD awareness and promote preventive practices among students in 19 secondary schools and three youth detention centers;  To sensitize and prepare students to participate with active share in the fight against HIV/AIDS;  To provide anonymous, unlinked information to those in need through the help-line;  To ensure quality services at the chosen STD clinics;  To build the capacity of health and social care providers in HIV/AIDS/STD and counseling skills; and  To provide inter-sectoral and inter-agency collaboration in the fight against AIDS. Main Activities:  School-based intervention program  Program in youth detention centers  STD referral clinic  Program for PLWHA  Help-line services  Capacity building  Voluntary counseling and testing (VCT) center  Networking with local and regional NGOs (i.e. RANAA)  Harm reduction among IDUs Lessons Learned:  Incorporate school doctors early on to be involved in program delivery at school level.  Additional effort should be made to convince the authorities at youth detention centers of the importance of using anonymous, unlinked registries of all counseling cases to ensure confidentiality.  Well-designed plans for the clinic sessions in STD clinics are needed to determine which topics will be covered as well as define which messages will be conveyed.

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

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It is recommended to decentralize the counseling services in the STD referral clinic by involving more actors in order to avoid a collapse in service delivery. Summer vacations from school sessions are good opportunities for planning advocacy and marketing of the help-line. Liaising of the support group with NAP and other concerned agencies (national & international) is strongly recommended. The multipartner/stakeholder approach could be very beneficial and provide the needed materials and services, including availability of ARV. Further formal and in-service training of the social workers of the youth detention centers is recommended, to strengthen their knowledge and enhance their counseling skills, to enable them to participate effectively. It is recommended to establish an anonymous unlinked registry for counseling at youth detention centers, in which type of queries raised and responses should be registered. More effort is needed from medical personnel in STD referral clinic to advocate for counseling as a preventive tool against STD. A well designed marketing and advocacy plan is needed for the help-line services, in which the following should be identified; target groups, target sites, the message, mode of advertising and resources & costs. Data processing and data interpretation of the help-line registry is needed, to achieve better understanding of the performance of the line and to facilitate the setting up of the line future plan. Collaboration and partnership with other potential actors and stakeholders‟ governmental and non-governmental is highly recommended in order to strengthen the support group and services offered to PLWHA.

Source: Project documentation provided by Caritas/Egypt.

PROJECT/PROGRAM NAME: HIV/AIDS Prevention and Impact Mitigation among Refugees in Cairo IMPLEMENTING ORGANIZATIONS: Sacred Heart Church, Cairo UNHCR/Egypt UNAIDS

TARGETED POPULATION: School children between the ages of 13-18 years. PROJECT/PROGRAM CONTACT: Ashraf Azer, Project Coordinator UNHCR 8 El-Fawakeh Street, EL Mohandessin Cairo, Egypt Tel: +202. 7621570-3; Fax: +202.762.1576 Email: azer@unhcr.ch

23 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

Purpose: On December 2004, an HIV awareness program for school children was launched by Sacred Heart Church in Cairo as part of the UNAIDS/ UNHCR sponsored project, “HIV/AIDS Prevention and Impact Mitigation among Refugees in Cairo”. This project component targeted school children aged 13 to 18 years in four community learning centers delivering educational programs in Sakakini, Maadi, El Haggana and Shubra. Main Activities: A set of teachers‟ guidelines was developed by Sacred Heart Church, entitled “HIV/AIDS Awareness Program in Refugee Community Educational Centers” . This was achieved through conducting a literature review of existing HIV awareness publications, tools and resource materials from UNAIDS, UNESCO, UNHCR, MoHP/NAP, Family Health International, Right to Play association, SUDIA and MAAN. Teachers were trained to use these guidelines, which were field tested and subsequently adapted. The teachers consequently met with the children throughout the academic year and summer vacation on a bi-weekly basis and covered the different topics from the guidelines. These topics included: exploring values; decisionmaking; communication; gender roles; self esteem building; safe passage from childhood to adulthood; HIV/AIDS, its definition, transmission and prevention; combating stigma and discrimination; and looking after oneself and after one another. The project culminated in a closing ceremony of the program in September 2005 after one year of conducting HIV/AIDS awareness activities. The purpose of this ceremony was to share the student‟s knowledge acquired on HIV/AIDS and values explored through the awareness raising activities. Source: Project document provided by UNHCR/Headquarters.

PROJECT/PROGRAM NAME: ISHRAQ Project

TARGETED POPULATION: Primary: Out-of-school girls aged 11-15 in target rural communities. Secondary targets: Parents, boys, community leaders, program promoters. PROJECT/PROGRAM CONTACT: Mona Moneer, Program Officer for Youth Save the Children/Egypt Cairo, Egypt Tel: +202.862.3668/69; Fax: +202.862.3666/67 Email: mmoneer@savechildren.org.eg

IMPLEMENTING ORGANIZATIONS: Save the Children/US - Egypt Population Council/Egypt Center for Development and Population Activities (CEDPA) Caritas/Egypt

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

Purpose: The ISHRAQ program was launched in 2004 by Save the Children and Population Council, in collaboration with CEDPA and Caritas. This initiative is aimed at improving the life opportunities of rural out-of-school girls by providing them with safe meeting spaces and a second chance at attaining education. Consisting of learning and recreational modules, the ISHRAQ program uses sports activities in the latter to develop girls' leadership and decision-making skills. ISHRAQ also engages parents, adolescent boys, and community leaders, as well as works with schools and youth centers to provide a sheltered environment for the girls. HIV/AIDS awareness raising activities are included in the program‟s Adolescent Reproductive Sexual Health component. Partnerships have been established for this project with the Ministries of Education, Youth and Sports, Health, as well as the National Council of Childhood and Motherhood. Additionally, various community leaders have partnered with the project, including religious, women and popular leaders. Objectives:  To increase functional literacy;  To strengthen social skills and self-efficacy among girls;  To increase girls‟ mobility;  To improve positive health practices and behaviors;  To enhance family and community support of girls‟ life opportunities;  To improve local and national decision-makers‟ support of girl-friendly measures and practices; and  To provide safe public places for girls‟ learning and education activities. Main Activities: For main target group (Out-of-school girls 11-15 years of age): 1. Learning Component: - “New Horizons” activities for basic life-skills and reproductive health (CEDPA) - “Learn to be Free” for literacy (Caritas) 2. Sports Component - Sports and recreational activities 3. Leadership skills-building for girls (Training about leadership and take a role in their communities) For secondary target groups: 1. Parents: Awareness-raising meetings 2. Boys: Specialized program in life-skills, with a gender component (CEDPA‟s “New Visions”) 3. Community Leaders: Close involvement in program 4. Program promoters: Extensive training Key Accomplishments: The Population Council evaluated ISHRAQ and the results showed a positive impact on the girls‟ literacy levels, general knowledge, and participation in sports. Following the success of the pilot
25 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

phase the partners joined with the Egyptian Ministry of Youth and the National Council for Childhood and Motherhood to work towards expanding the program to other out-of-school girls in rural Egypt. Sources: Project document provided by Save the Children/Egypt; Population Council website (www.popcouncil.org/me/ishraq.html)

PROJECT/PROGRAM NAME: In-school Adolescents Program

TARGETED POPULATION: Primary: Adolescents between the ages 12-18 years who are in school (approximately 5,000 adolescents) Secondary: parents; community leaders; teachers; program facilitators PROJECT/PROGRAM CONTACT: Mona Moneer, Program Officer for Youth Save the Children/Egypt Cairo, Egypt Tel: +202.862.3668/69; Fax: +202.862.3666/67 Email: mmoneer@savechildren.org.eg

IMPLEMENTING ORGANIZATIONS: Save the Children/US – Egypt

Purpose: The In-school Adolescents program is a three-year project that began in October 2004 and will end October 2006. It was designed based on the results of a 2004 attitudes and perception study on reproductive health issues among male and female adolescents and their parents. The needs identified in this study covered health, social, education and recreation issues and the program design includes activities to help adolescents be equipped to lead healthy, successful and fulfilling lives, as well as access life opportunities. Objectives:  To increase access to health services;  To increase access to public safe spaces for learning and recreation;  To strengthen adolescents‟ capacity to develop and implement activities;  To improve family and community support of youth-led activities; and  To increase local capacity to implement adolescent development programs. Main Activities: Primary target group: (adolescents 12 – 18 years):  Conduct meetings for youth with their facilitators to acquire knowledge on communication, teamwork, leadership, and life skills. Discuss issues or topics of interest according to needs identified in self- assessments (twice weekly).  Implement recreational activities that include field trips, camps, competitions, sports, talent clubs, summer camps, and celebrations.
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Mapping of Children, Young People and HIV/AIDS Activities in MENA

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Implement health component, which includes information and awareness building (including HIV/AIDS), as well as links adolescents to available health services in and out of their villages. Implement peer to peer program, in which adolescents are trained to deliver messages to their peers. Conduct mobile health and awareness campaigns. Conduct adolescent development activities aimed at community development that are related to school health, environmental issues, and recreational opportunities.

Secondary target groups: 1. Adolescents‟ parents  Conduct meetings with parents.  Parents‟ participation in program activities.  Conduct awareness raising campaigns for parents about different issues related to youth development.  Conduct educational seminars. 2. Program facilitators  Build capacity of facilitators to work with adolescents through intensive training, meetings, and workshops.  Participation in program activities, including implementation, monitoring, and evaluation. 3. Governmental and local leaders  Advocate to leaders on adolescent development program through training, workshops, and regular meetings.  Link community leaders to adolescents to further collaborative efforts towards adolescent development.  Conduct seminars to discuss youth and adolescent issues, as well as advocate policies for to meet adolescent needs. Source: Project document provided by Save the Children/Egypt.

PROJECT/PROGRAM NAME: Egypt HIV/AIDS Hotline IMPLEMENTING ORGANIZATIONS: Egyptian Ministry of Health and Population Ford Foundation UNICEF/Egypt

TARGETED POPULATION: General population, particularly youth PROJECT/PROGRAM CONTACT: Dr. Nasr Mohamed Egyptian Ministry of Health and Population Cairo, Egypt

Purpose: In 1996, the National AIDS Program of the Egyptian Ministry of Health and Population launched a telephone AIDS Hotline entitled „Ask About AIDS‟, which was funded by the Ford Foundation. Its purpose is to provide the Egyptian population, particularly youth, with a confidential and
27 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

anonymous means to request pertinent information and pose questions regarding HIV/AIDS. The service provides both HIV/AIDS information and counseling. Main Activities: The service is staffed by male and female HIV/AIDS counselors employed by the Ministry of Health and trained in confidential HIV/AIDS counseling. Information about the hotline is advertised on public buses, in metro stations and in newspapers. The hotline has received calls from every governorate of Egypt, as well as from Egyptians living in the Gulf states and Europe. Most of the callers to the hotline are young, unmarried and are able to raise questions concerning premarital sex, condom use, homosexuality, drug use as well as sex education. Counselors‟ responses to questions are monitored by a counseling trainer to ensure that they are factually correct, non-judgmental and provide full information. There are plans to extend the hotline to other areas of Egypt. Key Accomplishments: In 2001, 64% of the callers were single, 32% were married (with data being unavailable concerning the remaining 4%), and 72% were between the ages of 13 and 25. Calls from women initially represented only 20% on average of calls, but rose to 25% by 2001. Within a year of its inception, the hotline received 1,000 calls per month, although by 2001 this figure had dropped to 5,169 calls for the year. Sources: “Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran”; USAID website (www.usaid.gov/our_work/global_health/aids/News/successpdfs/jordanstory.pdf)

PROJECT/PROGRAM NAME: HIV/AIDS Youth Awareness Project IMPLEMENTING ORGANIZATIONS: Youth Association for Population and Development (YAPD)

TARGETED POPULATION: Adolescents aged 15-18 in youth clubs/centers and secondary schools (25,000 youth). PROJECT/PROGRAM CONTACT: Dr. Hisham El-Roby Youth Association for Population and Development Alexandria, Egypt Tel. +203.010.1516322 Email: yapd@yapd.org.eg

No project information or descriptions were made available at the time of this exercise.

28 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

IRAN
PROJECT/PROGRAM NAME: Prevention of Mother-to-Child Transmission of HIV/AIDS IMPLEMENTING ORGANIZATIONS: Iranian Ministry of Health TARGETED POPULATION: Vulnerable women and HIV/AIDS-infected mothers in Iran PROJECT/PROGRAM CONTACT: Dr. Mohammad Mehdi Gouya, Director Center for Disease Control Ministry of Health Tehran, IRAN Email: mgoya57@yahoo.com

Objectives: By the end of 2007, all identified HIV-positive mothers and their newborns will be covered to receive ARV prophylaxis, based on the WHO and national guidelines. Main Activities:  Development of the guidelines and revise yearly;  Identify the vulnerable women and HIV+ mothers, mainly through voluntary counseling and testing centers;  Integration of the program into Primary Health Care System and antenatal clinics; and  Provision of preventive measures including ARV for identified mothers and the newborns, free of charge. Key Accomplishments:  To date, almost all HIV-positive women who are identified by the health systems are covered for care and provided ARV prophylaxis during pregnancies. Source: Documentation provided by UNICEF/Iran office.

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

PROJECT/PROGRAM NAME: HIV/AIDS and Adolescent-Friendly Services IMPLEMENTING ORGANIZATIONS: UNICEF/Iran Iranian Ministry of Health

TARGETED POPULATION: Adolescents and young people PROJECT/PROGRAM CONTACT: Renato Linsangan UNICEF/Iran P.O. Box 19395, 1176 Tehran, IRAN Tel: +9821.2259.4994; Fax: +9821.2259.4948 Email: rlinsangan@unicef.org

Purpose: In order to avoid an epidemic from occurring in the country, UNICEF is spearheading prevention efforts aimed at children and women. UNICEF and the Iranian Government have agreed on a five-year programme of cooperation, targeting 13 selected disparity districts. The programme will focus on prevention through information, education and communication as well as on the provision of a replicable model for adolescent-friendly services. The programme will support activities aimed at:
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Breaking the silence surrounding HIV/AIDS, addressing stigma and discrimination, and building a participatory response to HIV/AIDS; Ensuring that vulnerable children and young people are informed about HIV/AIDS and have the necessary life skills and learning opportunities to enable them to avoid risky behavior; Promoting healthy lifestyles and expanding access to youth-friendly, gender-sensitive services to enable young people to have access to confidential HIV testing and counseling; Addressing the gender inequities, violence, discrimination and unequal power relationships that fuel the epidemic; Ensuring that young people are central figures in the planning, implementation and monitoring of activities that involve and affect them; and Providing technical assistance in the development of local and national HIV/AIDS policies.

UNICEF/Iran will specifically begin three projects in 2005 addressing youth and HIV/AIDS, one of which is the HIV/AIDS and Adolescent-Friendly Services project that will target adolescents and young people at the local level. This project is scheduled to be completed at the end of 2009. Objectives: By the end of 2009, adolescent-friendly services (AFS) will be available and a corresponding national policy will have been developed in the 13 aforementioned districts. Main Activities: There are three main sub projects to this initiative and they consist of advocacy, capacity development and strategic provision of services. The following are the main activities for the first year of implementation:  Development of training module;
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Mapping of Children, Young People and HIV/AIDS Activities in MENA

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Training the trainers; and Support NGOs to implement and deliver AFS.

Lessons Learned:  It is possible to advocate for HIV prevention action, even in societies where cultural or political norms are restrictive and issues like HIV/AIDS are classified as sensitive. This initiative should be conducted through a culturally sensitive dialogue with a number of partners, through research/evidence based, provision of high level technical support and solid follow-up.  Applying a pragmatic HIV prevention approach should not be a concern in Islamic societies, especially if a non-confrontational, evidence based and participatory approach is used. As Iran has systematically involved all partners and gained confidence from all parties, both traditional and non-traditional, the country could serve as an example for the wider Islamic world.  Broadening partnerships is necessary to succeed; involvement of mass organizations for adolescents and young people is essential for disseminating messages and engaging youth in prevention and peer group activities. In Iran, there is an enormous interest among these organizations and among the media to provide correct information about HIV.  High level political commitment and support is a must, as it is the basis for the involvement and engagement of non-traditional partners. It is doubtful whether the integration of HIV and life skills messages in the national curricula would have been possible without the demonstrated commitment of the President of the nation to act on HIV prevention. Source: Documentation provided by UNICEF/Iran office.

PROJECT/PROGRAM NAME: HIV/AIDS Communication and Education Project IMPLEMENTING ORGANIZATIONS: UNICEF/Iran Iranian Ministry of Education Iranian Ministry of Health

TARGETED POPULATION: Youth aged 6-18 years. PROJECT/PROGRAM CONTACT: Renato Linsangan UNICEF/Iran P.O. Box 19395, 1176 Tehran, IRAN Tel: +9821.2259.4994; Fax: +9821.2259.4948 Email: rlinsangan@unicef.org

Purpose: In order to avoid an epidemic from occurring in the country, UNICEF is spearheading prevention efforts aimed at children and women. UNICEF and the Iranian Government have agreed on a five-year programme of cooperation, targeting 13 selected disparity districts. The programme will focus on prevention through information, education and communication as well as on the provision of a replicable model for adolescent-friendly services. The programme will support activities aimed at:

31 July 2006

Mapping of Children, Young People and HIV/AIDS Activities in MENA

 

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Breaking the silence surrounding HIV/AIDS, addressing stigma and discrimination, and building a participatory response to HIV/AIDS; Ensuring that vulnerable children and young people are informed about HIV/AIDS and have the necessary life skills and learning opportunities to enable them to avoid risky behavior; Promoting healthy lifestyles and expanding access to youth-friendly, gender-sensitive services to enable young people to have access to confidential HIV testing and counseling; Addressing the gender inequities, violence, discrimination and unequal power relationships that fuel the epidemic; Ensuring that young people are central figures in the planning, implementation and monitoring of activities that involve and affect them; and Providing technical assistance in the development of local and national HIV/AIDS policies.

UNICEF/Iran will specifically begin three projects in 2005 addressing youth and HIV/AIDS, one of which is the HIV/AIDS Communication and Education Project targeting youth aged 6-18 years. This project will be implemented at both the national and local levels, including 13 districts. This project is scheduled to be completed by the end of 2009. Objectives: By the end of 2009, 75% of girls and boys aged 6 to 18 years will possess the necessary information, knowledge and skills on how to protect themselves against HIV/AIDS. Main Activities: There are four sub projects: advocacy, social mobilization, information and education, and capacity development. The main activities will include the following:  Engaging religious leaders;  Developing child and adolescent-friendly materials; and  Promoting life skills among children and young people, especially most vulnerable ones. Lessons Learned:  It is possible to advocate for HIV prevention action, even in societies where cultural or political norms are restrictive and issues like HIV/AIDS are classified as sensitive. This initiative should be conducted through a culturally sensitive dialogue with a number of partners, through research/evidence based, provision of high level technical support and solid follow-up.  Applying a pragmatic HIV prevention approach should not be a concern in Islamic societies, especially if a non-confrontational, evidence based and participatory approach is used. As Iran has systematically involved all partners and gained confidence from all parties, both traditional and non-traditional, the country could serve as an example for the wider Islamic world.  Broadening partnerships is necessary to succeed; involvement of mass organizations for adolescents and young people is essential for disseminating messages and engaging youth in prevention and peer group activities. In Iran, there is an enormous interest among these organizations and among the media to provide correct information about HIV.  High level political commitment and support is a must, as it is the basis for the involvement and engagement of non-traditional partners. It is doubtful whether the integration of HIV and

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Mapping of Children, Young People and HIV/AIDS Activities in MENA

life skills messages in the national curricula would have been possible without the demonstrated commitment of the President of the nation to act on HIV prevention. Source: Communication from UNICEF/Iran office.

PROJECT/PROGRAM NAME: HIV/AIDS Curriculum Development IMPLEMENTING ORGANIZATIONS: UNICEF/Iran Ministry of Education

TARGETED POPULATION: School youth aged 6-18 years. PROJECT/PROGRAM CONTACT: Renato Linsangan UNICEF/Iran P.O. Box 19395, 1176 Tehran, Islamic Republic of Iran Tel: +9821.2259.4994; Fax: +9821.2259.4948 Email: rlinsangan@unicef.org

Purpose: In order to avoid an epidemic from occurring in the country, UNICEF is spearheading prevention efforts aimed at children and women. UNICEF and the Iranian Government have agreed on a five-year programme of cooperation, targeting 13 selected disparity districts. The programme will focus on prevention through information, education and communication as well as on the provision of a replicable model for adolescent-friendly services. The programme will support activities aimed at:
     

Breaking the silence surrounding HIV/AIDS, addressing stigma and discrimination, and building a participatory response to HIV/AIDS; Ensuring that vulnerable children and young people are informed about HIV/AIDS and have the necessary life skills and learning opportunities to enable them to avoid risky behavior; Promoting healthy lifestyles and expanding access to youth-friendly, gender-sensitive services to enable young people to have access to confidential HIV testing and counseling; Addressing the gender inequities, violence, discrimination and unequal power relationships that fuel the epidemic; Ensuring that young people are central figures in the planning, implementation and monitoring of activities that involve and affect them; and Providing technical assistance in the development of local and national HIV/AIDS policies.

UNICEF/Iran will specifically begin three projects in 2005 addressing youth and HIV/AIDS, one of which is the HIV/AIDS Curriculum Development Project that targets school youth aged 6-18 years. This project will be implemented at both the national level. This project is scheduled to be completed by the end of 2009. Objectives: By the end of 2009, 75% of girls and boys in school aged 6 to 18 years will possess the necessary information, knowledge and skills on how to protect themselves against HIV/AIDS.
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Mapping of Children, Young People and HIV/AIDS Activities in MENA

Main Activities:  Conducting of a rapid need assessment on HIV/AIDS life skills;  Development of life skills materials;  Development and conducting of training courses for the trainers and the teachers; and  Integration of material into school curricula. Lessons Learned:  It is possible to advocate for HIV prevention action, even in societies where cultural or political norms are restrictive and issues like HIV/AIDS are classified as sensitive. This initiative should be conducted through a culturally sensitive dialogue with a number of partners, through research/evidence based, provision of high level technical support and solid follow-up.  Applying a pragmatic HIV prevention approach should not be a concern in Islamic societies, especially if a non-confrontational, evidence based and participatory approach is used. As Iran has systematically involved all partners and gained confidence from all parties, both traditional and non-traditional, the country could serve as an example for the wider Islamic world.  Broadening partnerships is necessary to succeed; involvement of mass organizations for adolescents and young people is essential for disseminating messages and engaging youth in prevention and peer group activities. In Iran, there is an enormous interest among these organizations and among the media to provide correct information about HIV.  High level political commitment and support is a must, as it is the basis for the involvement and engagement of non-traditional partners. It is doubtful whether the integration of HIV and life skills messages in the national curricula would have been possible without the demonstrated commitment of the President of the nation to act on HIV prevention. Source: Documentation provided by UNICEF/Iran office.

PROJECT/PROGRAM NAME: Triangular Clinics - IRAN IMPLEMENTING ORGANIZATIONS: Iranian Ministry of Health

TARGETED POPULATION: PLWHA; IDUs; Patients with STIs; Family members and partners. PROJECT/PROGRAM CONTACT: Dr. Mohammad Mehdi Gouya, Director Center for Disease Control Ministry of Health Tehran, IRAN Email: mgoya57@yahoo.com

Purpose: The purpose of this initiative is to provide a whole package of primary prevention, counselling, testing, care and treatment for three main groups: people living with HIV/AIDS; IDUs; and patients with sexually transmitted infections (STIs). The target group also includes partners and families of the above groups. First piloted in 2001 in
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Kermanshah by the Medical University Health Division, the triangular were implemented and became government policy in 2002. Activities:  PLWHA: Provide information for people most at risk to raise awareness of the existence of the clinics; specific education about HIV/AIDS and pre-test counselling for at-risk groups; HIV testing for at-risk groups followed by post-test counselling; family counselling (with consent of the identified case), HIV/AIDS education; condom provision and regular testing.  IDUs: Provide HIV/AIDS education; HIV pre-test counselling; HIV testing and post-test counselling; treatment of STIs; distribution of condoms, needles and syringes; Methadone Maintenance Treatment is also available in some clinics (a pilot project has been completed in a few clinics and will be expanded to all the clinics). By providing free needles and syringes and also Methadone treatment, there will be no need for advertising for the clinics and the clients themselves inform their peers to attend the clinics. According to the data available, 49,537 syringes and 31,086 condoms were distributed among IDUs and people with risky sexual behaviors in 2004.  STI patents: Provide diagnostic services, care and treatment of STIs and partner notification. Outcomes:  All services are provided by health care providers, physicians and counsellors and information at all levels is completely confidential.  Triangular clinics in the Islamic Republic of Iran are considered by WHO as a Best Practice in the region.  More than 72 Triangular Clinics have been established. All 30 provinces and 23% of the districts, have access to at least one Triangular Clinic. According to data available more than 14,000 people have been provided with counselling in 2004.  Clinics have been established in more than 23 prisons and a referral mechanism exists between in- and out-of-prison clinics through close cooperation between the MoH and prison system. Lessons Learned: By integrating the HIV program, which includes a comprehensive package of primary and secondary prevention, into the primary health care system and into antenatal clinics, it will be easier to reach urban and rural areas. In this program, the Triangular Clinics will serve as referral centres. Source: Documentation provided by UNICEF/Iran office.

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IRAQ
PROJECT/PROGRAM NAME: Peer Education Program (still in planning stage) IMPLEMENTING ORGANIZATIONS: UNICEF/Iraq Iraqi Ministry of Youth and Sports Iraqi Ministry of Health TARGETED POPULATION: Adolescents under 18 years of age PROJECT/PROGRAM CONTACT: Alexander Malyavin, Health Advisor UNICEF/Iraq Amman, Jordan Tel: +962.6.551.5921 Email: amalyavin@unicef.org; shrasheed@unicef.org

UNICEF/Iraq, in collaboration with the Ministry of Youth and Sports and the Ministry of Health, is in the process of developing a peer education program targeting in-school and out-of-school adolescents up to 18 years of age at the Governorate level. Given the unstable environment and difficulties on the ground currently affecting Iraq, program start-up has been delayed. Nonetheless, planning is underway for this program. This peer education program is being designed to address adolescent needs by providing educational sessions at youth centers and events, including sessions on HIV/AIDS. The HIV/AIDS component will be covered in sessions addressing healthy life practices and life skills building. It is envisioned that a training-of-trainers will eventually be incorporated so that educational messages can be conveyed by youth to their peers. Currently, life skills and HIV/AIDS education manuals are currently being reviewed for appropriate adaptation to the Iraqi context. UNICEF conducted a KAP study in 2004 that included knowledge and attitudes of youth on HIV/AIDS. Findings from this baseline information will serve to better design the program content and appropriately adapt materials to best meet the needs of Iraqi youth. Source: Communication from UNICEF/Iraq Health and Nutrition Advisor

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JORDAN
PROJECT/PROGRAM NAME: HIV/AIDS Prevention for Youth TARGETED POPULATION: Primary: Vulnerable youth (out-of-school youth; unskilled young workers; and youth working in tourism areas) Secondary: Health care workers and NGOs PROJECT/PROGRAM CONTACT: Dr. Ali As‟ad, NAP Manager Ministry of Health Amman, Jordan

IMPLEMENTING ORGANIZATIONS: Jordanian Ministry of Health/National AIDS Programme

This project was implemented in October 1998 and targets out-of-school youth, unskilled young workers and youth working in tourism sites in various locations in Jordan, mainly in Amman, Zarka, Irbid, Jerash, Madaba, Karak, Wadi Moussa and Aqaba. A situation analysis on youth was conducted to examine vulnerabilities regarding sexual behavior and influencing factors. The analysis included quantitative (KAPB) and qualitative (focus group discussions), as well as fed the design of the project. A multisectoral partnership was developed to work with these vulnerable youth and a steering committee was established to ensure multisectoral inputs and support. Objectives: To promote and reinforce safe sexual behavior among vulnerable youth. Main activities:  Conduct a situation analysis on youth in the context of vulnerability;  Develop a multisectoral partnership for working with vulnerable youth;  Build youth‟s capacity in inter-personal communication and peer education; and  Provide education to youth on safe sexual behaviors. Source: EMRO/WHO website (www.emro.who.int/asd/CountryNews-SpecialProjects-JOR.htm)

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PROJECT/PROGRAM NAME: Youth Peer Education IMPLEMENTING ORGANIZATIONS: Family Health International (FHI)/Jordan Jordanian Ministry of Health Local NGOs and CBOs Jordanian universities USAID (funding agency)

TARGETED POPULATION: Youth 16-24 years of age (high school and university students, as well as hard-to-reach youth) PROJECT/PROGRAM CONTACT: Dr. Basma Khraisat, Country Director Family Health International/IMPACT – Jordan Ibn Khaldoun Street, Loay Medical Center P.O. Box 510648 Amman 11151 Jordan Tel: +962.6.462.8088; Fax: +962.6.462.8077 Email: impact@go.com.jo Website: www.fhi.org

Purpose: “Youth Peer Education” is an ongoing national project that began in August 2002. It is part of the IMPACT project implemented by FHI/Jordan, in collaboration with the Jordanian Ministry of Health and local NGOs and CBOs. As mentioned above, it targets high school and university students as well as hard-to-reach youth between the ages of 16-24. To date, 1465 peer educators have been trained in Jordan through this initiative. Objectives:  To increase knowledge and awareness of ways to prevent HIV transmission, focusing on ABCs approach: A: Abstinence B: Be faithful if married, and C: Use condoms if you cant do A or B;  To increase responsibility in decision-making that lead to healthy lifestyles;  To increase knowledge on HIV/AIDS transmission and prevention; and  To increase awareness of behaviors that put young people at risk for HIV transmission. Main Activities:  Inclusion of faith-based organizations in peer education and NGO-related activities;  Referrals to hotline and counseling centers;  Capacity building of two NGOs that conduct peer education/outreach among young Jordanians (i.e. Red Crescent Society/Family Awareness Center-Zarka);  Link university peer educators to extracurricular activities; and  Integrate HIV/AIDS messages into university student council print materials. Key Achievements:  At least 1465 youth peer educators have been trained to date.  Over 90,000 youth reached by this project throughout Jordan.  Program was initially implemented in two universities and now it is expected to expand to other universities  The project supported the national World AIDS day initiative.

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Over 107,000 printed materials with important prevention messages were produced and disseminated in the last three years.

Lessons Learned:  There was an unexpectedly enthusiastic involvement of young people who volunteered for the program.  Cultural barriers were broken through a gradual approach to discussing sensitive topics: sexuality, HIV/AIDS, stigma and discrimination toward PLWHA.  The recognition that patience and a slow, careful participatory process is needed to render a program successful.  New concepts and approaches were introduced and used for peer education, VCT, a HIV hotline, and BCC.  Evidence – based data is important for decision making at all levels. Source: Project documentation provided by FHI/Jordan.

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LEBANON
PROJECT/PROGRAM NAME: HIV/AIDS Peer Education Project in Beirut TARGETED POPULATION: Youth communities involved in sports clubs, scouts and cultural organizations; students in schools and universities PROJECT/PROGRAM CONTACT: Rana Kabalan, Project Coordinator Lebanese Red Cross Beirut, Lebanon Tel: +961.3.110.242 Email: rana_kabalan@yahoo.com

IMPLEMENTING ORGANIZATIONS: Lebanese Red Cross International Federation of Red Cross and Red Crescent Societies (IFRC) (Funding agency)

Purpose: Established in 2001, the “HIV/AIDS Peer Education Project” targets young people in communities throughout all districts of the country. Its implementers, the Lebanese Red Cross, took great strides to gain the trust of the community in order to dispel as much resistance as possible when broaching socially taboo issues. In order to accomplish this, the implementers invested much time and effort to understand the communities with which would work and make training activities culturally-appropriate. Objective:  To develop a sustainable HIV/AIDS peer-to-peer program;  To increase levels of HIV/AIDS/STI awareness;  To reduce stigma and discrimination towards PLWHA; and  To provide youth with a trusted source of HIV/AIDS/STI information. Main Activities:  Training of Trainers activities are held every two years to allow for sustainability of the project given that all the trainers are volunteers.  Training of peer educators is a continuous activity targeting the volunteers of the youth department in the Lebanese Red Cross. Trainings are conducted through a two-day workshop for not more than 20 participants per workshop. The content of the workshops focus on STIs, HIV/AIDS, the epidemiological situation, condom use and promotion, youth and HIV/AIDS, PLWHA, self-esteem, decision-making, peer pressure, high risk groups and peer education.  Local HIV/AIDS activities are implemented after volunteers are trained as youth peer educators the volunteers.  Sessions in the universities and the schools are given upon request of the university/school and usually consist of HIV/AIDS awareness and education and/or stigma and discrimination of PWLHA.
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Trainings of counselors are provided in order to build the capacity of the volunteer in the program. After receiving this training, volunteers will become responsible for a hotline that will start operating in January/ February 2006, aimed at providing youth with counseling on AIDS, drug use, STIs, as well as other issues.

Lessons Learned: The program faced a lot of challenges, particularly during its inception. Some of these issues revolved around volunteer commitment as well as responses from specific branches. Others concerned sensitivities around the discussion of HIV/AIDS issues, especially in areas where the subject is still a taboo. Initially, some communities felt that sex education is still not acceptable. Source: Project documentation provided by Lebanese Red Cross.

PROJECT/PROGRAM NAME: HIV/AIDS Prevention through Outreach to Vulnerable Populations in Beirut

TARGETED POPULATION: Vulnerable populations, including street youth, female sex workers and their clients, men who have sex with men, and drug users. PROJECT/PROGRAM CONTACT: Dr. Mostafa El Nakib, NAP Manager National AIDS Program, Ministry of Health Beirut, Lebanon Elie Aaraj, Director SIDC Daou Bldg, Yussef Karam Street, Sin El Fil Beirut, Lebanon Tel: +961.01.482.428; Fax: +961.01.485.647

IMPLEMENTING ORGANIZATIONS: Soins Infirmiers et Developpement Comunautaire (SIDC) Lebanese Ministry of Health/National AIDS Program

Purpose: This project began in 1999 and was designed to facilitate the adoption of HIV/AIDS risk reduction and health behaviors among vulnerable populations, as well as create a supportive environment to sustain prevention practices among these groups in Beirut. Vulnerable groups are defined in this project as street youth, women sex workers and their clients, men who have sex with men, and drug users. The project‟s coverage area includes all of Beirut, its suburbs and coastal areas. Objectives:  To increase awareness of HIV/AIDS risks and promote risk reduction practices among vulnerable populations;  To facilitate access to STI care and HIV counseling and testing for vulnerable populations;  To facilitate access to psychosocial support for vulnerable populations; and  To propose policy measures aimed at reducing the vulnerability of marginalized populations.

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Main Activities:  Undertaking of a situation analysis on vulnerable populations;  Development of interpersonal, group and other educational strategies for vulnerable populations;  Identifying and training resource persons on outreach approaches (i.e. social workers, health educators)  Regular outreach activities for vulnerable populations;  Identifying, training and supporting peer educators;  Drop-in services for vulnerable populations;  Referral network to health, counseling and social services for vulnerable populations;  Collaboration with different gatekeepers to facilitate outreach to vulnerable populations (bar/hotel managers, police, etc); and  Proposing policy changes in keeping with both public health and human rights concerns. Source: EMRO/WHO website (www.emro.who.int/asd/CountryNews-SpecialProject-LEB.htm)

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OCCUPIED PALESTINIAN TERRITORIES
PROJECT/PROGRAM NAME: School HIV/AIDS Education IMPLEMENTING ORGANIZATIONS: Palestinian Ministry of Health Jerusalem AIDS Project Palestinian Family Planning Association (PFPA) Makassed Islamic Charitable Hospital Galilee Health Society Middle East Regional Network on AIDS (MERNA) TARGETED POPULATION: School-attending adolescents 12-18 years old PROJECT/PROGRAM CONTACT: Jerusalem AIDS Project (JAIP) P.O. Box 7179 Jerusalem Tel: + (972) 2 6797677 Fax: + (972) 2 6797737 Email: jaipisrael@yahoo.com

Purpose: Young people are at increased risk for HIV/AIDS and in communities where limited access to public information is available via media, schools play a most important role in conveying accurate information, supporting development of appropriate attitudes and encouraging preventive behavior. While data on HIV/AIDS in the Occupied Palestinian Territories is limited and official reports from WHO indicate that no data is available at all, the fear of HIV infection exists and sporadic reports indicate that the disease is present both in Gaza and West Bank. Objectives:  To develop culturally appropriate teaching materials on HIV/AIDS for use in schools, based on a theoretical model and guided by UNAIDS approaches;  To integrate the teaching materials with existing curricula towards a comprehensive school-based education on HIV/AIDS prevention;  To train teachers in teaching the preventive education curricula on HIV/AIDS; and  To support teachers and students with updated information and tools. Main Activities:  An expert consultation was held to identify locally produced curricula and teaching materials that could be adapted for the Palestinian context. The group decided to adapt a program developed by the Jerusalem AIDS Project for use with Israeli Arab school students. Following a series of meetings and team work, the manual and accompanying posters (on flipcharts) of the Arab language curriculum were ready for dissemination in mid 1995. The

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hundreds of copies of the six-unit curriculum and teaching aids were published entitled: "Youth and AIDS". A training-of-trainers workshop was designed and interested teachers, as well as healthcare professionals working in the community, were invited to attend. The workshop was developed so that it would equip participants not only with the knowledge on HIV and its prevention, but also with teaching and communication skills on how to discuss this sensitive topic with youth. Six training workshops were held on yearly bases from July 1995 to 2000. Participants received a kit that contained the teacher's manual, two sets of cartoon flipcharts, posters, leaflets and a certificate appointing graduates "AIDS Educators". Approximately 60 teachers and community healthcare professionals participated in each workshop, half of them were Palestinians. A newsletter sent to all graduates of the training workshops provided up dated information and served as a forum of exchanging experiences.

Outcomes: A culturally appropriate school curriculum on HIV/AIDS education has been available for Palestinian schools since 1995, with links to updates and improvements. Coupled with dozens of trained AIDS educators in Gaza and many other Palestinian cities, the project is documented as the first comprehensive preventive education on HIV/AIDS program in the Occupied Palestinian Territories. The establishment of an NGO on HIV/AIDS, which took responsibility to further develop activities and materials on education for HIV/AIDS prevention, was a major step forward towards sustainability. Thousands of Palestinian school children were educated to date with this program. The module was also introduced in neighboring countries (e.g. Jordan, Egypt and Israel) and has resulted in regional collaborations. Lessons Learned:  Materials developed for schools need to be culturally appropriate, but can be adapted from existing good materials with no need to re-invent the wheel.  Teachers' training is a key for dissemination, but would require policy development and acceptance, to allow for sustainability and wide coverage.  HIV prevention could serve as a bridge between professionals from diverse cultures and communities when a regional approach in place. Sources: "Schenker I. (2006) HIV/AIDS Capacity Building as a Bridge in a Global Fight. Bridges. WHO. Jerusalem. pp 32-33."; "Erez, A., Schenker, I. (2002).HIV/AIDS and peace building in the Middle East. Entre Nous: 53. December. WHO-EURO, pp 15-16."; and " http://www.emro.who.int/asd/facts-countryprofile.htm"

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PROJECT/PROGRAM NAME: Palestinian Family Planning Association (PFPA) Hotline IMPLEMENTING ORGANIZATIONS: Palestinian Family Planning Association (PFPA)

TARGETED POPULATION: General population, in particular young people PROJECT/PROGRAM CONTACT: Dr. Izzat Ayoub Palestinian Family Planning Association

Having identified a need for information about sexual and reproductive health among Palestinian young people, the PFPA began a hotline in both Gaza and the West Bank in 1999, funded by the Ford Foundation. Telephone communication was deemed a viable means of information dissemination given the geo-political restrictions on mobility of Palestinians. The hotline aims to reduce the level of anxiety and distress among young people in relation to their SRH through providing appropriate, credible and timely advice. Counselors are trained to handle a wide range of SRH problems and provide appropriate referral for specialized care where necessary. The service is operated on a 6-day-per-week basis from 8:30AM to 5:30PM. It has become increasingly widely known through newspaper advertising and word of mouth, and has attracted calls from all over Gaza, including Arabs within Israel. The PFPA has learned that this form of counseling is socially acceptable and communities have encouraged them to continue this initiative. Sources: Shepard, B. and Jocelyn DeJong. “Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran”; (Interview with Dr. Izzat Ayoub, Palestinian Family Planning Association, July 2003 interview conducted by the aforementioned authors).

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SUDAN
PROJECT/PROGRAM NAME: HIV/AIDS Prevention among Refugees TARGETED POPULATION: Young people in Dar Es Salem Camp in North Khartoum PROJECT/PROGRAM CONTACT: Sudan Family Planning Association (SFPA) P.O. Box 170 Khartoum, Sudan Tel: +(249) 11 451095 Fax: +(249) 11 451095

IMPLEMENTING ORGANIZATIONS: Sudan Family Planning Association (SFPA)

Purpose: Sudan is surrounded by the AIDS belt of Uganda, Ethiopia, Kenya, Zaire, Central African Republic, where HIV prevalence is high. Due to the civil war in the south, migrants come to Khartoum and settle in refugee camps. 85% of this population is between 18-30 years of age. The Sudan National Project for AIDS survey shows that 70% of registered cases of AIDS are among migrants and displaced persons. The Sudan Family Planning Association (SFPA) implemented a project in Dar Es Salem Camp for displaced persons and migrants located in North Khartoum. The target group was a total of 39,545 young people. Objectives:  To raise awareness of HIV/AIDS/STI among both sexes in the target population; and  To contribute to the prevention of HIV and unplanned pregnancies through condom distribution. Main Activities:  A peer education approach was adopted. Thirty-five educators were selected in and by the refugee community, and were trained at SFPA headquarters on IEC, condom use and safer sex by experts from Khartoum University and local volunteers.  Peer educators were equipped with appropriate educational material, 3,000 posters and 3,000 leaflets designed with their help, and bicycles, which served as a means of transport and motivation. Outcomes: Project managers feel that this project was a success story for the SFPA. While qualitative evidence supports this, shortage of resources did not permit a proper survey
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to be implemented to evaluate the impact of this intervention on the target population. Lessons Learned:  A situation analysis and surveys are key for determining priority areas intervention.  Community participation and involvement from project design to implementation is determinant in such sensitive activities.  Appropriate approach and strategies (peer education in this case) contribute to the reaching of a population in crisis.  Appropriate incentives can be an important motivation for peer educators.  The experience gained in this project is being used by SFPA to design and implement other HIV/AIDS projects that target displaced people. Source: “Learning from the field: Experiences in HIV Prevention from Family Planning Associations Worldwide”. IPPF, 2002. http://new.ippf.org/ContentController.aspx?ID=8409

PROJECT/PROGRAM NAME: Right to Play (RTP) IMPLEMENTING ORGANIZATIONS: UNICEF/Sudan Ministries of Education, Social Welfare and Youth and Sports

TARGETED POPULATION: Displaced children living in camps PROJECT/PROGRAM CONTACT: UNICEF/OLS (Southern Sudan) P.O. Box 44145 Nairobi, Kenya Thuraya - 88216.511.01892 Satellite phone - 873.762.516.020

Purpose: This project had its first year of implementation in Juba, Bahr el Jebel state, southern Sudan in 2004. It addresses children‟s right to play but with much broader objectives than simply providing recreational activities. Children in conflict and post-conflict areas face barriers to healthy physical and emotional development as a result of the destruction of their communities and families. They have experienced fear, violence, uncertainty, loneliness, stress and idleness. Local government structures in Sudan do not operate child-focused health, education and recreation programs. A large need exists for organized activities for children that can reduce the stress of everyday life and encourage the development of positive coping skills. Increased awareness of health issues is also extremely important, and in the context of the long-anticipated comprehensive peace agreement, this project offers opportunities for peace building amongst participating children and adults. Objectives:  To develop individual capacity to provide on-going sport and play activities to teach leadership, communication and conflict resolution skills to children and youth;
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To provide children and youth in Juba access to regular and inclusive sport and play activities as a means to promote healthy lifestyle behavior, with an emphasis on HIV/AIDS education; and To develop the capacity of local government and community based organizations to support long-term access to regular and inclusive sport and play activities for children and youth in Juba.

Main Activities:  The development and revision of a „community map‟ showing schools, recreation and park facilities and community centers;  Over 50 coaches and over 100 teachers trained in coach-to-coach, life safe play safe and/or red ball child play methodologies.  Three workshops were held for 24 people (5 females), based on inclusiveness, and demonstrating specific games designed for persons of all abilities.  A Live Safe Play Safe Manual was developed with Equatoria State Union for the Visually Handicapped (ESUVH) creating a version in Braille.  Day of the African Child and World AIDS Day activities were organized.  An equipment loan system was adopted in 8 locations for the community and coaches to access.  Contacts were established with a disabled persons association, with the construction of a prototype for basketball wheelchairs.  The facilitation of Play Days for Day of the African Child. Source: Annual Report 2004 for UNICEF Southern Sudan Office.

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SYRIA
PROJECT/PROGRAM NAME: Community-based HIV/AIDS Education and Communication for Out-of-School Youth IMPLEMENTING ORGANIZATIONS: Ministry of Health/National AIDS Program TARGETED POPULATION: School drop-outs in Damascus and surrounding rural areas. PROJECT/PROGRAM CONTACT: National AIDS Program Ministry of Health Damascus, Syria

Objective: To decrease vulnerability of out-of-school youth in the workplace. Main activities:  Identify risk and vulnerability related to out-of-school youth via based on qualitative and quantitative research;  Build a multisectoral partnership for the design and implementation of the project;  Develop communication and education strategy and plan;  Implement the action plan;  Monitor and evaluate the project; and  Share information and results. Source: EMRO/WHO website (www.emro.who.int/asd/CountryNews-SpecialProjects-syr.htm)

PROJECT/PROGRAM NAME: Religious Leaders and Advocacy Program IMPLEMENTING ORGANIZATIONS: UNICEF/Syria

TARGETED POPULATION: Islamic and Christian religious leaders PROJECT/PROGRAM CONTACT: Mhd Imad Al-Daker, HIV/AIDS Project Officer UNICEF/Syria PO 9413 Damascus, Syria Tel: +(963) 95-319584 Email: midaker@unicef.org

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Through UNICEF/Syria efforts, significant work with sensitizing and building-awareness among religious leaders regarding HIV/AIDS was conducted. These religious leaders included Islamic and Christian leaders. Workshop trainings were conducted for Islamic imams, as well as for Orthodox leaders. Initially, all religious participants were against points raised in the trainings, but after presentations and awareness building during the workshop, resistance decreased and support increased. This Syrian initiative contributed greatly to UNDP‟s Regional Initiative on HIV/AIDS and Religious Leaders, which resulted in the 2004 Cairo Declaration. Source: Presentation made by UNICEF/Syria HIV Project Officer

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TUNISIA
PROJECT/PROGRAM NAME: Youth and Reproductive Health IMPLEMENTING ORGANIZATIONS: L‟Office National de la Famille et de la Population (ONFP) Tunisian Scouts Movement Tunisian Family Planning Association National Union for Tunisian Women Groupement de médecine de travail Tunisian HIV/AIDS/STI Association Ministries of Public Health, Defense, Education UNFPA/Tunisia Universite Libre de Bruxelles TARGETED POPULATION: Out-of-school young people between ages 15-24. PROJECT/PROGRAM CONTACT: Chokri Ben Yahia, Chargé des Programmes UNFPA Tunis P.O. Box 863, Tunis Tel : +216 71 564 942 Fax: +216 71 572 431 Email: chokri.benyahia@undp.org

Purpose: Surveys conducted in Tunisia show that most students have incomplete and often inaccurate information about SRH. Institutional channels to provide young people with much needed information on sexual and reproductive health issues needs to be reinforced. Thus, young people turn to their peers for information. These surveys also show that young people would like to have more reliable and accurate information sources on SRH. Young Tunisians remain one of the key groups having unmet needs regarding reproductive health mainly because of difficult access to reproductive health information, counseling and services in the country. “Youth and Reproductive Health” 1997-2001 is an innovative project implemented by ONFP in collaboration with national governmental and non governmental organizations and funded by the UNFPA and the Government of Belgium. The design of the project used two major approaches (1) peer education and (2) partnership. Various partners participated in the design of the project (ONFP staff, NGOs, GOs, UNFPA staff and international consultants recruited by UNFPA). This allowed for appropriate identification of objectives, activities, areas of intervention, as well as the roles and responsibilities. Objectives:  To improve the knowledge of 85,000 young people out of school in sexual and reproductive health issues; and  To facilitate the access of 10% of young people to appropriate sexual and reproductive health services. Main Activities:
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Conducting of research consisting of quantitative or qualitative studies on youth knowledge, attitudes and practices; Development of a training curriculum, whereby contents were designed by partners to be used during training of trainers and peer educators‟ workshops; Training of trainer sessions for NGO participants selected from regions covered by the project. These trainers were then able to train peer educators on sexual and reproductive health issues; Training of peer educators on sexual and reproductive health issues; Providing technical support to trainees by equipping them with the necessary documentation, facilitating technical sessions by experts or providing them some didactical materials such as the "Magnel Kit" (didactical material which furnishes basic information on contraception, STIs/AIDS, pregnancy, etc.); Conducting field activities that consisted of each NGO training 200 peer educators of both sexes. A data collection tool was designed and distributed to peer educators to register information and measure achieved results; and Conducting annual evaluations.

Outcomes: Process Outcomes  Nearly 75,000 young people were sensitized in SRH issues. The scout‟s movement had sensitized more than 22,000 young people out of school;  More than 3,000 peer educators were operating in the field, responding to peers needs and questions;  Approximately 250,000 units of condoms were purchased each year and distributed to NGOs and GOs;  Each year, thousands of educational and promotional materials were designed and distributed to NGOs, peer educators and beneficiaries;  A cadre of nearly 80 staff were trained on how to work with youth in providing counseling and information services on SRH issues to adolescents and youth in regions; and  Several materials developed: printed brochures; audio-visual clips; promotional items and didactical materials (kits and guidelines). Ownership and Partnership  Through this project, a favorable environment was established to debate young people‟s SRH issues and to design other similar projects (at national and regional level) conducted either by ONFP or by NGOs.  The government‟s favorable response to such programs is an enormous step towards reaching young people, such as in universities, schools, and ministries in charge of youth issues. Lessons Learned:  According to information collected from the field, the most important issues perceived by young people and that had most impact on their behavior were: the means of prevention and mode of transmission of HIV/AIDS/STIs; condom use; and pregnancy. Given this situation, training sessions either for trainers or for peer educators addressed these issues and appropriate materials were developed and disseminated.
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To further establish a favorable environment and ensure optimum results, teachers were involved in the process of developing the project. In addition, teachers monitored field activities and provided technical assistance to peer educators. This approach enabled the project to ensure teachers‟ participation in the project. In order to establish the concept “youth to youth”, many of the materials were designed by young people for young people. To support project activities and ensure optimum efficiency dissemination, the national media was also involved (TV, Radio, newspaper) and many spots relating HIV/AIDS/STI prevention were disseminated.

Source: Project documentation provided by UNFPA/Tunisia.

PROJECT/PROGRAM NAME: HIV/AIDS Prevention in Vocational Training Schools IMPLEMENTING ORGANIZATIONS: Association Tunisienne du Planning Familial (ATPF) International Planned Parenthood Federation

TARGETED POPULATION: Male and female young people in vocational training schools PROJECT/PROGRAM CONTACT: Association Tunisienne du Planning Familial (ATPF) 9 Rue Essoyouti El Menzah 1, Tunis 1004 Tel: +(216) 71232 419 Website: www.atfp-jeunes.org.tn

Purpose: Research carried out by the Tunisian Family Planning Association (ATPF) on the sexual health needs of young people indicated that there is: a lack and misunderstanding of information related to HIV/AIDS/STI and their prevention; an increase in sexual activity among youth; and a need for further information and services. The study results were discussed in a national workshop that resulted in identifying the need for a peer educator program, appropriate messages, as well as identifying peer educator selection criteria. Objectives:  To provide appropriate information on sexual and reproductive health to male and female students in government vocational training schools through peer education in 15 governorates of Tunisia; and  To establish youth counseling centers in the aforementioned areas. Activities:  A training of trainers (ToT) session was held in two phases for 18 trainers.  Young people were referred to youth counseling centers by their peer educators.

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

 

Peer educators were supplied with appropriate educational and teaching materials such as a peer educator‟s guide, brochures and reproductive health fact sheets and monitoring tools. Trainer/supervisors trained under the project provided the peer educators with ongoing support. The project was evaluated through annual meetings, bringing together all the stakeholders to share experiences and lessons learned, as well as to introduce amendments to project activities, as needed.

Outcomes: After receiving training on SRH (adolescence, HIV/AIDS/STI, contraception) and interpersonal communication, 300 peer educators located in 15 regions provided information to 6,000 young people on an ongoing basis throughout the year. Lessons Learned:  The pool of trainers was a major achievement of this project. They were motivated to work voluntarily with the ATPF in other activities and continue to contribute to the training efforts in the new project “dual protection for youth”.  Lack of adequate support and monitoring led to the peer educator turnover in some of the regions.  The clear definition of NGO and GO roles vis a vis a real partnership, contributed actively to the achievement of the project objectives.  The selection, training and provision of ongoing support and monitoring of peer educators were key to maintaining youth-friendly programs of high quality.  Coordination between the regional and central levels needs to be improved.  The attitude of referral center staff needs to be improved.  The needs of youth in terms of information were varied and peer educators could not respond to all concerns.  Contrary to popular belief, talking about sexuality is not a taboo subject for youth: young people yearn for such information and are looking for opportunities to discuss such matters. Source: “Learning from the field: Experiences in HIV Prevention from Family Planning Associations Worldwide”. IPPF, 2002. http://new.ippf.org/ContentController.aspx?ID=8409

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YEMEN

PROJECT/PROGRAM NAME: Community-based Interventions in Sheik Othman District, Aden Governorate IMPLEMENTING ORGANIZATIONS: Social Service Center, Sheik Othman NAP/Ministry of Health Ministry of Education Ministry of Social Affairs UNICEF/Yemen

TARGETED POPULATION: Vulnerable young men and women aged 15-24 PROJECT/PROGRAM CONTACT: Ms. Raseena Yaseen, Director Social Service Center c/o UNICEF/Yemen P.O. Box 725 Sana‟a, Yemen Tel: +(967) 1 211 400

Background: In April, 2005 a baseline survey was conducted in Sheik Othman and Dar Saad districts to examine HIV/AIDS knowledge, attitudes, and practices of young people (15-24), especially in three vulnerable neighborhoods in Sheik Othman (Saysaban, Memdara, Abdulqawi) and one neighborhood in Dar Saad (Basateen). The survey indicated that their knowledge, as measured by the ability to name at least three correct modes of HIV/AIDS transmission or at least three correct methods of HIV/AIDS prevention, figures at only 45% and 28% respectively. Regarding the perception of risk and in spite that 52% and 47% heard that prostitution and homosexuality respectively are present in their areas, the possibility of existence of AIDS cases in Aden is underestimated by 41% of the respondents. Nevertheless, stigma and negative attitudes towards HIV/AIDS patients are rather prevalent and there is a common attitude that AIDS patients need to be isolated in special health settings (78%). Purpose: The aim of the Sheik Othman community-based intervention was to target young people residing in the three vulnerable neighborhoods with basic life-skills based information on HIV/AIDS using peer education approaches, which especially focus on the gap in knowledge revealed by the baseline survey. The awareness sessions were conducted by young peer educators from Aden secondary schools. However, during sessions, potential candidates from the community were identified and helped build skills to prepare them to be future peer educators. Objective: At least 70% of youth in targeted communities will have good knowledge of HIV/AIDS transmission and prevention.
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Main Activities:  Conducted baseline survey to explore the HIV/AIDS knowledge, attitudes, and practices of targeted population;  Advocacy with political and religious leaders and with local councils and district director;  Community outreach;  Training of peer educators;  Training of community focal points;  Pre-testing of information, education, and communication materials; and  Mass media activities (TV, radio, and press coverage of peer education sessions served as an advocacy tool as well as means of awareness-building for general population). Key Accomplishments: Approximately 1,300 young men and women were targeted and reached through HIV/AIDS peer education sessions in a period of two months. From this group, 30 potential peer educators were identified to be trained. Lessons Learned:  Conducting baseline surveys help in understanding the needs of the targeted population as well as the magnitude of risk;  The use of existing networks in communities is crucial for community outreach and to ensure that high-risk and vulnerable youth are targeted;  Advocacy at the community and political levels is a pre-requisite;  Partnership with different governmental and non-governmental agencies synergizes efforts. In the case of this project, Ministry of Social Affairs, Ministry of Education, School Health, National AIDS Programme, local councils, local NGOs, local schools, and district directors were involved at all stages of the initiative;  Building on existing initiatives is very cost effective, and promotes sustainability (community based activities made use of previously trained peer educators);  Consulting with the target population on where, when, and how to conduct awareness sessions always yields better results; and  Youth participation enhances the outcomes of such initiatives. Peer education sessions were conducted by previously trained young peer educators. Source: Project documentation provided by UNICEF/Yemen.

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PROJECT/PROGRAM NAME: Peer Education Initiative in Aden Secondary Schools IMPLEMENTING ORGANIZATIONS: Office of Education, Aden National AIDS Programme (Supported by UNICEF Yemen Country Office)

TARGETED POPULATION: Students in secondary schools of Aden PROJECT/ PROGRAM CONTACT: Ms. Khadiga Qassem Awad, Director of Schools Supervision, Aden c/o UNICEF/Yemen P.O. Box 725 Sana‟a, Yemen Tel: +(967) 1 211 400

Background: In March 2005, a secondary school baseline survey, which covered all 27 secondary schools in Aden, revealed that only 37% of the students know at least 3 modes of transmission and lesser proportion 33% know 3 preventive measures. Although 77% think HIV/AIDS cases exist in Yemen, only 55% perceive that HIV/ AIDS cases exist in Aden. The study also indicated that TV, school and friends are the main sources of information on HIV/AIDS. This survey was the guiding tool to start peer education activities based in schools. The Peer Education Initiative was initiated with the selection of 27 male and female students representing all secondary schools in the 8 districts of Aden, who were trained on life-skills/peer education. The methodology used was based on a Jordanian lifeskills/peer education manual, which was field tested among 500 secondary school students. Purpose: The aim of this initiative is to form a team of peer educators who can conduct HIV/AIDS peer-education sessions for their peers in the Aden governorate, as well as field test the Jordanian "Youth Peer Education and Life-Skills Manual" in Aden secondary schools, so it can be further adapted into the Yemeni context. Objectives: At least 70% of young people have adequate awareness and knowledge of HIV/AIDS. Main Activities:  Advocacy sessions with educational supervisors, headmasters and teachers;  Advocacy with Ministry of Education at central and local levels;  Conducted baseline survey to assess the HIV/AIDS knowledge among secondary schools students;  Training of trainers to train peer educators;  Training of peer educators;  Field testing of peer education manual;  Media coverage and round table discussions; and
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

Adaptation of the peer education manual according to results of field testing.

Key Accomplishments:  To date, 500 secondary school students were targeted with peer education sessions. These sessions were an opportunity to field-test the peer education manual.  Feedback from the field-testing was used to adapt the manual to Yemeni context, which is, at this time, awaiting final approval from Ministry of Education to be used as an extra-curricular activity. Lessons Learned:  Advocacy at central and local levels with decision makers in the Ministry of Education is a crucial step for successful school-based awareness;  In order to start HIV/AIDS peer education initiatives, educational supervisors, headmasters and teachers should become stakeholders of the initiative;  Interpersonal communication with families at an early stage can minimize future resistance; and  Adolescents have great potential and need support to ensure their participation and success. Source: Project documentation provided by UNICEF/Yemen.

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III.

A Way Forward to Future Programming of Children, Young People and HIV/AIDS Activities

Touching upon the finding‟s of the MENA region‟s only publication on young people‟s sexual and reproductive health, “Breaking the Silence and Saving Lives: Young People‟s Sexual and Reproductive Health in the Arab States and Iran”, the MENA region‟s youth are experiencing lives in tremendous transition – growing urbanization; rising unemployment; breakdown of social networks; exposure to global media; migration; the widening generation gaps; and changing gender roles. In addition, the region‟s population is experiencing its biggest youth bulge, where one-third of the region‟s population is aged 10-24. Add to this the fact that the region‟s youth is lacking access to adequate SRH and HIV/AIDS information, education, counseling and services. This all leads to a large youth population that is seemingly becoming more and more vulnerable to HIV/AIDS. With these points in mind, the MENA region is in need of effective, youth-friendly and youth-focused HIV/AIDS prevention efforts to work against the growing vulnerabilities. Although MENA is currently experiencing a low HIV/AIDS prevalence, relative to other regions, it is however, experiencing the second highest rise in HIV/AIDS infections between 1996 and 2001 – 300% (preceded only by Eastern Europe‟s 1,300% rise)10. At this point, prevention is key, particularly among the growing youth population and at these times of transition and socioeconomic change. There are many examples of projects included in this mapping document that have addressed specific programming needs of young people in the region and have approaches that have been vetted by their governments and communities, as well as have experiences with implementing in the MENA context. Program managers will greatly benefit from tapping into these resources and applying them to their current and future programming. We have seen examples of projects that have provided children and young people with HIV/AIDS information and education through peer education approaches in formal and informal settings, as well as projects that have integrated life skills building and adolescent-friendly SRH services into their project activities. There are projects in the region with significant experience with reaching hard-to-reach at-risk and vulnerable groups, such as street youth, sex workers and IDUs. Successful efforts with working with advocacy and religious leaders to understand the threat of HIV/AIDS and the importance of taking action sooner rather than later.

10

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Despite the fact that not enough programming has been initiated in the area of children, young people and HIV/AIDS, where quite a few countries are not even addressing the issue yet, very important and significant steps have been taken and several lessons have been learned that could benefit the programming in other countries in the region. It is now in the hands of program managers and project implementers to use this valuable information for their planning, advocacy, and implementation purposes. Time is of the essence, where preventing HIV/AIDS among its youth maybe the MENA region‟s main hope for diverting the path of the HIV/AIDS epidemic.

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IV. Appendices

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Appendix 1: Matrix of Children, Young People and HIV/AIDS Activities in MENA by Priority Program Area

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Priority Programming Area
Harm Reduction/ Drug Prevention Outreach to Vulnerable Groups Peer Education/ Skills Building

Young Refugees/Internally Displaced Persons

Out-of-School Youth

Algeria
Assoc.AIDS/UNFPA HIV/AIDS/STI Prevention among Youth HIV/AIDS, Malaria and TB Control Horn of Africa Corridor Project Caritas AUI Intervention Program ISHRAQ Project In-School Adolescents Program HIV/AIDS Prevention and Impact Mitigation among Refugees in Cairo Egypt HIV/AIDS Hotline Prevention of HIV/AIDS among Youth at the Workplace HIV/AIDS Adolescent-Friendly Services HIV/AIDS Curriculum Development Triangular Clinics HIV/AIDS Communication and Education Project Prevention of MTCT of HIV/AIDS X X X X X X X X X X X

Djibouti
GFATM SEC/WB MoH/UNICEF X X X X X X X X X X X X X X X X X X X

Egypt
Caritas STC/PopCouncil/ CEDPA/Caritas STC Sacred Heart/UNHCR MoH/Ford/UNICEF MoH/NAP

Iran
MoH/UNICEF MoE/UNICEF MoH MoE/MoH/UNICEF MoH/UNICEF X X X X X X 63 July 2006 X X X X X X X X X

Community-based

Religious Leaders

Country/ Agency

Orphans and Vulnerable Children

Project/Program Name

Institutional Capacity Building

Youth Centers/Extracurricular

Adolescent-Friendly Services

Care, Treatment and Support

Esp Vulnerable Adolescents

HIV/AIDS in Conflict/ Post- Conflict Countries

Human Rights

School Health

VCT Services

ARSH/SRH

Advocacy

IEC/Media

Gender

PMTCT

Mapping of Children, Young People and HIV/AIDS Activities in MENA

Harm Reduction/ Drug Prevention

Outreach to Vulnerable Groups

Peer Education/ Skills Building

Young Refugees/Internally Displaced Persons

Orphans and Vulnerable Children

Out-of-School Youth

Iraq
UNICEF/Govt Peer Education Program Youth Peer Education HIV/AIDS Prevention for Youth X X X X X X X X X X

Jordan
MoH/FHI NAP/MoH

Lebanon
LRC/IFRC SIDC/MoH HIV/AIDS Peer Education Project HIV/AIDS Prevention through Outreach to Vulnerable Populations Palestinian Family Planning Association Hotline School HIV/AIDS Education HIV/AIDS Prevention among Refugees Right to Play Program Community-based HIV/AIDS Education for Out-of-School Youth Religious Leaders and Advocacy Program HIV/AIDS Prevention in Vocational Schools Youth and Reproductive Health Project X X X X X X X X X X X X X X X X X X X X X X

OPT
PFPA/Ford JAIP/MoH X

Sudan
SFPA/IPPF UNICEF

Syria
NAP/MoH UNICEF

Tunisia
ATPF/IPPF MoH/UNFPA/NGO X X X

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Community-based

Religious Leaders

Country/ Agency

Project/Program Name

HIV/AIDS in Conflict/ Post- Conflict Countries

Institutional Capacity Building

Youth Centers/Extracurricular

Adolescent-Friendly Services

Care, Treatment and Support

Esp Vulnerable Adolescents

Human Rights

School Health

VCT Services

ARSH/SRH

Advocacy

IEC/Media

Gender

PMTCT

Yemen Country/ Agency
Adolescent-Friendly Services

MoE/MoH/UNICEF Govt/UNICEF Peer Education Initiative (Aden) Community-based Interventions (Aden)
IEC/Media

Project/Program Name

X X X

Harm Reduction/ Drug Prevention Peer Education/ Skills Building

65 X X

X

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July 2006

School Health Out-of-School Youth Outreach to Vulnerable Groups VCT Services ARSH/SRH Esp Vulnerable Adolescents PMTCT Youth Centers/Extracurricular Young Refugees/Internally Displaced Persons

Human Rights Gender Care, Treatment and Support Orphans and Vulnerable Children HIV/AIDS in Conflict/ Post- Conflict Countries Advocacy Religious Leaders Community-based Institutional Capacity Building

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Appendix 2: Global Good Practices in Children, Young People and HIV/AIDS Programming

UNAIDS Best Practice Collection – Summary Booklet of Best Practices, 2000
www.unaids.org

1. Tsa Banana Adolescent Reproductive Health Programme - BOTSWANA Implemented by Population Services International; Funded by USAID Objectives: The Tsa Banana adolescent reproductive health programme was designed to:  Identify, develop, and promote reproductive health information, products, and outlets that are youth-friendly  Encourage young people to visit clinics, pharmacies, and youth centers for advice on how to avoid teen pregnancy and protect themselves against HIV/AIDS  Train retailers and clinic workers to respond to the special needs of their young clients. Main Activities: The one-year project was implemented in Lobatse from March 1995 and included the following activities:  A communications campaign;  Youth-oriented social marketing of condoms;  Community outreach through peer sales educator; and  Development of adolescent-friendly outlets for distribution of condoms and information. Peer educators taught adolescents condom-negotiation skills, correct condom use, and ABC: Abstain, Be faithful, and Condomize. Condom demonstrations were held to instruct adolescents about the correct use of condoms. The programme also provided peer education sessions in primary and secondary schools. In secondary schools, the education sessions targeted all students and addressed topics related to AIDS, HIV transmission, teen pregnancy, and condoms. In primary schools, the education sessions targeted only those over 13, and mainly provided information on puberty and encouraged abstinence. Outcomes: Research showed that 68% of female and 71% of male adolescents had heard of the Tsa Banana programme. Most (59% of females and 64% of males) had been exposed to Tsa Banana promotional items such as T-shirts, stickers, and pamphlets. More than 20% had heard about or seen a Tsa Banana condom
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demonstration. Some 41% of female adolescents and 33% of males were directly involved in Tsa Banana activities. Lessons Learned: Males and females differ both in their responses to the Tsa Banana campaign and in societal trends. Future interventions should be designed to allow for these differences. Moreover, additional emphasis may be needed to counter undesirable changes. Growing awareness that condoms protect against the risks involved in having casual and/or multiple partners may simultaneously tend to stigmatize condoms – through the associations with high-risk behavior – even as it increases the perception of benefits that accrue from using them. This enhanced understanding of the complexity of the factors that affect programme impact will help programme managers improve ongoing as well as future AIDS prevention programs. 2. AIDS Prevention through the National Union of Youth and Students – ERITREA Implemented by National Union of Eritrean Youth and Students (NUEYS); Funded by UNFPA, PSI, UNICEF, Family Planning Service Expansion and Technical Support Project (SEATS) Objectives: The programme seeks to improve health for all young people 14 to 30 years of age by training volunteers in reproductive health and family planning so that they can establish peer education programs in their schools and share their knowledge with peer groups. Main Activities: Given the prevailing situation and indications of an increase in the problems of young people and their poor awareness about reproductive health and responsible sexuality, NUEYS and the Planned Parenthood Association of Eritrea (PPAE) in 1994 designed a project of comprehensive reproductive health education and services. In recent years, HIV activities have taken on a larger profile in the overall effort. They include.  Regular sensitization seminars for high school students;  Training for adolescent reproductive health counseling;  Peer education programme;  Workshop on how to involve men in family planning and introducing female condoms;  Condom distribution;  Provision of clinical STD case management and family planning services;  Reproductive health counseling, library and recreational services for young people;  Drama and film production; and
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

Radio and newspaper.

Outcomes: A review of the cumulative achievements of the four health centers shows strong growth of services from 1996 to 1999. It is difficult to separate the HIV/AIDS component from other activities, but the following figures have been collected. Note that the clients are people between the ages of 14 and 35, in Asmara and other towns in which the centers are found. Lessons Learned: The programme illustrates the potential of a national organization like NUEYS to participate in a major public health effort – in this case, to mobilize young people against HIV/AIDS and reach out to them with services. The national union's size allows it to participate as a partner with government ministries and major international NGOs, possibilities that would be denied an organization with fewer members or a smaller geographic coverage. An important lesson learned by NUEYS in all its activities is that different populations of young people must be reached in different ways. It is relatively straightforward to bring HIV/AIDS information and activities to young people in school, but the difficult situation of the country means that concentrating only on school-based activities would miss large numbers of potential beneficiaries. Therefore, the strategy of diversity – attacking the problem of HIV/AIDS and the lack of reproductive health knowledge from multiple directions and using various media – is the most effective way to reach all young people, including some of the most vulnerable such as those who are out of school but living in or near urban areas. 3. Life Skills Programme: "My Future Is My Choice” – NAMIBIA Implemented by Youth Health Development Programme (YHDP), through multisectoral committees, and the Ministries of Youth, Health, and Education; Funding: UNICEF, Sida, Irish Aid, World AIDS Foundation, UNICEF Committee of Germany Objectives: The main objective is, by the year 2001, to provide life-skills education to 80 per cent of the country‟s young people, aged 10–18 years. The project is designed to:  Inform them about sexual heath, pregnancy, STDs, alcohol and drug abuse, and HIV/AIDS to help them make positive decisions  Improve communication skills between boys and girls, friends, and young people and their parents by providing them with information and communication or decision-making skills on sexual health. Main Activities:
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My Future Is My Choice is a ten-session programme that aims to give young people the information and life skills they need to think and make choices about their future. This involvement in their own development allows them to think for themselves and take responsibility for their future. In other words, the programme tries to give young people the courage, confidence, and skills to make informed choices about how they behave. Young people who have completed secondary school receive ten days of training as MFMC facilitators. They then facilitate MFMC groups of 20–22 young people who voluntarily sign up for the programme. The ten two-hour sessions are spread over three to five weeks and are held at schools after regular classes or in the community for out-of-school youth. Young people, trained as master trainers, supervise the facilitators. The program‟s 622 facilitators and 45 master trainers are responsible to a regional or subregional YHDP committee, which includes young people. Each facilitator works through the MFMC training manual, which has six or seven activities each session. The opening and closing activities are short and often include a game. There are at least three 20–25 minute participatory or skills development activities each session. All participants have workbooks, with information from the session and space to take notes. Three participants evaluate each session. In the last session, each participant does a peer education action plan. In addition, each school has a contact teacher who provides some oversight of the facilitator's activities. Outcomes: In 1997, approximately 7,500 young people went through the course, followed by 21,000 in 1998. In 1999, the manual was revised and made more participatory and focused. Just over 20,000 young people went through MFMC in 1999. The target for 2000 is a minimum of 40,000 young people to receive 20 hours of peerfacilitated life-skills education on sexual and reproductive health. Lessons Learned: An important lesson learned is that building the "ownership" of the activity in the communities where it takes place is a key component of success. Building such ownership is not only a matter of good will and openness, but also of organizational structure. This lesson was recognized fairly early on in the program‟s life, with the result that MFMC was decentralized in 1999 to allow the regions to manage and monitor project implementation. This has been successful, with increased inclusion of young people in the management and supervision of the activities – as equal partners with the staff of the Youth, Health, and Education Ministries. This has been a learning experience for both the adult and youth committee members. One concrete application of this experience was that the revision of the training manual in 1999 involved young people and experts. Capacity development for partners is a long-term process, and skills still need to be strengthened in project management and monitoring and evaluation. Nonetheless, by listening more to the young people, the project partners believe
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they have produced a training programme that more closely meets the needs of its participants. 4. Treasuring the Gift - Zambia Implemented by Lusaka Interfaith HIV/AIDS Networking Group (Christian Council of Zambia, Evangelical Fellowship of Zambia, Makeni Islamic Community, Zambian Episcopal Conference, Bahai Community, independent churches, and the Salvation Army) with funding support from Project Concern International (Zambia). Objectives The aim of the project is to support, strengthen, and sustain leaders of youth groups attached to religious organizations, using their religious values and traditions to promote good sexual health. The project's operational objective was to develop sexual health learning materials that require little or no literacy among participants, and that enable youth groups attached to religious organizations to:  Gain relevant and accurate information on sexuality, reproduction, and  HIV/AIDS and other STDs  Develop values and attitudes that will promote sexual health  Practice skills necessary for good sexual health  Support their members in promoting their sexual health  Take action in their communities to promote sexual health. Main Activities: A consultant writer was assigned to produce a book aimed at religious communities to help them prepare youth for adulthood in a world with AIDS (Zambia has one of the highest HIV rates in the world). The book production process involved:  Recruitment of a production team, made up of professionals, NGO representatives, and youth from a variety of religious organizations; the production team consisted of 14 young school leavers in their early twenties; the Lusaka Interfaith Networking Group identified youths to work with the consultant, who trained them to prepare the materials;  Training for the team, involving information about sexual health and religious attitudes to sexual health; the dominant training methodology was use of participatory learning activities;  Choosing topics for inclusion in the learning pack (personal values, communication skills, risky situations and self-control, dealing with negative peer pressure, interpersonal relationships, puberty and masturbation, reproduction, pregnancy, abortion, STDs, HIV prevention, living with HIV/AIDS, and breaking traditional barriers)  Youth groups, using participatory learning and action (PLA) techniques including mapping, flow diagrams, and focus groups.  The production cycle involved a series of meetings designed to test the activities as well as graphics, diagrams, and other elements, and adapt them
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as needed. That information was then fed into the writing process. Representatives of the Interfaith Group were consulted at each stage of the process and met with young people from the production team and the facilitators to make suggestions for improvement. There was agreement that there should be only one book for all faiths, rather than separate versions for Christians, Muslims and Bahais. Outcomes Treasuring the Gift: How to handle God's gift of sex, is a 142-page book for leaders of religious youth groups. It contains 18 participatory learning activities, supported by 47 pages of background information. The material is suitable for children and youth from the age of 10 upwards and can be used by mixed or single-sex groups. The instructions are clearly laid out and written in simple English to facilitate translation. It is fully illustrated with diagrams, line drawings, and photographs. Users of the book need only a minimum of training in facilitation and participatory approaches. The activities are designed to encourage honest discussion about the realities of sexual behavior among young people, religious and non-religious, and to allow youth to practice the skills they need to avoid emotional hurt, unplanned pregnancy, or infection with STDs, including HIV. Each topic is supported by information and advice, enabling facilitators to lead discussions and answer questions with confidence. Among other, more indirect outcomes:


 

An Islamic youth group has been created that plans to continue after the end of the programme, broadening its activities beyond sexual health and HIV/AIDS prevention; The Salvation Army (a Christian group) is planning a youth HIV-prevention workshop to share the work of its two participants in the programme; One participant has been asked to facilitate a day's workshop on sexual health and HIV prevention with one of the youth groups where she was conducting pretests.

One of the programme objectives was to produce a resource that did not require literacy from participants. It was thought that PLA techniques might be suitable, as they do not require literacy. The book is very easy to use: the instructions are simple, and a young person with only a few days‟ training can use it successfully. During the pretesting, some young people who were not part of the programme, and had had no training at all, used the book to lead groups. Lessons Learned The project clearly demonstrates how using young people themselves to disseminate messages is highly effective. In addition, the following lessons were learned:

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



 

Participatory approaches increase the confidence and experience of those who use them, and being involved in all phases of a production process ensures that facilitators will find it easy to teach the materials they helped design. Interfaith approaches to sensitive topics do work as long as representatives of religious groups are brought in at the beginning of the process and consulted throughout. High levels of literacy are not essential to use text-based sexual health information materials. Using outside consultants is often necessary, but their work can be made more effective by including target groups in the process from the outset. The consultant recruited for the project had worked in Zambia before and had previous experience in producing reproductive health materials for a Zambian audience. These considerations encouraged cooperation with the Interfaith Networking Group and enhanced their willingness to collaborate. The consultant was identified by Project Concern International, and was immediately accepted because of the strong existing relationship between Project Concern and the Interfaith Group.

Reducing Girls’ Vulnerability to HIV/AIDS: The Thai Approach – THAILAND http://library.unescoiicba.org/English/HIV_AIDS/cdrom%20materials/PDFfiles/reducingcse.pdf 1. Sema Pattana Cheewit (Sema Life Development Project) This project was initiated to help highly disadvantaged girls enroll in secondary school by providing them with scholarships of 3,000 baht (about US$ 77) per year. This amount was felt to be sufficient to cover all educational costs and other personal costs during the school year. 2. Thai Women of Tomorrow (TWT) Project This project has the same objective as the Sema Pattana Cheewit Project and focuses on the same group of children, namely, girls who have finished Grade 6 and do not go further in their education. There is, however, greater emphasis on changing attitudes of girls and their parents towards prostitution and on vocational training as an alternative to school. 2. Education Loan Fund Project This project aims to help disadvantaged families, but it focuses on a higher education level. Children (both girls and boys) who finish Grade 9 and cannot afford to enter upper-level secondary school, or secondary school graduates who wish to continue to vocational school or university training, are eligible for a

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loan from the education fund. Girls in the Sema Pattana Cheewit Project are given priority consideration in the determination of loan recipients.

Force for Change: World AIDS Campaign with Young People http://gbgm-umc.org/programs/wad98/force.html 1. The Asian Red Cross and Red Crescent AIDS Task Force (ART) The Asian Red Cross and Red Crescent AIDS Task Force (ART) was established in 1994 by professionals and young volunteers from 10 national Red Cross and Red Crescent Societies in Asia to promote HIV/AIDS activities at grass-roots level. In its first two years, ART trained 1000 young people as peer educators using a life-skills approach (see box). Teams of Red Cross/Red Crescent staff worked with young people in each country to develop culturally sensitive training manuals on sexual and reproductive health and HIV/AIDS. The manuals were pre-tested with groups of young people in each of the ten countries. Following this, Red Cross/Red Crescent staff met with young people from national Societies to discuss cultural differences reflected in each manual, to finalize the texts, and to develop principles for conducting sexual and reproductive health training to help young people protect themselves and their peers. 2. Youth-friendly Health Services, Lusaka, Zambia In 1994 a group of NGOs in Lusaka, Zambia, realized that existing primary health clinics were not meeting the health needs of young people. The NGOs joined with the Ministry of Health and the district council in organizing an informal working group to identify these needs and develop a strategic plan. The working group meetings were attended by young people, health staff and NGO representatives. One of the priorities identified was the need to increase the direct involvement of young people in the provision of services. Consequently, 52 young people were trained over a period of two weeks to provide counseling on pregnancy, sexually transmitted diseases, substance use, financial matters, and communication with partners. Once trained, these peer counselors provided counseling and condoms to young people who came to the clinic for them. If a young person required medical care, the peer counselor also served as a link between the young person and the medical staff. Involving young people as peer counselors had the double effect of (a) increasing attendance at the clinic because services were more suited to the needs of young people, and (b) creating strong links between the adults and young people in the community. Young people felt more comfortable talking first with their peers and then, if necessary, with an adult health care provider. 3. Clear Skies Project, Doi Saket, Thailand The Clear Skies Project was created in a rural district outside Chiang Mai, Thailand, to provide emotional and practical support for people with HIV
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infection or AIDS. The project is entirely run by people who are themselves living with HIV/AIDS, many of them under the age of 25. The project arranges weekly meetings where HIV-positive people come together to discuss common concerns such as health problems and community discrimination. They discuss possible solutions and work in partnership with various institutions, government offices, and health care centers. The project has also worked with other groups to draw up a document outlining the rights of people living with HIV/AIDS. One of the project's main activities is to provide home care for people with AIDS who are too ill to leave their homes. Volunteers train families to look after sick family members. The project also conducts workshops on meditation and yoga, maintains a herbal medicine garden, and facilitates access to health clinics and hospitals. The project works closely with health care providers to increase their sensitivity to the need of people living with HIV/AIDS for caring, sensitive, and confidential care. Many of the newest staff members at Clear Skies Project are young men and women. They are vocal advocates of prevention efforts, speaking out at conferences and in schools on the realities, risks and pains of HIV infection. They have been particularly effective in raising school youth's awareness of the difficulties faced by people living with HIV/AIDS. In classrooms where they have spoken, they have often changed young people's attitudes from discrimination and fear to feelings of compassion and solidarity.

International Planned Parenthood Federation: Learning From the Field http://new.ippf.org/ContentController.aspx?ID=8409 1. Vulnerable Youth – ‘Limers’ – GUYANA Objectives: To address the growing epidemic among this population, Guyana Responsible Parenthood Association (GRPA) expanded one component of a larger Guyana Youth HIV/AIDS STI project, to reach those most at risk: young, in- and out-ofschool youth. Main Activities: GRPA conducted outreach work among limers and minibus drivers in their own territory. Besides visiting minibus stops and sea wall parties and distributing information and condoms, GRPA worked on developing rap messages about HIV/STI prevention to be distributed to minibus drivers and conductors. By participating in a collaborative effort, GRPA was able to focus its attention and resources on a subgroup – young, female limers and the men with whom they have sex – in need of HIV/STI prevention information and increased access to condoms.

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Outcomes: At this stage of the project, GRPA staff are known to the limers, drivers and conductors. The HIV/STI prevention message is spreading and condoms are being distributed. Lessons Learned: The originality of this project lies in its community behavior change approach. Instead of targeting just young women or just minibus drivers, GRPA focused on the “community” of minibus drivers who in the past have not used condoms, and the young girls who were sexually involved with them. GRPA also went to places where the community met instead of trying to motivate people to come to them. The importance of the use of a specialized language (rap music) that is meaningful to this particular community, which gives legitimacy and credibility to the message being disseminated. 2. YES! Youth Empowerment System - PERU Objectives:  To strengthen the capacity of INPPARES to offer quality services and products to youth;  To increase the organized participation of youth within the institution in all phases and activities of the project;  To increase the availability of IEC materials and methodologies for working with youth; and  To improve knowledge, attitudes and practices related to SRH and HIV among youth by increasing access to information and education. Main Activities: A key strategy of YES! (to ensure that the specific needs of youth are met) is the active participation of youth in all phases and levels of the project. The YES! stations are operated and managed by youth educators who were selected to ensure a balanced gender mix and youth perspective. Over 75 per cent of project staff are under the age of 30, with 50 per cent younger than 25. The educators attended an intensive, off-site initial training weekend designed to increase knowledge and skills in addressing SRH matters, as well as to build a sense of teamwork and commitment to the project. The INPPARES project coordinator fosters an environment conducive to individual creativity and team co-operation with the station educators. During the initial stage of the project, staff met with local government officials from the selected neighborhoods and went house to house to speak with neighbors, business owners and youth to build community awareness and support. Municipalities agreed to provide physical space for the YES! Stations. Within the stations, educators offer private counseling to individuals, couples and groups on questions about sexuality, family planning, violence and other SRH
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topics. The YES! educators also run a variety of SRH educational and servicerelated activities at the stations, including rap sessions and discussions. They use youth-friendly games and materials developed specifically for the project by youth. In addition, a multimedia area offers youth the opportunity to use educational CD- ROMs designed and created by staff and tested by young people. The YES! stations seek to make the critical link between information and clinical services through a referral system with clinics, which are located within walking distance of the stations. Outcomes: A primary innovation of the YES! project is in offering local youth a space where they feel comfortable and have a sense of ownership; the effective use of trained peer educators who were responsible for educational activities; a variety of IEC materials were produced, ranging from traditional materials such as posters and flyers, to technologically advanced interactive CDs and educational games; the YES! project was particularly successful at reaching younger youth aged 10 to 14 – an age group which is often difficult to reach in SRH programs. Lessons Learned:
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Finding acceptable locations for the YES! Stations was difficult and security was an ongoing concern; The provision of condoms in the stations was not achieved during the project period and remains an area of challenge; In spite of the promotion of clinical services by the YES! stations, the number of youth clients seeking services at the peripheral clinics did not increase; The role of youth at all levels, but particularly youth volunteers in the stations, should be formalized to enhance youth involvement at an institutional level; Clinic staff should receive further training for effectively working with youth, and staff who are receptive to working with youth populations should be hired; and Efforts should be focused on marketing existing IEC materials produced by the YES! Project.

3. Providing Education and Services to Young People – NEPAL Objectives:  To collaborate with other agencies to improve the young people‟s access to information and services.  To advocate for necessary changes in government policies for the inclusion and expansion of sexual and reproductive health services for youth.  To increase physical and economic accessibility of sexual and reproductive health information and services for young people.  To increase the participation and involvement of young people at all levels in governance, management and sexual and reproductive health programs.
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Main Activities: The SRH activities including HIV/AIDS were implemented in an integrated way with other services. The most important approaches have been to promote and provide SRH services to young people through establishing and mobilizing the Youth Information Centers (YICs) and peer groups. Capacity building programs were organized for members, peer groups, youth club members which aim at expanding the coverage of SRH programme with a youth and gender-sensitive focus. Outcomes: The project has provided information, education and counseling for promoting SRH. It develops, produces and distributes various types of print materials such as Teenagers‟ curiosity and STI/AIDS booklets, Be Wise about Sex in Nepal, posters, condom wallets, flip charts, All You Wanted to Know brochures. Some special projects developed video films to show in rural and urban areas. Street drama was also used as an effective medium. FPAN also used the popular medium of radio to get information to young people. Lessons Learned: Young people seek access to services only if they are youth-friendly. Young people are interested in information about SRH including HIV/AIDS. Communities are generally supportive of the project efforts and were positive in working with the young people to provide sexual and reproductive health information.
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Current efforts by government and non-government sectors in relation to HIV and AIDS are inadequate. Clinical investigation of HIV is very limited and not easily accessible. The prevalence of HIV may be much higher than the reported and estimated figures. Coordination and collaboration with other local governmental and nongovernmental organizations is important to increase the access and effectiveness of the programme. It also avoids duplication, is more costeffective and may make the programme more sustainable.

4. Preventing HIV and STIs among Youth - MALAWI Objectives:  To reduce the high incidence of HIV and other STIs among the youth 15-24 years in Lilongwe City, Chiseka and Tsabango.  To increase access to accurate information and services on HIV/AIDS and other sexually transmitted infections among the youth 15-24 years by 20 per cent to adopt safer sexual practices within one year of project implementation. Main Activities:
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The project has used advocacy, information, education and communication for behavior change, the provision of youth-friendly services and capacity building in both the Organization and the targeted communities to achieve the results.
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In the area of advocacy and IEC, the project has used the existing cultural systems, market theatre and youth advocacy clubs. Forty youth peer educators, 38 traditional counselors and 47 traditional leaders (3 chiefs, 20 group village headmen and 24 village headmen) were trained to provide information to the young people in the project area. The trained volunteers were successful in mobilizing young people to discuss and provide information on HIV/AIDS and other STIs. Some of the youth and the traditional counselors were trained to perform drama and traditional dances containing messages on the prevention of HIV and STIs. The peer educators and counselors encourage young people to abstain from early sex. For those already sexually active, the traditional counselors and youth peer educators distribute condoms during the discussion or counseling sessions. Three market theatre groups were established and trained to provide accurate information on HIV/AIDS and other STIs using drama, poems, songs and other traditional dances. These groups visited market places, schools and streets and stage open-air performances, distributing leaflets and condoms. A total of 13 plays (skits), five poems, six pieces of choir/songs and four types of traditional dances and music were produced. Seventeen youth clubs have been formed and youth meet regularly to discuss issues affecting them and what they can do to prevent the spread of HIV and other sexually transmitted infections. The club members also produce plays, songs, dances and poems and perform in the community to sensitize the communities on the need to adopt safer sexual practices in order to reduce the spread of STIs and HIV.

Outcomes: A total of 9,600 male and 373 female condoms have been distributed. Ten health personnel have been trained in syndromic management of STIs and how to provide SRH services using the youth-friendly approach. 494 young clients aged 15-24 were treated for various STIs during September to December, 2001. Educational sessions were delivered by Youth Club members. Market theatre groups were also established. Lessons Learned: The use of peer education is more effective in managing projects aimed at preventing the spread of HIV and other STIs among youth.
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Activities conducted by the youth themselves are more innovative. The peer educators have been central in promoting and distributing both male and female condoms to the sexually active youth.

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 

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The creative use of theatre and other forms of folklore for communication, motivation and promotion is effective. Since the training of youth in market theatre, there has been an increased interest in services, and changing behavior patterns observed among the young people. The use of entertainment in education and communication of HIV and other sexually transmitted infections promotes the discussion of the issues by those attending and participating in the public gatherings. This then promotes dialogue and continuous communication among the young people in the communities leading to increased interest and motivation to prevent HIV and other sexually transmitted infections. The use of participatory training methods helps culturally accepted groups of people to adopt new innovations among the traditional counselors and can help in preventing the spread of HIV in the communities.

5. Promoting Adolescent Reproductive Health and Empowerment – MALAYSIA Objectives:  To provide accurate information on human sexuality including physical and emotional changes during adolescence, human reproduction, pregnancy, family life, sexual behavior and reproductive health.  To help adolescents to question, explore and assess their behavioral patterns and attitudes towards sexual and reproductive health in order to develop positive values, increase self-esteem, be more gender-sensitive and have greater understanding of their roles and responsibilities as an adolescent, as a family member and to others.  To help adolescents develop interpersonal skills, including enhancing communication with peers and parents, decision-making, peer refusal skills and maintaining healthy and responsible relationships.  To empower adolescents to make responsible decisions regarding sexual relationships including abstinence, resisting peer pressure, preventing the onset of health-damaging behaviors that affects their reproductive health and, practice of health-promoting behaviors including educating their peers on such responsibilities. Main Activities: Workshops were held among services providers from across the country on concepts related to ARH. A Steering Committee and Technical Working Group were established, comprising representatives from youth-related Government Agencies and NGOs to provide guidance and technical input in the design of the project. The project focuses on seven key concepts related to ARH and comes in an attractive and user-friendly box package that contains 9 separate books and modules. The seven concepts are: Concept 1: Understanding My Body Concept 2: Taking Care of My Health Concept 3: We Are Equal
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Concept 4: Rights and Responsibilities Concept 5: Me and My Values Concept 6: My Friends and I Concept 7: My Family and I In addition to receiving information, participants are also involved in practical, hands-on exercises where they are given opportunity to share and receive information, explore re their own values and attitudes and develop or further strengthen their skills in relation to healthy living and well-being within the context of reproductive health. Core promotion and preventive messages are inserted at appropriate intervals and are reinforced at the end of each activity to ensure optimum comprehension. Outcomes: At an ASEAN Regional and National Training Workshop on Adolescent Reproductive Health, 70 youth/peer educators and youth service providers from 10 countries received training and are now serving as Training of Trainers and Educators (TOTE). Lessons Learned: The project is offering its expertise to NGOs and other organizations interested in adapting and translating the methodology into other languages to facilitate dissemination of the contents of the Module. Consultation and participation of young people in the design of promotional material is important.

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Appendix 3: References

“Force for Change: World AIDS Campaign with Young People.” http://gbgm-umc.org/programs/wad98/force.html, June, 2005. “HIV/AIDS and Youth at a Glance.” Health, Nutrition and Population, World Bank. October 2003. “International Planned Parenthood Federation: Learning From the Field.” http://new.ippf.org/ContentController.aspx?ID=8409 , May 2005. Jenkins, C. and Robalino, D., “HIV/AIDS in the Middle East and North Africa: The Costs of Inaction.” World Bank, 2003. Preventing HIV/AIDS in the Middle East and Africa: A Window of Opportunity to Act (World Bank Regional Strategy). World Bank, 2005. Reducing Girls‟ Vulnerability to HIV/AIDS: The Thai Approach. http://library.unescoiicba.org/English/HIV_AIDS/cdrom%20materials/PDFfiles/reducingcse.pdf, June 2005. Shepard, S. and DeJong, J. “Breaking the Silence and Saving Lives: Young People‟s Sexual and Reproductive Health in the Arab States and Iran.” 2005. “The State of the World‟s Children.” UNICEF, January 2004. UNAIDS Best Practice Collection – Summary Booklet of Best Practices, 2000 www.unaids.org, May 2005. UNAIDS/WHO Epidemiological fact sheets, 2004. “Youth and HIV” website, based on 2003 UNAIDS data. http://www.youthandhiv.org/index.php?p=B_facts , May 2005.

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