Plan India
Satbir Singh Bedi | 08 Mar 2014

Plan India – an affiliation of Plan International is working in 11 states of India. For over 30 years, Plan has helped communities throughout India to help themselves, so that children have access to their rights including the right to protection, basic education, proper health care, a healthy environment, livelihood opportunities and participation in decisions which affect their lives.

Plan also work with Adolescents and Most at Risk Adolescents (MARA) who are vulnerable to HIV & AIDS.  
Young people (aged 10-24) constituted almost 400 million and represented on third of the Indian population. Adolescents aged 10-19 years constitute 325 million of the population, which is one fourth of the total population. It is generally acknowledged that significant proportion of young people experience high risk or unwanted sexual activity, do not receive prompt or appropriate care and experience adverse reproductive health outcomes. Indeed youth constitute a large proportion of the HIV positive population; it is estimated that over 35 percent of all reported HIV incidences in India occur among young people 15-24 years of age.
It is seen that among adolescents between 15 and 19 years of age, 8 percent of the girls reported sexual debut before 15 years of age, compared to 2.7 percent of the boys.  However, only 3 percent of the girls and 19 percent of the boys in this age group, who had had sex, reported using a condom the first time they had sexual intercourse.  Sexually active adolescents are vulnerable to STIs including HIV.  In the age group of 15-19 years, among those who have ever had sexual intercourse, 10.5 percent of the girls and 10.8 percent of the boys reported having STIs or symptoms of STIs.  In addition, 0.07 percent of the girls and 0.01 percent of the boys in this age group were found to be HIV positive. 
Preventing the transmission of HIV is one of the key challenges for adolescent survival and health.  Although AIDS is estimated to be only the eighth leading cause of death among adolescents aged 15-19 years, and the sixth leading cause among 10-14 year-olds, it takes a disproportionately high toll in high-prevalence countries. Investment in HIV prevention and treatment is critical to reversing the spread of HIV in adolescence.  Offering adolescents and young people high-quality reproductive health services and ensuring that they have sound knowledge of sexually transmitted infections, empower them in their choices and behaviors. Making such services and knowledge available in early adolescence, particularly for girls, is imperative; by late adolescence, the risk of infection for young people in high-prevalence countries is already considerable.
Why focus on adolescents?
1.            Their development may make them more vulnerable: They may have less knowledge, lack confidence and skills to make safer behavior choices, be less concerned about the future and more susceptible to positive and negative peer influence;
2.            They are less likely to identify themselves as being a member of an ‘at risk group’ which can make them harder to reach;
3.            They may be more easily exploited and abused;
4.            They are less likely to have access to or use available services because of a lack of awareness, limited resources or legal barriers to accessing services as a minor;
5.            They are in the main still children- interventions cannot respond to them in the same way they do for adults;
6.            Their behavior is less fixed, so risk behaviors are sometimes experimental and temporary
Most at Risk Adolescents (MARA) and their vulnerability to HIV/ADS:
MARA is defined as adolescents whose behavior and living conditions put them at risk of contracting HIV. A meeting report and discussion paper from the Interagency Youth Working Group, USAID, the United Nations on HIV/AIDS (UNAIDS) Inter-Agency Task Team on HIV and young people emphasized to call more attention to young people within the groups considered ‘most at risk’ for HIV – those who sell sex, those who inject drugs and young men who have sex men. Due to their vulnerability one could also add Street and Working Children, Children of Female Sex Workers and trafficked children to the MARA category.
The above groups of adolescents are not prioritized as target group for HIV intervention in the National AIDS Control Programme-IV (NACP-IV) of Government of India. Other programmes are also not sufficiently to address on prevention of HIV amongst these adolescents.
To have a better understanding on addressing these adolescents Plan India seek ideas, suggestion, practical experiences or best practices from members, experts, NGOs, institutions etc on the following:
1.        What are the gaps and challenges on policies and programmes addressing HIV & AIDS amongst Adolescents and MARA who are vulnerable to HIV & AIDS?
2.        What would be strategies to address this issue
3.        What are the areas of convergence to address these adolescents and MARAs?