By Thomas Scalway
Consultant Panos Institute AIDS Programme London

Discussion:
Before we begin the process of developing an ASEAN youth network, we need to establish why we need an ASEAN youth network, and why we need to involve young people in responding to AIDS more generally. Clearly there are some obvious reasons. Youth need to be represented within the ASEAN decision making process. Young people are best placed to talk about their own experiences, needs and priorities. They are the ones best placed to motivate their peers - and it is difficult to overestimate the degree of influence that one young person has on another.

There are strong epidemiological reasons for targeting youth - most of which have been laid out already. Figures in 2000 and 2001 show young people between the ages of 10 and 24 years 2 make up 25 percent of the world’s population, roughly 1.7 billion people. Of these,86 percent live in developing countries. Although birth rates have declined since the 1980s, the young age structure, particularly in poorer countries, means an overall increase in the number of people entering their reproductive years. Statistically, young people now are the healthiest, most educated, and most urbanized of any previous cohort.

However, increasing urbanization, and increasingly stark gaps between rich and poor, brings greater exposure to high-risk behaviors. Complications associated with pregnancy, childbirth, and unsafe abortions are the major causes of death for women aged 15 to 19. In parts of Africa, young women are more than five times more likely than young men to contract HIV.
But young men are also highly vulnerable to HIV, often because they perceive themselves as invulnerable. Of all population groups, young men are the most likely to be involved in activities associated with HIV risk. They are more likely to inject drugs than any other group, and to do so using risky methods. In most countries they have more sexual partners than any other group, yet they report that they feel less at risk from AIDS. In many countries they are the most frequent purchasers of sex. They are also the group who most commonly assault their sexual partners.

Perhaps one of the most persuasive arguments for targeting young people is the fact that they are receptive to influences while they are still in the process of developing their attitudes and sexuality. Catching them while they are still finding out about their bodies and responsibilities to others makes more sense than trying to counter habitual attitudes and patterns of behaviour in older adults. In addition, many are still at school, where structures are in place to deliver education. In the developing world, more than 70 per cent of children currently complete at least four years of schooling - with young men accounting for more of this number than young women. Many young men are members of youth clubs, sports teams or other youth organisations. These formal and informal educational institutions already have a number of the necessary resources necessary for providing AIDS-related services. Where there are ready-made venues, teachers, role models, and large catchments of young men, the foundations of HIV-prevention programmes are already in place.

The United Nations estimates that one-half of all new HIV/AIDS cases are among 15- to 24-year-olds. Young people of both sexes are at a particularly challenging stage in the life-cycle, often facing problems such as unemployment, adolescent pregnancy, and drug and alcohol abuse. Each of these issues requires different approaches to reach youth and to respond to their needs.

So young people are a key window of opportunity within the response to HIV/AIDS. In this context it is particularly worrying that few countries have an official policy regarding adolescent reproductive health. Many countries, from the level of government down to schools and families, impose social or legal barriers to discourage young people from seeking reproductive health information and services. Religious beliefs, cultural traditions, entrenched notions of gender, age and sexuality restrict open and frank dialogue on young people, HIV/AIDS and sexual health. Similarly, hierarchies of age, and a range of other power inequalities, inhibit young people - particularly those most affected by HIV/AIDS, from having their say in the way their societies are dealing with the epidemic.

This is not a minor issue. This is a global epidemic, one that makes SARS look tame in comparison. However, the response to this epidemic, from the international level right down to the national and provincial level, is one that is very rarely driven by those with most at stake.

This can be highlighted by a brief examination of the way in which the response to AIDS is being shaped. As AIDS climbs up the international agenda, money follows, with more being spent now than ever before. Estimates range from $1.5billion to $2.8 billion spent in 2002. While some countries are decreasing their overall development budget, the proportion of money spent on HIV/AIDS is generally going up. The US, for example, has seen a six-fold increase in overseas HIV/AIDS assistance since 1995 and the UK has increased its HIV/AIDS spending from £38m in 1997/98 to £207m in 2001/02.

The renewed focus on HIV/AIDS was underlined when President Bush chose his State of the Union Address in January to announce that the US would spend $15 billion over 5 years on fighting the epidemic worldwide. The fact that the global HIV/AIDS epidemic was addressed in an event as high profile and important to the administration as the State of the Union Address, speaks of the increased recognition of the need to address HIV/AIDS globally. This announcement is also topical because of the way the US is allocating the funds. Rather than using them to boost up an international, coordinated response through the global fund, which only received a minority of funds, they are once again side-stepping international organisations and are making a series of bilateral agreements instead.

There seems to be an increased interest and urgency in addressing the epidemic in this region as became evident at a high-level meeting on HIV/AIDS -- "Accelerating the momentum in the fight against HIV/AIDS in South Asia". The meeting was organized by UNAIDS and UNICEF, the United Nations Children's Fund, on 3-4 February 2003 in Kathmandu.

More money does not equate to more opportunities for participation. Conversely, many current strategies seem to be undermining locally owned and driven responses.

In a recent survey by Panos, only 24% of the 277 organisations working on AIDS thought that communities affected by HIV/AIDS were adequately represented in general decision making. Donors were asked about the extent to which institutional, bureaucratic or political constraints detracted from their efforts to ensure their work was guided, owned and implemented by communities most affected by HIV/AIDS. The majority reported that there was a real issue here, with 21.6% of all donors reporting that institutional factors almost totally prevented the work from being guided, owned and implemented by communities most affected by HIV/AIDS, with a further 5.4% saying that these factors completely precluded ownership by those most affected. Remarkably, only 2.7% of donors feel that these factors do not come into play.

And there are strong institutional reasons why participation and ownership - particularly amongst youth - has not been as great as it should have been.. With levels of spending on HIV/AIDS increasing year on year, people working within donor agencies are under intense pressure to keep transaction costs down, and to prove maximum impact of the funds they spend.

Institutional constraints generally require relatively short project funding cycles. Projects with concrete deliverables, like posters, leaflets or high-profile events, are invariably favoured. As those within the donor community are testifying these constraints are becoming more intense, not less.

So we are operating in an environment where decisions are being made often without our input, where donor agencies are having to shift large amounts of money quickly without being able to consult with the different stakeholders, including youth. We are operating in an environment where national and international politics can eclipse the needs of those most affected, and the age group which offers the greatest window of opportunity.

None of this is rocket science, and these sentiments have been expressed in various different ways in just about every AIDS forum in the last 20 years. International policy discourse is replete with declarations, statements and objectives targeting youth. One of the key challenges will be to create a network, a functional political entity that can hold policymakers to their word.

Youth legislation and policy:
There are various different policies we should keep tabs on.
ICPD: The Program of Action drawn up at the International Conference on Population and Development in Cairo in 1994 urges countries to “ensure that the programs and attitudes of health-care providers do not restrict the access of adolescents to appropriate (reproductive health) services and the information they need…”
According to IPPF: This Conference sketched out some important sexual and reproductive health rights includes being able to:

Have a happy life and personal relationships; decide yourself whether to be sexually active or not; enjoy a safe and healthy sex life in which you protect yourself and are protected by your partner against disease and illness; feel completely well and happy in your body and; your mind; decide if, when and how many children to have; make sure that women and girls stay healthy while pregnant; make sure that babies are born healthy...
GFATM The global fund for AIDS, TB and Malaria has changed the landscape of AIDS funding. The fund should bring real increases in the amounts of cash designated for HIV/AIDS, and, as a tool for measuring international commitment to the cause and the contribution of individual countries, the fund should be an effective tool.
Within the Global Fund, one of the criteria for proposals is:

“Aim to eliminate stigmatisation of and discrimination against those infected and affected by HIV/AIDS, especially for women, children and vulnerable groups.”

Based on the idea of Kofi Annan in April 2001, when he called for the creation of a Global Fund to fight AIDS TB and Malaria, the fund was brought to life after the United Nations General Assembly Special Session on AIDS in autumn 2001 and approved its first round of proposals in 2002. The second round of proposals was approved in January 2003. The creators of the Fund hoped it would become the main funding mechanism channelling cash from heavyweight donors through to the most needy recipients. Its remit is global and it disburses funds on a country basis, mostly for integrated programmes involving a collection of organisations at national level. For many, the fund is the best method for balancing the need for a rapid dispersal of cash to fight HIV, whilst ensuring this is done in an accountable manner, with ample participation of local stakeholders. However, cash for the fund has not been as forthcoming as originally hoped. Instead of having 10bn dollars a year for HIV/AIDS, only 3.3bn dollars has been available over a 3 years time span. The impact of these shortfalls have been far-reaching. For example, it was announced in February 2003 that the Fund had to ask Caribbean communities to downgrade a proposal it had submitted as the Fund did not have sufficient money to support the whole project.
In the Southeast Asian region most country’s have a national CCM and the contact addresses and phone numbers of the CCM members are available on the Global fund website. The ASEAN Task Force on AIDS decided in October 2002 to put forward a proposal to the Global Fund to fund its Workplan II.

UNGASS (General Assembly Special Session on AIDS) represented a watershed in terms of United Nations thinking on HIV/AIDS and included a stress on youth issues.

The UN General Assembly Special Session on AIDS noted in its Declaration of Commitment on HIV/AIDS ‘Global Crisis-Global Action’ ‘that people in developing countries are the most affected and that women, young adults and children, in particular girls, are the most vulnerable.’ The UN committed itself to

‘By 2005, ensure that at least 90 per cent, and by 2010 at least 95 per cent of young men and women aged 15 to 24 have access to the information, education, including peer education and youth-specific HIV education, and services necessary to develop the life skills required to reduce their vulnerability to HIV infection, in full partnership with young persons, parents, families, educators and health-care providers;’

(Article 53 UNGASS Declaration of Commitment)
In another relevant part of the declaration the commitment is to:

‘By 2003, develop and/or strengthen strategies, policies and programmes which recognize the importance of the family in reducing vulnerability, inter alia, in educating and guiding children and take account of cultural, religious and ethical factors, to reduce the vulnerability of children and young people by ensuring access of both girls and boys to primary and secondary education, including HIV/AIDS in curricula for adolescents; ensuring safe and secure environments, especially for young girls; expanding good-quality, youth-friendly information and sexual health education and counselling services; strengthening reproductive and sexual health programmes; and involving families and young people in planning, implementing and evaluating HIV/AIDS prevention and care programmes, to the extent possible;’ (Article 63, UNGASS Declaration)

One of the indicators, which measures the impact and continued commitment to UNGASS at a national level is the success or failure of a country to have a policy or strategy that promotes sexual health education for young people.
UNGASS also named as a target that the percentage of young people aged 15 -24 who are HIV-infected are reduced by 25% in most affected countries by 2005 and a 25% reduction, globally, by 2010. We should aim to remind our UN colleagues and other policymakers of these commitments.

MDG: At the United Nations Millennium Summit in September 2000 world leaders placed adopted the Millennium Development Goals (MDGs), which set clear targets for reducing poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women by 2015. Each goal is divided into targets, which come with a set of indicators to measure progress in achieving the Goals.

Goal number 6, Target 7 deals with HIV/AIDS:“By 2015, to have halted and begun to reverse the spread of HIV/AIDS” One of the indicators is the prevalence rate amongst 15-24 year old women.
The Convention on the Rights of the Child (CRC): The CRC (1989) is a set of legal rules. The CRC has 54 different paragraphs (called articles) that cover the rights of children and young people. Some of these rights apply to your sexual and reproductive health.191 Governments around the world have signed and approved the CRC. They have promised to make sure that all children and young people below the age of 18years, survive, grow, are protected and participate as active members of society.

So, with all this legal and policy infrastructure supporting young people and HIV/AIDS, and the clear imperative to bring young people more central due to their window of opportunity and the fact that a variety of forces are covering their voices now, how do we best bring this about?

There are a number of existing networks and programmes aiming to mobilise youth in the region - and we certainly do not want to reinvent the wheel. Rather we want to build on existing bodies and networks, and draw on the different strengths of each.
First we need to ask ourselves some crucial questions. Are the regional networking needs of young people being met? Do young people have sufficient input into ASEAN and other transnational policy processes? If not, what kind of a structure could give them this voice? If a new initiative is required, are we absolutely certain of our mission and our objectives?

Outlining a process:
Firstly, we need to establish our needs (presuming we are not happy with the status quo), mission and objectives. Here we need to work out what the problems are, what the solution to these problems are, and from these, determine our objectives and mission.
Then we need a stakeholder analysis. Who is already doing what? We need a list of organisations that are involved in doing the above types of activities. How could we draw upon the skills, networks and capacities of these organisations? How do we bring them on board?
Then we need to come up with a plan. This will build on the needs we have identified, the solutions to the various goals and challenges of regional networking and advocacy on HIV/AIDS. It will maximise synergies with other organisations and networks, and piggy back on other programmes’ capacity wherever possible.

First, here are some general considerations:
These are drawn from Panos’ efforts at networking, and our experience in participating in other peoples networks - ranging from Regional HIV/AIDS Information Network in Southern Africa, through to the UNAIDS partnerships within the new HIV/AIDS Communication Framework, and our work with Rockefeller on Communication for Social Change.

1) Networks are difficult to sustain. Goals and motivations need to be anticipated and supported. Political and institutional tensions can be destructive - use clear explicit frameworks and memorandums of understanding. Talking and face to face communication is much safer and more valuable than email. Be sensitive to local territorialities.

2) Fundraising needs to take place both short and long term. In the short term there is a need for visible “products”, strong indicators, and for creative approaches to developing a holistic, unified strategy, then fundraise for small parcels of it.
In the longer term it is important to be involved in policy and funding discourse for example the Global fund and Country Coordinating Mechanisms, continual PR, networking, and fostering articulate champions. The people setting the AIDS agenda should never be able to forget that this youth network is there.

3) We need to strike balance between the provision of structure, and allowing youth to lead. Different groups have different needs, but some degree of structure and order makes activities more fun and productive than encouraging young people to reinvent their own structures whenever the whim takes them.

4) Need to make it fun. Most of the successful projects for youth have a strong “fun” component. The strategy of “edutainment” is one of the most effective methods of educating all ages, particularly young people. And projects can be made to be fun, even if they have a serious purpose. Pop concerts with people singing about HIV/AIDS are an obvious example. In South Africa they have Love Life, which has a Love Train. A brightly coloured train that tours the country providing vital AIDS information and services.

5) ITCs provide new opportunities. The internet, mobile telephony, digital imaging, the drop in the cost in producing high quality sound or video files, new high speed data cables and satellite connections all offer valuable new opportunities for engaging youth. Young people are some of the quickest to pick up on the value of all these technologies.
New networking technologies are bring a range of new opportunities that need exploiting. Examples of online forums, telephone hotlines, and other use of technologies abound. And the affinity many young people have for technology, plus the options for privacy in discussing sexuality, or for broadcasting messages to large audiences, means that the way in which young people use and adopt these technologies is really at the very first chapter of its evolution
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6) The media is one of your most powerful allies. Youth issues make good news, reporters are anxious for the kinds of stories young lives produce. The media is a key instrument in terms of influencing policymakers. Get the media on your side, and the policymakers will follow. The media is also a key method for communicating across networks. The media can offer a forum for the exchange of HIV information (it is one of the main sources for young people) as well as news about recent policy and programme developments. The media can offer a space for debate, where different views can be aired and heard, often without the constraints of age and social status that hinder participation of young people in other types of debate and decision making.

7) The last point is obvious, but it can easily be forgotten as we get increasingly sophisticated in our strategies, and more complex as institutions or networks. Remember that the aim is to reduce the massive harm that AIDS is wrecking, to care for one another, to work within a common cause for a common purpose. It means being non-judgemental of behaviours and beliefs that are different to ours, and of accepting and embracing each of our differences.