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Light at the End of the Tunnel:

HIV Prevention for Colombia’s Internally


Displaced Youth
A Case study supported by
The United Nations Population Fund - UNFPA

“For us young people, it’s like being in a dark, long


tunnel: first, it was the war, then running away from
it, and now fear of dying of AIDS. But now, we can
see the light at the end of the tunnel …

Hector, 17. Barrancabermeja, Colombia

Margaret Sanger Center International at


Planned Parenthood of New York City

2007
Margaret Sanger Center International,
Planned Parenthood of New York City
26 Bleecker Street
New York, NY 10012-2413
Tel. 212.274.7200
Fax. 212.274.7300
www.ppnyc.org

ACKNOWLEDGEMENTS
This report was written by Dr. Fabio Castaño, Associate Vice President, Margaret Sanger Center
International at Planned Parenthood of New York City (MSCI/PPNYC). Ms. Shana Ward, former
Program Officer MSCI/PPNYC and intern Ms. Eundira Hill provided research support. MSCI/PPNYC is
deeply indebited to Dr. Angela González-Puche, Manager of Proyecto Fondo Mundial Colombia (PFMC)
and her Bogotá-based team for their invaluable assistance in coordinating the mission and site visits that
were conducted in order to gather information for this report. PPNYC/MSCI are grateful to PFMC’s local
executing agencies in Barrancabermeja, Bogotá, Bucramanga, and San Pablo for their efforts coordinating
interviews, focus groups and local events with youth, communities, local authorities, and other
stakeholders. Vital support was also provided by Ms. Linda Eriksson, the Program Officer of IOM.
UNHCR and Observatorio de Paz of the Corporación para el Desarrollo del Magdalena Medio provided
significant logistical and travel assistance. And the entire project would not have been possible without
the invaluable financial support of the United Nations Population Fund (UNFPA). Finally, PPNYC/MSCI
will be forever indebted to the many displaced young Colombians (“los y las jóvenes”) who shared their
time and their stories.

Photographs courtesy of “Proyecto Colombia” and Fabio Castaño.


Contents
Acronyms......................................................................................................................………………………..…i

Map of Colombia ...................................................................................................…… ……………………….ii

Executive Summary ..................................................................................................………………………….. .1

1. Background...............................................................................................................………………………..1
What are internally displaced youth and why they are vulnerable to HIV?
UNFPA and MSCI organizational expertise about internal displaced youth and youth-focused HIV
prevention
Guiding principles for HIV prevention programs targeting internally displaced youth (IDY)

2. The crisis of Colombian internally displaced persons (IDP)........……………………………………….6


Social and economic context
The conflict’s history
Displacement
Sexual and reproductive health situation of IDP

3. Proyecto Fondo Mundial Colombia: a national response to prevent HIV among IDY ……………….11
Goals and objectives
Structure and operation

4. Findings ……………………………………………...................................………………………………..13
Rights-based approach
Protection, security, justice, and reparation
Gender Equity Promotion
Youth participation and ownership
Assessment, surveillance, monitoring and evaluation
Coordination and mainstreaming for a multi-sectoral approach and durable solutions
Evidence-based HIV programming
Quality Services
Training and Capacity Building
Resource mobilization, collaborative partnership, and advocacy

5. Conclusion …………………………………………………………………………………………………26

6. Recommendations ...............................................................................................………………………..…26

Appendices ………………………………………………………………………………………………………28
List of organizations that have participated in the Country Coordinating Mechanism (CCM)
Contact list Colombia
List of global organizations with experience on youth, HIV, and internal displacement
Annotated bibliography related to HIV, youth and internal displacement
Notes
Acronyms and Abbreviations
AIDS Acquired Immune Deficiency Syndrome
ART Antiretroviral Treatment
AUC Autodefensas Unidas de Colombia (Self-Defense Forces of Colombia)
BCC Behavioral change and communication
CCM Country Coordinator Mechanism
CSOs Civil society organizations
ELN Ejército de Liberación Nacional (National Liberation Army)
FARC Fuerzas Armadas Revolucionarias de Colombia (Revolutionary Armed Forces of Colombia)
FP Family Planning
GDI Gross Domestic Income
GBV Gender-based Violence
GFATM Global Fund to fight AIDS, Tuberculosis and Malaria
HIV Human Immunodeficiency Virus
IDPs Internally Displaced Persons
IDC Internally Displaced Children
IDY Internally Displaced Youth
ICPD United Nations International Conference on Population and Development
IEC Information, Education, Communication
ILO International Labor Organization
IOM International Organization for Migration
LEPs Local executing partnerships
MSCI Margaret Sanger Center International
MPS Ministerio de Protección Social (Ministry of Social Protection)
MSM Men who have sex with men
MTCT Mother-to-child transmission
NGO Nongovernmental Organization
OAS Organization of American States
OCHA United Nations Office for the Coordination of Humanitarian Affairs
PEPFAR President’s Emergency Plan for AIDS Relief
PPNYC Planned Parenthood of New York City
PROFAMILIA Associación Pro bienestar de la Familia Colombiana
RH Reproductive Health
RHRC Reproductive Health for Refugees Consortium
SRH Sexual and Reproductive Health
STI Sexually Transmitted Infection
SV Sexual violence
SYW Safe Youth Worldwide
UN United Nations
UNAIDS Joint United Nations Program on HIV/AIDS
UNDP United Nations Development Program
UNFPA United Nations Population Fund
UNHCR United Nations High Commissioner for Refugees
UNICEF UN Children’s Fund
UNIFEM UN Development Fund for Women
USAID United States Agency for International Development
VCT Voluntary Counseling and Testing
WFP World Food Programme
WHO World Health Organization
YFS Youth Friendly Services

i
Map of Colombia

Areas under armed conflict from where internally displaced persons are expelled
Project sites
Project sites visited

ii
EXECUTIVE SUMMARY

As of 2006, after Sudan and the Democratic Republic of the Congo, Colombia had the third-largest
displaced population in the world and the worst humanitarian crisis in the Western Hemisphere. Over
three million Colombians displaced since 1985 account for 7% of the country’s total population. Children
and adolescents, who represent about half of all displaced, are the most vulnerable to sexual violence,
early-unwanted pregnancy, HIV, and other sexually transmitted infections.

In November 2006, the United Nations Population Fund (UNFPA) requested the assistance of Margaret
Sanger Center International (MSCI) of Planned Parenthood of New York City (PPNYC) to conduct an
assessment and write a country case study of the largest HIV prevention program in Colombia focused on
internally displaced youth (IDY), “Construction of a multi-sect oral response in sexual and reproductive
health, with emphasis on prevention and attention to STIs/HIV/AIDS among adolescents and young adults
living in a context of internal displacement in Colombia,” better known as “Proyecto Fondo Mundial
Colombia (PFMC).” Between November and December 2006, Dr. Fabio Castaño, MSCI’s Associate
Vice President for International Programs, began work on this collaboration with UNFPA by visiting
Colombia to gather information about the lessons learned from the implementation of the project.

Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and implemented by the
Country coordinating mechanism (CCM) and the International Organization for Migration (IOM), this
HIV/AIDS prevention and treatment project is the most comprehensive initiative to date targeting IDY in
Colombia and the Western Hemisphere.

To conduct the research, Dr. Castaño traveled to project sites in four cities and met with individuals from
local executing agencies (LEA), local governments, project beneficiaries, and other stakeholders. He used
an assessment framework combining human-rights and programming principles based upon several
existing tools to determine the extent to which PFMC was addressing specifics HIV-related concerns of
IDY and whether such efforts were making a difference.

Working within the enormous challenge of armed conflict, poverty, and political and social fragility
in Colombia, the CCM, GFATM, and IOM successfully implemented a comprehensive initiative to
reduce the vulnerability of IDY to HIV. The project increased social awareness about HIV and the special
vulnerability of young people (particularly IDY); improved coordination among international donors,
governmental agencies, and civil society organizations (CSOs); and build up the capacity and skills of
thousands of young leaders, local authorities, health providers, teachers, and local executing agencies.
Although the MSCI assessment found that there was potential for improvement in various areas, the
project is a “must see” initiative in which agencies such as UNFPA could gather information and learn
lessons to inform projects in other countries supporting HIV prevention and care among youth displaced
due to emergencies and conflict.

BACKGROUND

What are internally displaced youth and why they are vulnerable to HIV?

“Internally displaced persons are persons or groups of persons who have been forced or obliged to flee
or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the

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effects of armed conflict, situations of generalized violence, violations of human rights or natural or
human-made disasters, and who have not crossed an internationally recognized State border.”1

In addition to these characteristics defining Internally Displaced Persons (IDP), agencies and authors
stress the fact that IDP usually leave their land, their property and belongings, their jobs, and, in many
instances, their families and communities. Almost 25 million people currently live in situations of internal
displacement in 52 countries as a result of conflicts or human rights violations. Although internally
displaced people now outnumber refugees by two to one, their plight receives far less international
attention probably because unlike refugees they do not cross international borders.2

As part of an increasing recognition that most IDPs are women, children, and young people, concepts
such as Internally Displaced Women (IDW), Internally Displaced Children (IDC), and Internally
Displaced Youth (IDY) have been added to the literature on refugees and displacement.3 Although youth
are often defined as individuals between the ages of 15-24, this report focusing on IDY uses the broader
definition of youth (ages 10-24) first used by the World Health Organization (WHO) and later by
UNFPA.4 This age range better reflects the fact that sexual and reproductive health problems, including
early-unwanted pregnancy, sexual violence, HIV and other STIs, affect many displaced persons between
the ages of 10-14.

Emergencies create and enhance the conditions in which the HIV/AIDS crisis thrives. The destruction of
community and family, disintegration of social norms, increase in female headed households, lack of
health services/information and increased rape and sexual violence are all factors that render displaced
populations particularly vulnerable to HIV transmission. This is especially true for the most vulnerable of
the populations in a society, such as young people. The destruction of community and family networks
and disruption in social norms governing sexual behavior that occur in emergencies often lead to sexual
relations at an earlier age and increased risk taking among young people. The many serious consequences
of such behaviors include sexually transmitted infections (STIs) and HIV, unwanted pregnancies, and
unsafe abortions.5 And, if the trauma that such young people experience is not remedied by adequate
social support, many will suffer serious physical and mental health consequences.6 Despite these difficult
circumstances, however, many internally displaced young people serve as critical agents for
reconciliation, peace building, community recovery, and social development in their communities.

UNFPA and MSCI organizational expertise about IDYand HIV prevention


Recognizing that a collaborative approach is the preferred model for effectively meeting the protection
and assistance needs of IDPs, the UN system has worked over the past decade to improve the
coordination of its humanitarian operations targeting the needs of such populations.7 As a result, most
UN agencies now collaborate on humanitarian operations tailored to IDPs and IDY including: OCHA,
UNDP, UNICEF, UNIFEM, UNFPA, UNHCR, WFP, and WHO. In addition, governmental and non-
governmental organizations (NGOs), including faith-based organizations, have stepped up their efforts to
collectively address the plight of young people affected by crises such as internal displacement.

UNFPA plays an important role in ensuring that sexual and reproductive health issues are addressed
as part of larger responses to refugees and internally displaced populations in conflict and post conflict
situations. UNFPA advocates for the reproductive health and human rights of women and girls including
their protecting them from sexual and gender based violence. The agency promotes gender equality
within sexual and reproductive health programs, with a special focus on empowering women’s groups.
And, UNFPA provides support for the critical reproductive health education and services that are
needed to prevent unwanted pregnancy and care for individuals diagnosed with STIs, including
HIV/AIDS. Indeed, working in collaboration with NGOs, governments and international agencies,
UNFPA currently supports emergency health programs in more than 30 countries.

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In addition to working to build the programmatic capacity of local partners in many countries, UNFPA
has helped to advance the larger policies that best support the most effective humanitarian responses to
IDY among wide ranging UN-affiliated organizations. For example, building upon the United Nations'
Guiding Principles on Displacement and an interagency consultative process on Emergencies and
Transition, UNFPA and UNICEF organized and hosted an Experts Group Meeting on Adolescent
Programing on Emergency and Transition in December 2006. In addition to advancing a common
framework for more effective and coherent programmatic responses in situations of conflict and post-
conflict, the forum identified specific strategies for action and partnerships that will help ensure program
implementation.

Over the past three decades, Margaret Sanger Center International (MSCI), the international arm of
Planned Parenthood of New York City (PPNYC), has worked to improve the sexual and reproductive
health (SRH) of individuals in more than 50 countries worldwide. MSCI’s comprehensive technical
assistance has supported the work of numerous UN agencies and has strengthened the capacity of local
governments and organizations to provide comprehensive sexuality education and HIV prevention
programs that specifically address the needs and rights of young people and women. MSCI has worked
closely with several key international and national organizations to improve the SRH of youth, refugees
and displaced populations in Southern Africa and to reduce gender based violence (GBV)8 and HIV
prevalence in Africa and the Caribbean.

For example, from 1999 to 2003, MSCI collaborated with UNHCR on the “Young Refugee &
Reproductive Health Programme” in Southern Africa. As part of such efforts, MSCI conducted needs
assessments and focus groups with refugee youth from Angola, Burundi, Congo-Brazzaville, DR Congo,
Ethiopia, Rwanda, Sudan, and Uganda living in refugee camps in Botswana, Namibia, and Mozambique.
Based on the information gathered from these assessments, MSCI developed and implemented a series of
training programs that were deisgned to help a network of refugee peer educators in Namibia and
Botswana promote the sexual and reproductive health of young people in their communities. For
example, these educators increased their fellow refugees' knowledge of safe reproductive health practices
and prevetion of STIs, HIV/AIDS and teenage pregnancy. In addition, during this period, MSCI's regional
office in South Africa trained master trainers from UNHCR and NGOs serving IDPs and refugees in
Southern Africa on sexual and reproductive health (SRH) programming that is tailored to the needs of
refugees.

MSCI’s unique expertise in HIV prevention among youth led to a successful partnership with UNFPA
called Safe Youth Worldwide - SYW (2002-2005). This project used a framework of “essential
elements” for effective youth-focused HIV prevention programs, including guiding approaches, program
strategies and managerial practices, to improve the quality, sustainability, and organizational capacity of
seven implementing partner agencies. The initiative resulted in collaborations between governmental
agencies and more than 100 local groups that provided HIV prevention programs to more than one
million youth in five countries.9

Since 2005 MSCI has provided technical assistance to “Proyecto Fondo Mundial Colombia” (PFMC), a
project focused on HIV prevention for internally displaced youth in several provinces in Colombia
supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). As part of such
efforts, MSCI trained more than 75 representatives of organizations from 48 municipalities on youth-
focused HIV prevention and youth-friendly services. Finally, in 2006, MSCI and local partners in the
Dominican Republic worked with displaced Haitian populations living in bateyes (slums surrounding
sugar cane plantations) to improve medical services and prevention programs, and create awareness about
the linkages between the proliferation of HIV among women and young people and high rates of GBV.

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Guiding principles for HIV prevention programs targeting IDY
In recent years, international humanitarian organizations have started to pay greater attention to plight of
young people living in conditions of displacement. Despite the greater attention to the needs of such
young people, however, serious gaps remain in the services that are being provided to them, particularly
when it comes to addressing the link between their displacement and their increased vulnerability to
violence, sexual abuse, HIV/AIDS, STIs and other serious sexual and reproductive health conditions.
Unfotinately, the guiding principles that underlie the rights of IDY to be protected from such life
threatening challenges remain poorly understood and and are thus underaddressed.

For example, youth-focused policy and legislation are not available in most countries dealing with
displacement. Moreover, as a result of a lack of communication among local and international
humanitarian agencies working to develop strategies for meeting the needs of youth in emergencies and
transition, there are many duplications of effort that diminish the potential overall impact. In addition,
funding for programs that explicitly target the needs of young people affected by internal displacement
remains highly limited and the initiatives that do exist tend to focus on young people as problems, not as
essential resources with energy and creative solutions.10

In order to help bridge this gap between the needs of IDY and programs responding to their sexual and
reproductive health, MSCI developed and implemented an assessment framework in one targeted country,
Colombia. MSCI used this framework to determine the extent to which existing HIV prevention programs
were addressing specific concerns of IDY and wheter such efforts were making a difference.

MSCI's framework for conducting this assessment was based upon several existing tools including UN-
developed guiding principles on displacement, 11 objectives for HIV prevention among IDPs, 12 and
MSCI's essential elements for youth-focused HIV prevention.13 These resources were combined to group
principles and elements in a framework of to two categories: human rights specific and program-related.
This framework was the used to analyze the experiences and lessons that can be learned from PFMC.

Human rights principles:


1. Rights-based approach: Programs and interventions employing a rights-based approach ensure that
the rights of young people in conditions of forced displacement are respected and protected. Such
programs educate young people about their own human rights, including their rights to access
reproductive health care, and involve young people in the implementation of the programming that is
provided. By raising young people’s awareness of their own rights, program developers createan
environment that is most likely to foster effective youth participation and use of key services, as well
as the adoption of responsible behaviors. Indeed, recognizing IDY as powerful actors in their own
lives is the key to breaking the chain of marginality, poverty, and exclusion from society that is so
often their fate. It is also important that interventions work towards reducng stigma against youth and
people living with HIV and AIDS andpromote voluntary counseling, and testing (VCT) and access to
critical prevention and treatment services.
2. Protection, security, justice, and reparation: As is often the case for IDPs, IDY are often an oppressed
minority group within a country thatlacks protection against many life-threatened situations,
including HIV/AIDS. As a result, programs and interventions targeting such youth should make every
effort to ensure their security and protection and should work closely with national and international
agencies developing legislation and strategies to remove the effects of human-rights violations, and
promote justice and the right to integral reparation.
3. Gender Equity Promotion: Programs should work to promote equitable gender norms and equitable
access to health and education services for IDY. Working from both male and female perspectives,
programs should promote the empowerment of women and girls and prevent GBV at the societal,

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community, family and interpersonal levels. They should also help boys and men redefine gender
roles in ways that will help them to stay healthy and.
4. Youth participation and ownership: Finally, many interventions for IDY can be strengthened by the
active particiapation of young people in in program design and implementation. Indeed, programs
that are developed in this manner can draw upon young people’s considerable strengths while also
respecting their capacities to shape their own destinies. In some situations, however, such active
engagement of young people in program design may increase their vulnerability and risk of
persecution, particularly in areas with armed conflict. Therefore, decisions about engaging young
people in program development should be made on a case-by-case basis.

General programming principles:

5. Assessment, surveillance, monitoring and evaluation: Baseline data (disaggregate between IDPs and
non-displaced populations, as well as gender and age) must be collected in order to allow for
effective monitoring and evaluation of HIV interventions over time.
6. Coordination and mainstreaming for a multi-sectoral approach and durable solutions: Strong
coordination and communication among all agencies providing HIV/AIDS programs to IDY need to
occur throughout all phases of intervention (acute emergency, transition and longer-term
development) in order to ensure that outcomes can be measured and to assess whether the benefits of
such programs are sustained over time. It is also crucial to facilitate linkages across different sectors
of HIV prevention, including broader health services, education, and economic and job opportunities,
in order to minimize duplication of services and maximize the collective impact of such efforts.
7. Evidence-based HIV programming: Programs should draw upon the criteria that have been found to
most effectively create an environment that promomtes healthy sexual development and the practice
of behaviors that can best protect against HIV/AIDS. Such policies and programs identify
developmentally appropriate interventions (age, need, right) for HIV prevention, treatment, and care.
They employ communication strategies that are most likely to promote behavior change and integrate
these strategies into all and integrate it into counseling, information, education and communication
(IEC) activities as well as thesocial marketing of health services so that the same essential messages
are promoted through multiple channels. And, such programs address sexuality as a positive part of a
young person’s development and a subject about which all young people are entitled to receive
information that is free of shame, guilt, and fear-laden messages. Finally, such programs and services
should be culturally appropriate and should build on the existing positive values and practices within
the cultural, religious, and social contexts that are served, while counterbalancing negative values and
practices.
8. Quality Services: The most successful programs will ensure the provision of or linkage to key youth-
friendly services that include VCT, access to condoms, management of sexually transmitted
infections (STIs), and referral to networks where IDY can access necessary services and opportunities
that are similar to the level of those being provided by their surrounding host communities. For
example, as antiretroviral therapy (ART) become available to surrounding host communities,
programs that target IDY and IDPs in general, should also have access.
9. Training and Capacity Building: The development of skills and capacities for program implementers
and stakeholder should be a major component of all interventions aim to prevent HIV among IDY.
10. Resource mobilization, collaborative partnership, and advocacy: Finally, in all displacement
situations there is a need for significant resource mobilization among governmental agencies, local
and international donors, communities and the private sector. Effective programs will work with and
ensure the accountability of governments and key NGOs at the local, regional, and country levels in
order to ensure that the needs of IDY are addressed in HIV-related legislation, policies, and budgets.

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2. THE CRISIS OF COLOMBIAN INTERNALLY DISPLACED POPULATION

Social and economic context


Colombia is a country of a little more than one million square kilometers (the size of France, Spain, and
Portugal combined). About one-fourth of its population lives in rural areas. As of the 2005 national
census, the country’s population was 42.09 million, with almost even numbers of men and
women (48,8% male and 51,2% female).14 The country’s principal ethnic majority are the
mestizos, a population of mixed indigenous and European descent who account for around 58%
of the total population. Other ethnic groups in this country are: whites, descendants of the
Spanish (20%); mulatto, mixed African and white descent (14%); Afro-Colombians (4%); and
indigenous (1%). The reduction since the 1950s of infant mortality to the current level of 17,2
per 1,000 live births has spurred an improvement in life expectancy to 72.8 years. The per capita
gross national income (GNI) as of 2005 was $2,290.15

In the 1990s, Colombia’s economy suffered a significant downturn as a result of the financial and trade
liberalization process that consisted of cuts in public spending (including health and education),
decentralization of state functions, liberalization of labor markets and removal of price controls. The
stagnation of the economy was reflected in the worst decline of growth indicators of the century. In this
period the decrease in basic health spending dropped the vaccination rates in children under one year of
age from coverage of more than 90% in 1996 to coverage of barely 70% in 1999. Although there has been
a slight recovery in the GNI in the past five years, the country still face high levels of poverty and
unemployment, and adverse effects on school attendance and social security.

In 2000, 49.5% of people living in urban areas were below the poverty line, whereas in rural areas the
percentage of poor people was 84.9%. Colombians’ economic opportunities are shaped by one of the
world’s least equitable land and wealth distributions. By the year 2000, 5 percent of the landowners had
contol of almost 80 percent of land and 61.5% of annual income was in the hands of 20% of the
population, whereas the poorest 20% had to survive with 2.4% of the income. According to the World
Bank report in 1998-1999, after Brazil, Colombia was the country with the highest social inequality in the
continent.16 The income gap between the richest 10% of the population and the poorest 10%, increased
from 52.1 times in 1991 to 80 times by 1999.17 This social and economic inequality has facilitated
worsening and spreading of social and armed conflict.18

The conflict’s history


Colombia, which has the oldest democracy in Latin America, has seen conflict of one kind or another for
over 150 years. The escalation of violence known as “La Violencia” (1948-1964) appears in retrospect as
the opening act of the strife that continues to this day. The war in Colombia represents the American
continent’s longest running internal conflict marked by organized armed rebellion and official repression.
The causes of the conflict are an intermixing of historical legacies, such as social and economic inequality
in access to resources and to the political arena. Increasingly, it has been transformed into a struggle for
the control of territorial and economic resources.19

The parties involved in this conflict in the last two decades are the Colombian Revolutionary Armed
Forces (FARC) and the National Liberation Army (ELN) which are left-wing insurgent groups or
guerrillas, the Self-Defense Forces of Colombia (AUC) which is an umbrella organization of right-wing
paramilitary groups, and the Colombian national armed forces. Contrary to humanitarian law, all parties
make use of “dirty war” strategies, namely the targeting of civilians, of which internal displacement is a

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direct and intended result. The human rights violations have increased with the continual deterioration of
Colombia’s internal conflict.

Since the mid-1960s, the FARC and ELN have been responsible for the killing and abduction of civilians,
kidnapping, hostage-taking, disappearances, recruitment of child soldiers, the cruel and inhuman
treatment of captured combatants, and the forced displacement of civilians. Further, FARC forces
disregard international legal norms using prohibited weapons (land mines and gas cylinder bombs),
attacking medical workers and facilities, and recruiting child soldiers. In the 1970s and 1980s, local
landowners and businessmen created small “self-defense” groups to defend themselves and their property
against guerrilla violence. These groups strengthened by death squads created by drug cartels created the
paramilitary group known as AUC. This army, which has operated with the tolerance of Colombian
military units, has a long history of abuses against civilians, including massacres, assassinations, torture,
forced displacement, forced disappearances, and kidnappings. Both guerrilla and paramilitary groups pay
for war with profits from illegal activities, such as kidnapping, contraband, vacuna (levies or bribes to
farmers), and the international trade in weapons and narcotics. 20

In December 2002, AUC started peace talks with the government and demobilizations of combatants in
late 2003. By April 2006 when the process officially finished, over 30,000 paramilitary members had laid
down their arms. 21 However, their conversion to peaceful civilian life has been fitful and incomplete and
some smaller dissident blocs continue to operate in the eastern plains and in the northwestern part of the
country.

In order to encourage AUC members to negotiate, the Colombian Congress approved the Justice and
Peace Law (Ley de Justicia y Paz), which carries penalties of prison terms ranging from five to eight
years for serious crimes such as massacre, murder, and kidnapping. Since the demobilization did not
effectively dissolve the institutional structures of the AUC, many suspect that the Justice and Peace Law
merely provides a cloak of impunity under which the group’s illicit activities – primarily narcotics-related
– will continue unimpeded. FARC and ELN, also continue to finance themselves through drug
trafficking, despite the coca antinarcotics “Plan Colombia” that has received US$4 billion of American
support in six years. While officials say the program has eradicated more than a million acres of coca
plants, Colombian drug traffickers are still managing to supply 90% of the cocaine used in the U.S. and
50% of the heroin—the same percentages supplied five years ago, when the program began.

Although the two other major armed groups, FARC and ELN, continue to finance themselves through
kidnapping and drug trafficking, governmental efforts have been successful in significantly reducing the
kidnapping rate. President Alvaro Uribe’s strategies between 2002 and 2005 caused guerillas to surrender,
or be apprehended or killed. On May 28, 2006, President Uribe was reelected with 62% of the vote thanks
to the economic growth, a decrease in kidnapping by the left-wing guerrilla groups, and a reduction in
paramilitary violence.

Displacement
After Sudan and the Democratic Republic of the Congo, Colombia has the third-largest displaced
population in the world and the worst humanitarian crisis in the Western Hemisphere. Since 1985 over
three million Colombians have been displaced representing 7% of the total population. Forced
displacement figures have increased dramatically in the past ten years to more than 200,000 newly
displaced annually. In 2006, 219,886 (or an average of 602 persons daily) were forced to leave their
homes.22 In addition, the United States Committee for Refugees (USCR) estimated that at least 290,000
Colombians lived in refugee like circumstances in various countries of the Americas, including: about
75,000 in Ecuador, 20,000 in Panama, 20,000 in Costa Rica, and 150,000 in the United States.23

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The characterization of violence and displacement in Colombia is complex, multifaceted, and changing –
symptomatic of the instability of conflict situations. Displacement in Colombia is not merely incidental to
the armed conflict but is also a deliberate strategy of war. At the heart of this strategy is the armed
factions’ ability to gain control of large tracts of land, forcing people off their property.24 The displaced
population consists mainly of farmers and residents of small towns with Afro-Colombians and indigenous
people disproportionately represented,, comprising one-quarter of the total internally displaced persons
(IDPs), by virtue of often living in areas of strategic interest to the warring parties.

Forced displacement has contributed to a vast migration and the urbanization of Colombia. While the
flow of displaced people crossing the borders to Ecuador, Panama, and Venezuela is steadily growing, the
provinces of Antioquia, Bolivar, Caqueta, and Valle de Cauca, and major urban areas such as Bogotá,
Barranquilla, Medellin, Cali, Cartagena, Cúcuta, and Florencia are the traditional receptor sites. One-
quarter of the total number of IDPs now live in slums of these cities, 25 and almost 70% of IDPs have
moved to 780 small towns in search of better security.26 However, the IDPs in urban areas are
increasingly exposed to crime, violence, and actions by paramilitary-backed ‘cleansing squads’ causing
secondary (and even tertiary) displacement within cities. 27 28

In Colombia, over 65% or more of all IDPs are permanent, while 24% of IDPs want to return to their
original home.29 Loss of access to productive assets, land in particular, keeps IDPs virtually trapped
inside urban centers with few options.30

Violence and displacement affect groups in different ways. Men are the primary targets of homicides,
massacres, and selective assassinations, while women tend to suffer from sexual violence and emotional
trauma.31 Women and girls account for more than 55% of the displaced population and together with male
children account for nearly 72% of the IDPs in Colombia.32

Children and adolescents represent an estimated half of all displaced and are more vulnerable to abuses,
such as forced conscription or sexual violence, and are regularly deprived of food, education, and health
care. Displaced youth also confront serious limitations in accessing the labor market and are drawn to
violence and delinquency. Human Rights Watch found in 2003 that one out of every four irregular
combatants in Colombia is under the age of 18 and UNICEF reported that armed groups have recruited an
estimated 5,000 child soldiers.33 Young IDPs are also exposed to various threats and risks. IDP girls are
more vulnerable to sexual exploitation and teenage pregnancy than other teenagers. UNHCR says that
30% of IDP women under 20 have at least one child, compared to 19% among non-internally displaced
women.34

While Colombia has probably the most advanced IDP legislation in the world, it remains poorly
implemented. Public policies addressing internal displacement issues still apply standardized models of
assistance, with little recognition of the heterogeneity of the displaced population and their basic needs
(e.g., women, children, indigenous, and Afro-Colombian minorities).35 In addition, there is still poor
coordination of programs and policies among the government’s different branches and local
municipalities and the response to IDPs has suffered from chronic under-financing. Moreover, the Pan
American Health Organization (PAHO) estimates that only 22% of displaced households have access to
local health services,36 due to various factors, including the lack of documents confirming their status37,
and the stigma attached to their displacement.

In recent years, international donors such as United Nations (UN) agencies, the European Union (EU),
and the United States Agency for International Development (USAID), among others, have contributed
resources to alleviate the humanitarian crisis and collaborated with Colombian authorities to formulate
and implement specific plans within the health, education, and family welfare sectors that include
promotion of human rights for IDPs.

8
Sexual and Reproductive Health Situation of IDPs
An overview of the health system in relation to IDPs: In 1993, the Colombian Ministry of Health passed a
new law, the General Social Security System (Ley 100), to provide universal health care to the entire
population. Ley 100 created two health care systems, one for those who can afford to pay for health care
and are part of the system through their employers (régimen contributivo) and one subsidized for those
who cannot pay and are in the lowest level of the poverty line (régimen subsidiado). To help meet the
demand for care, a third system has developed for those who are not formally a part of the subsidized
system because are not classified in the lowest level of poverty yet they have no insurance through
employers (vinculados). They receive a document attesting to their status and can receive emergency care
paying 30% of the cost of medical services.

At the same time, Ley 100 decentralized health services so that district mayors were charged with
developing plans and allocating resources for health care in their districts to ensure every citizen received
the health services she or he needed, including reproductive health care.

However, Ley 100 has not achieved its objective among much of the population, particularly the very
poor and displaced. Although municipal authorities have the responsibility to ensure health services to the
population, including IDPs, they do not necessarily have the skills or knowledge of health priorities to do
so effectively. Young people and the displaced are often left out of the health care system with little or no
access to care. A study by the University of the Andes38 found that of every two young people 18 years
old, one of them is excluded from the health system. Once they are no longer beneficiaries of the health
system through their parents, they no longer have access to services. In 1999, the Women’s Commission
for Refugee Women and Children found that “while reproductive health care services are more or less
available to Colombian women through the national health system and the services of organizations like
Profamilia39, displaced women suffer from a lack of access to this particular area of health care, just as
they lack access to health care in general.”40

For IDPs, the public health policy is fragmented and very erratic. IDPs are often unable to pay for
services or lack the necessary medical insurance coverage to obtain services. For these and other reasons,
providers often discriminate against them. When IDPs cannot pay, hospitals sometimes refer emergency
obstetric cases to other hospitals, resulting in increased danger to the mother’s health and life.41

Family planning: Over the past 35 years, the birth rate in Colombia has dropped by more than 50%. This
has been attributed, in part, to an increase in female education and family planning use. While women in
1965 were having an average of seven children, in 2005 the total fertility rate was 2.4 children.42
However, in 2005 Profamilia found that the fertility rate of internally displaced women was 4.2 children,
almost twice the national rate.43 Young Colombians typically begin sexual activity between the ages of 11
and 18, particularly those living in large cities and from lower socio-economic levels. Profamilia also
found that 63% of women 19 years old or younger in conditions of displacement were pregnant or already
mothers. While one of every three adolescents in the general population becomes pregnant by age 19, two
of every three displaced adolescents become pregnant by this age.44

Almost all Colombian women of reproductive age are aware of at least one contraceptive method.
Although about 84% of sexually active women were using a family planning method in 2000, there
continue to be major regional and rural/urban differences.45 The 2000 Profamilia survey showed that
women displaced by armed conflict and who live in marginalized areas were less likely to use family
planning and had more pregnancies and larger families (5.3 living children as compared to a national
average of 3.4). These large families contributed to their already significant problems in providing care
and resources for themselves and their children.46 IDPs and women living in poor urban and rural areas
face a difficult situation in securing contraceptive care since the family planning services through the

9
public sector are limited. The NGOs sector has had to step in to fill the gap. For example, by 2005
Profamilia was supplying 35 % of all contraceptive methods to IDPs compared to 23 % offered by the
public health care providers.47

Maternity care: Young women ages 15 to 19 die twice as often from causes related to pregnancy and
delivery, and among girls younger than 15, the risk is six times greater. Those who die from pregnancy-
related causes who are younger than 20 years old represent 14% of the total maternal mortality related
deaths. The Pan American Health Organization reported that in the late 1990’s 15% of all maternity
related deaths in Colombia were due to unsafe abortion, with the highest incidence among women from
20 to 29 years of age. Unsafe abortion is the second leading cause of maternal death.48 Furthermore, about
45% of pregnancies among adolescents under the age of 19 ended in abortion. While an estimated
337,000 abortions are performed every year in the country, Profamilia found in 2005, that 22 % of
displaced women had had one or more abortions compared to 17.5 % of non-displaced women. It
expected that this condition will change after the Colombian Constitutional Court in 2006 legalized
abortion in cases of rape, saving the life of the woman, or severe fetal abnormalities.

The 2000 survey, “The State of Displaced Women,” showed that IDPs received less antenatal care during
pregnancy than other Colombian women. About 56% of IDPs received no antenatal care. Twenty-seven
percent of IDPs surveyed experienced either a miscarriage or a stillbirth. Of these, 37% received no
treatment or medical care. 49

Gender-based violence: The Colombian government has attempted to address domestic or gender-based
violence, prevalent throughout the country, through the creation of legal institutions and legislative
changes for the penalization of violent partners. People who work in human rights in the country claim
that even though Colombia has one of the most modern and progressive legal frameworks, there is a huge
gap between legislation and action.50 The majority of displaced women and youth in Colombia face an
extraordinary amount of violence due to armed conflict or other physical, emotional, or sexual abuse from
their partners/spouses, strangers, friends, ex-husbands, fathers-in-law, or step-fathers.51 However, because
of a dearth of data, the exact incidence or the impact of the violence on women in Colombia due to the
armed conflict is unclear and difficult to estimate. In addition, many victims of domestic or sexual
violence do not trust the authorities enough to report incidents to them.52 In 2005, while 64 % of
internally displaced women interviewed in the Profamilia survey had suffered intimidation and
psychological violence and 44 % had experienced physical violence from intimate partners, only 21% of
all victims reported the incident.53

The 2001 Profamilia study showed that 50% of the female respondents surveyed reported physical
attacks, 50% of which were carried out by their partners. The paramilitary and guerilla groups also
subjected women and girls to additional violence. One in every five displaced women said she had been a
victim of sexual violence and 24% reported having been raped.

HIV/AIDS and sexually transmitted diseases: According to UNAIDS, less than one percent of Colombia’s
adult population (aged 15–49) are living with HIV/AIDS. In 2006, the number of deaths due to AIDS was
estimated to be 8,200. HIV related data are presented in the table below.

10
Table 1: Colombia HIV data

HIV/AIDS
People living with HIV/AIDS 160 000 [100 000 – 320 000]
Adults aged 15 and up living with HIV 160 000 [100 000 – 320 000]
Adults aged 15 to 49 HIV prevalence rate 0.6 [0.3 – 2.5]%
Men living with HIV/AIDS 118,000
Women aged 15 and up living with HIV 45,000 [24 000 – 95 000]
Deaths due to AIDS 8,200 [5200 – 12 000]

Source: Adapted from UNAIDS54

HIV in Colombia is primarily transmitted by men having sex with men (MSM) and heterosexual
infection. MSM have the highest reported HIV prevalence, with 18% of MSM testing positive in Bogotá
in 1999. Almost 98% of the population knows of HIV/AIDS but according to the 2005 Profamilia
survey, 20% of the population had no knowledge of sexually transmitted infections (STIs).55 The low use
of condoms (3%) among internally displaced women suggested that they were more vulnerable to STIs
and HIV.

Little is known about how conflict and internal displacement affect HIV prevalence because there are
very few statistics for IDPs. However, the Profamilia survey of 2000 found that adolescents displaced by
armed conflict had the lowest level of knowledge of HIV, AIDS, and STIs. The survey found that STIs
among displaced populations were as common as respiratory illnesses and diarrhea; yet only 28% of
women were able to identify any symptoms of an STI.56

There are severe stigmatization and human rights abuses by armed groups against people perceived or
known to be HIV-positive. NGOs permanently report that FARC and paramilitary groups undertake
“social cleansing” operations killing people testing positive, known homosexuals, or commercial sex
workers.

3. PROYECTO COLOMBIA: A NATIONAL RESPONSE TO HIV AMONG IDY

From the three largest funding sources for HIV and AIDS programs worldwide, the United States’
PEPFAR, the World Bank’s Multi-Country HIV/AIDS Programme, and the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM), only GFATM is supporting interventions in Colombia.

Between 2004 and 2006 the GFATM granted over US$8.5 million to support the project “Construction of
a multi-sectoral response in sexual and reproductive health, with emphasis on prevention and attention to
STIs/HIV/AIDS among adolescents and young adults living in a context of internal displacement in
Colombia,” which is better known as “Proyecto Fondo Mundial Colombia (PFMC).”

Goals and objectives


The overall goal of the project is to reduce the vulnerability of 600,000 young people to STIs, HIV and
AIDS, in 48 municipalities involved in situations of forced displacement, from a comprehensive approach
of attaining human rights, international humanitarian law, and gender equity. 57

The project has three specific objectives:


a) To strengthen the social response capacity in the selected municipalities, involving local authorities,
the private sector, community- and faith-based organizations, and youth leaders. Activities with the

11
civil authorities include consensus-building and awareness-raising, in order to obtain a political
commitment and their active participation in the development of the project.
b) To strengthen the response capacity of health and education teams in these municipalities, with an
emphasis on sex education advocacy in sexual and reproductive health, and prevention and care of
STIs, HIV, and AIDS among young people (10 to 24 years old). The capacity and skills of these
teams, responsible for articulating responses to IDPs, will be strengthened through training activities
and the provision of educational and treatment supplies. Inter-sectoral health and education teams will
be set up for each municipality involved.
c) To implement a training and empowerment program with 600,000 young people aimed at decreasing
their vulnerability to STIs, HIV, and AIDS by adopting healthy sexual behaviors, improving their
family and social environments, and creating sustainable social and economic development projects.
Activities to achieve this objective include a peer-education training program to promote adoption of
healthy behaviors and life skills, and implementation of sustainable youth-owned social and economic
projects.

Structure and operation


PFMC has a three-level functional structure. At the first level, the country coordinating mechanism
(CCM) and CCM executive board are responsible for establishing the project’s policies and strategies.
The second level, formed by the principal recipient of the grant and the national management team (la
gerencia), has managerial, administrative, and technical functions. The third level has the responsibility
for the project’s operation in each municipality. It consists of local executing agencies (working in
partnerships) or sub-recipients of grants, local authorities, and the health and education sectors. These are
all coordinated through the municipality coordinating mechanism (MCM) and the intersectoral group.

The Colombian CCM, formed on June 11, 2002, consists of several governmental agencies, UN agencies,
universities, civil society organizations (CSOs), and the principal recipient of the grant (see complete list
in the appendices). The Ministry of Social Protection (MSP), which was formerly the Ministry of Health,
leads the CCM. Most of the other organizations work in the project areas, specifically sex education for
young people, prevention and care of STIs/HIV/AIDS, and support to displaced populations.

The principal recipient of the grant is the International Organization for Migration – IOM. The IOM has
worked in Colombia for more than 40 years, implementing programs and projects to improve the
country’s response capacity to vulnerable populations affected by armed conflict. In this role, the OIM
has agreements with most of the members of the CCM and international donors and, besides PFMC,
manages additional resources for other projects focused on post-emergency assistance for IDPs.

The IOM is responsible for the overall financial management of the project and works closely with a
management team that set up the technical and strategic decisions recommended by the CCM.

The project’s management team (la gerencia) consists of a national manager and a technical team. This
group’s primary function is to issue the conceptual and methodological guidelines and tools for
implementing the project. It is also responsible for spearheading training and countrywide campaigns,
selecting the local executing agencies, and monitoring the implementation of activities.

The implementing or executing agencies are primarily CSOs, including academic, community-based and
non-government organizations. One hundred seventeen agencies formed 34 partnerships (local executing
partnerships – LEPs), which, after a request for proposal and bidding process, were selected for managing
the execution of the PFMC in 48 municipalities. At the municipal level, the counterparts of these LEPs
are the local MCM, a group of local stakeholders headed by the municipal mayor and the inter-sectoral
health and education teams.

12
The primary recipient population of the project is composed of 600,000 young people who live in the
areas that take in populations displaced by armed conflict. These receiving areas, generally located in
marginal urban areas of extreme poverty, are places with a high level of interaction and social peer
pressures among IDY and young people who were already living there. The project goal is to cover both
IDY and young people who are not displaced but live in the same areas or have close contact with them.
The families of those young people are indirect beneficiaries, as are students in the schools located in the
selected localities where sex education is incorporated into the school’s programs.

The selected 48 municipalities and nine boroughs of Bogotá are the primary areas that take in populations
displaced by armed conflict. They were selected based on information from the governmental “United
Registration System (SUR)”58 and from the Consultancy for Human Rights and Displacement, a well-
known NGO working towards raising awareness about internal displacement in Colombia.59 These
municipalities were the ones that had the greatest recurrence as receiving IDPs over the last eight years.
Some of the municipalities are at the same time “receiver and expeller.” All of the selected municipalities
take in more than 50% of the country’s displaced populations and more than 90% of the displaced persons
recorded by the SUR.

4. FINDINGS

MSC”s Associate Vice President, Fabio Castaño, visited Colombia in November-December 2006. In
Bogotá, and surrounding areas, he conducted interviews and participated in meetings with a number of
representatives of PFMC, IOM, UNAIDS, UNHCR, UNFPA, and the Ministry of Social Protection
(formerly the Ministry of Health). Then he joined a mission team, which included staff from PFMC and
UNHCR that traveled to project sites in Barrancabermeja, Bucaramanga, San Pablo, and Villavicencio.
See the data related to projects in each city in the following table.

Table 2. Characteristics of project sites visited

City Barrancabermeja
Population 10-24 years 62,380 Displaced persons 16,855
Population 10-24 years in poverty 18,402 Displaced persons (10-24 years) 5,326
conditions
Local executing partnerships – Corporación Obusinga -
LEPs Cafaba, Equipo de trabajo juvenil de la comuna 7 (ETJ7) - Fundación
Gente en Acción
Activities conducted • 1 meeting MCM
• Visits to 5 youth income generation projects at comunas 1, 3, 5, 6, 7
• 2 focus groups with youth: leaders of Obusinga, Colegio Camilo
Torres
• 1 visit to youth center at Barrio el Danubio
• Interviews with staff of LEPs

City Bucaramanga
Population 10-24 years 168,419 Displaced persons 30,147
Population 10-24 years in poverty 15,797 Displaced persons (10-24 years) 4,992
conditions
Local executing partnerships – Proinapsa-UIS – Cidemus
LEPs

Activities conducted • 1 focus group with staff LEA agencies


• 1 focus group with school teachers and leaders from Centro Juvenil
and Escuela Rural Paulon
• 1 visit to youth-friendly service: Centro de Salud Villahermosa
• 2 visits to communities to meet youth from 6 income generation
projects

13
City San Pablo
Population 10-24 years 8,635 Displaced persons 6,658
Population 10-24 years in poverty 5,213 Displaced persons (10-24 years) 1,647
conditions
Local executing partnerships – Corporación Nación - Corporación Boiti - Casa de los y las adolescentes
LEPs de San Pablo
Activities conducted • 1 meeting at MCM at local hospital
• 1 focus group with school teachers
• Interviews with health providers
• Meeting with youth from Casa de los/las adolescents and
demonstration of a video developed by youth on displacement

City Villavicencio
Population 10-24 years 102,739 Displaced persons 25,993
Population 10-24 years in poverty 20,480 Displaced persons (10-24 years) 6,472
conditions
Local executing partnerships – Asociación Sociocultural NACATSI - ANISA Colombia (Agencia Nacional
LEPs de Intervención Social Mediante el Aprendizaje - Asociación de Líderes
Juveniles OASIS
Activities conducted • 1 MCM
• AIDS celebration show presented by several IDY communities

In each city, LEPs supported the mission through organizing interviews, meetings with the municipal
coordinating mechanism (MCM), focus group sessions with adolescents, school teachers, and program
staff, and visits to youth centers and communities where IDPs live.

MSCI used the framework of guiding principles for HIV prevention among internal displaced youth,
described above, to organize findings from the activities conducted in each city.

Rights-based approach
The PFMC employs a rights-based approach as one of its core principles. From design through
implementation, the project promotes the exercise of the rights of youth as an integral part of their
psycho-social development, as citizens in the processes of social integration and construction, and as
health services clients, including prevention of HIV, STIs and other conditions that affect their sexual and
reproductive health, such as unwanted pregnancy.

Interviews and focus groups with LEPs and beneficiaries indicated that the tools developed by the project
and national and local trainings had a significant impact on fostering a positive view of youth and their
rights. The youth interviewed felt empowered, had a well-developed discourse on their rights, and had
found various avenues for participating in community decision-making. Nevertheless, several interview
subjects hoped that this or other projects would involve parents, educators, and community leaders to a
greater extent so that they could understand and value the diversity within the youth population. They had
a very positive view of the national and local mass media campaigns that the project supported to raise
awareness among youth and public opinion on exercising rights and a rights-based approach to HIV
prevention, such as “Estás en todo tu derecho” [“You Have Every Right”]. They suggested that
communication strategies such as these be deployed to draw greater attention to prevention of stigma and
discrimination against people living with HIV and/or non-heterosexual youth (MSM, gay and lesbian,
bisexual, transgender, etc).

14
PFMC has successfully coordinated with other human-rights related projects and has promoted
integration of displaced youth into their receiving and expelling communities, such as through support for
youth income-generating projects. Yet, full integration of youth,
especially displaced youth, as subjects with citizenship rights in “In this country poor people have fewer rights
the process of nation-building requires a much longer-term effort and they are not heard…among the poor, the
that exceeds the goals of this project. displaced have even fewer rights…and among
the displaced, women, youth and children have
less voice….”
A repeated concern that should be further explored is youth’s School teacher, San Pablo
perception of how others respect their rights as clients of health
facilities. They complained that the facilities were not
welcoming to them and the services offered did not always meet their health needs. The PFMC and its
LEPs trained health staff and facilitated implementation of VCT services for youth beneficiaries as part of
a strategy to develop “youth-friendly services” (YFS). In three of the four cities visited, the mission team
met with health staff. Although the experience varied at each site, there was consensus that the health
providers involved in the project needed more training on “sexual and reproductive rights of youth.” For
example, in Bucaramanga, staff interviewed in a “youth-friendly” health center reported that many health
providers in the center’s service network, despite receiving training in youth sexual and reproductive
health, were still resistant to informing, promoting, and offering emergency contraception to adolescents.
They consider this method “abortive” and against their values. Out of 180 available doses in this center,
only six had been used in a three-month period, since “the adolescents do not ask for them or do not come
to the center because they prefer to go to a pharmacy.”

Gender Equity Promotion


Throughout the development of tools and training processes, the project was especially thorough in
incorporating a gender perspective as a core approach to youth-focused HIV prevention. The local
executing agencies, especially those with an academic tradition, such as Proinapsa-UIS, in Bucaramanga,
indicated that from a theoretical perspective, the project was strong in this area. However, more
information is required to evaluate if the promotion of gender equity produces significant changes in the
way that sexual and reproductive rights are exercised by women, men, boys, and girls, and the type of
access they have to health and other social services and to
“ everyone agrees that both young men and the labor market. Although it was reported that the young
young women should protect ourselves from HIV, men involved in the project may have changed their
but it can still be considered inappropriate for perceptions of the rights of women and girls, it was also
girls to ask their boyfriends to use a condom, and possible that traditional masculine (machista) models persist
even worse that girls themselves carry
that predispose boys and girls to engage in risky sexual
condoms…a girl who does this is considered
easy.”
practices.
Sandra, 16 years old, Barrancabermeja
Some teachers interviewed suggested that fantasies persist of
the macho man idealized by the stereotype of the “man in uniform” – military, guerrilla or paramilitary.
The majority of these men are younger than 24 years old, who assert power by using women’s bodies “as
territory to be fought over by the warring parties.”60 Anecdotal data in San Pablo indicates that the
increase in HIV incidence as well as the disproportionate increase in unwanted pregnancies in adolescents
is caused by the “military effect” in the town.

Within the context of forced displacement in Colombia and the execution of the PFMC, women’s social
movements have provided successful experiences in local community organizations and advocacy for
citizenship building. For example, in San Pablo, the Women’s Association of Magdalena Medio has
mentored youth groups and facilitated the integration of the displaced population. Nevertheless, some
interviewees suggested that executing agencies should have established more strategic alliances with
these groups to empower young women. They could have promoted a more aggressive agenda for
exercising sexual and reproductive rights to reduce the vulnerability of women and girls within the family

15
and social spheres. Even though the tools deployed by the project helped local executing agencies to train
male and female youth in skills development such as negotiating condom use and understanding aspects
of masculinity, it was suggested that the local projects could have facilitated the development of clubs or
groups of boys and young men. Such groups could promote violence prevention against girls and women
and prevention of homophobia within the framework of peace building and development of a more
equitable society.

Many of the interview subjects said that the increase in intra-family and sexual violence within displaced
communities is fed by fear, insecurity, and distrust caused by rupture of the social fabric and anxiety over
constant threats from groups in conflict. Projects for IDPs are still weak in addressing gender-based
violence61 and the local projects within the PFMC could do more to involve other sectors, especially the
health sector. Since health facilities lack the capacity to identify instances where injury is the result of
domestic violence or sexual abuse, the number of undocumented cases of sexual violence and rape is
enormous and there are practically no data or studies investigating the links between HIV and violence
against women (VAW). The recent development in Colombia of legislation for prevention of and action
on gender violence was viewed as a good opportunity to focus attention from all sectors and local and
national organizations on the importance of GBV among IDPs and to propose interventions.

Protection, security, justice, and reparation


Since May 2005, when UNHCR sounded the alarm about systematic intimidation and violence against
IDYs in Colombia, NGOs and community groups have reported frequent cases of selective murders,
extortion, sexual violence, loan-sharking, and forced recruitment into armed groups or prostitution rings.62

In the project site visits, we observed that this situation was known and experienced in some way by all
the PFMC participants. This placed an additional burden on project implementation. Both at the national
level and in the cities visited, informants reported that in the past year security problems have occurred in
the municipalities where the project was operating.

In San Pablo and Bucaramanga, focus group and interview participants reported that armed squads
restricted the participation of youth in big gatherings such as some of the “edutainment” activities
organized by the project. In the month before the visit to San Pablo, a young homosexual was killed as
part of “social cleansing” undertaken by paramilitary groups operating in the region. A similar case
occurred the previous year.63 In other cities where the project operates, such as Buenaventura (which was
not visited by the team), youth were contained in areas defined by the perpetrator of conflict, who
hindered their free movement and placed serious limits on their security, autonomy, and opportunities to
participate in educational, productive, and entertainment activities. These cases contributed to the creation
of a culture of fear and prevented open and constructive discussion of the sexual and reproductive rights
of youth throughout society.

Moreover, in some cities health personnel connected to the project were reluctant to implement the
counseling and VCT in rural areas. They maintained that the confidentiality of the results and their
personal security would be compromised due to pressure from “social cleansing” groups to punish those
who tested positive. There was at least one known case in which a member of a LEP received serious
threats for refusing to share test results, causing the health worker to leave work and family.

In response to this situation, the PFMC requested the intervention of the UN, government agencies, and
international organizations monitoring the peace process, such as the Organization of American States
(OAS). Proposed solutions included documentation of cases, informing authorities immediately about the
cases, establishing strategies for protecting youth so that an HIV test did not become a greater risk for
them and for health workers, expanding and strengthening mass communication and information on HIV,
and reducing HIV stigma within the community and armed groups. It was also recommended that the

16
relationship with UNHCR be strengthened, since that “Where was the government when the
organization’s presence, logistical capability, and credibility paramilitary forces and the guerrillas forced us
in project locations were recognized and would guarantee to leave [our land]? Why are they given the
protection of the rights of youth. chance and the resources to reintegrate…while
we, by contrast, as displaced youth do not have
An additional issue arose in the discussion with beneficiaries much future….”
and LEPs during the visits. Displaced youth insisted that Carlos, displaced youth, Bucaramanga
they wanted more participation in the peace process with
paramilitary groups and they demanded justice and reparation to restore credibility to IDPs within the
political system and government agencies.

In May 2006, Colombia’s Constitutional Court ruled that displaced people and victims of human rights
violations have the right to receive reparations and to benefit from prosecution of demobilized
paramilitary groups.64 Nevertheless, this legislation has still not been put into practice. The PFMC
management team recognized that although this issue was not an express component of the program’s
agenda, the empowerment and strengthening of youth’s capacity through a rights-based approach tacitly
functioned as a form of reparation that society offered to youth that have been victims of conflict.
Similarly, the participation of displaced youth in income generating activities has facilitated reintegration
into society and has helped them renew their life plans.

Youth Participation and Ownership


Three strategies facilitated youth participation and ownership in the PFMC:

a) In most project sites, local youth organizations took on the role of direct executors of various project
activities in alliance with other civil society organizations.

Of a total of 112 local agencies and 947 community organizations that participated in project activities, at
least 60 % can be considered “youth” organizations, either because they were run by youth directly, or
because their principal mission and activity focused on youth.65 Of the LEPs that the mission team met
with during visits, at least two had member organizations that met these criteria (see Table 2).

The PFMC management team recognized that participation of local youth groups in the LEPs was one of
the project’s strengths. These groups understood and were sensitive to local culture and social dynamics,
and were connected to social networks. These characteristics led beneficiaries to adhere to HIV
prevention activities. In addition, they often contributed to the reduction of project operating costs (i.e.
staff time, local transport, in-kind contributions, etc).

During site visits in Barrancabermeja, Bucaramanga and San Pablo, youth groups participated actively in
municipal coordinating mechanism (MCM) meetings and in focus groups. In Villavicencio, Alianza
Juvenil Oasis’s participation was noteworthy (with two young female and male representatives) in the
MCM, and subsequently in the celebration activities for World AIDS.

The mission team witnessed the sense of ownership that young people had in the local projects and
organizations and the enthusiasm they expressed in all the
“Thanks to the project [PFMC] the local
government pays more attention to us and
activities. However, it was not clear that the project
collaborates with us, of course at times we must management team had determined the level and type of
plead… we do not know what will happen when youth participation in those projects, or that there was
the project ends or the government changes...” measurement of or data gathered on this participation. Nor
Manuel, 20 years old, San Pablo was there information obtained on the benefits of youth
organizations being part LEPs or these organizations’

17
sustainability. The young people perceived that despite the commitment and support of their allies within
the LEPs and the PFMC, support from local government authorities was still very limited.

Some people from the PFMC observed that the youth organizations would require support to develop
capacity for lobbying local governments.

b) Training youth leaders in development of life skills and peer education to improve their SRH and
HIV prevention and the multiplier effects of this training benefited thousands of youth and helped
secure youth participation.

From January 2005 to December 2006, the PFMC and its LEPs in 48 municipalities employed a peer
education strategy to train 218,480 youth leaders. This represented 102% of the established goal.66 The
training process included identification of youth leaders and members of youth networks and selection
and training of multiplier youths. Two eight-hour seminars were planned with groups of 40 young people
in each locality, from which a minimum of 30 multiplier youths were selected. With support from the
implementing agencies, the multiplier youths ran five four-hour sessions replicating the training for each
new peer group. The final stage of the peer education process involved participants in the replication
workshops sharing the information with their closest social groups through informal activities.
The training and assistance from PFMC for our own
productive projects has helped us have more LEPs’ staff recognized that peer training strategies
confidence in ourselves to participate in [the to reach youth within and outside the educational
decisions that affect] our neighbourhood and system motivated active participation of youth in
community. Now the adults invite us to local HIV prevention activities such as IEC campaigns in
community board meetings with voice and vote. the community, promotion of VCT, etc. Although
Javier, 18 years old, Bucaramanga there were no precise data, it was estimated that
many trained youth shared their training with peer
groups, families, and communities. Additionally, training in development of life skills and empowerment
stimulated youth involvement in productive projects, and strengthened youth networks and participation
in civic life through collaboration with community leaders, government officials, and community
organizations.

c) The development of a variety of “youth social enterprise projects,” 67 including cultural, sports, skill
development, and income generating projects was a good strategy to involve youth in development of
life skills.

Through December 2006, 1,900 young people in 16 municipalities participated in 141 social enterprise
projects that were selected to receive technical assistance and financial support.68 Using a validated
methodology, the PFMC encouraged youth involvement, selected proposals with the greatest potential
social impact, and then provided financial resources to each enterprise (an average of US$3,129 per
project). It then provided ongoing monitoring and technical assistance.

PFMC personnel interviewed stated that these projects were a tool for social inclusion and development
that strengthened youth’s exercise of autonomy and rights. Additionally, the projects promoted self-
esteem and self-care as well as the identification and acquisition of life skills and abilities as a means of
protection against STIs and HIV. They also enhanced conflict resolution and group relations and
strengthened community development.

As of December 2006, the PFMC did not have quantitative information to demonstrate the impact of
these projects on youth and their communities, nor how these projects might be protective factors or
might motivate behaviour change to prevent HIV. Nevertheless, during visits to several such projects69 in
Barrancabermeja, Bucaramanga and San Pablo, one of the strongest findings was the effect of this

18
strategy on youth’s sense of dignity and self-worth, particularly for IDY. Almost all youth reported
feeling empowered from not having to be dependent on governmental programs or charity.

Conversations with youth and LEPs revealed concerns over access to additional financial resources. As
the literature has documented, lack of credit and cash was the most significant constraint in pursuing a
livelihood, particularly for those IDPs with small businesses. In most cases of displacement worldwide,
the only resource for starting small businesses is aid agency programs.70 The PFMC should make a
detailed analysis of the means for sustainability of youth income-generating projects over the medium and
long term, and the potential linkages to government and private initiatives for training, labor market skills
development, microfinance, and other kinds of financial support.

Assessment, Monitoring and Evaluation


The PFMC had a monitoring and evaluation system that included baseline data of population, health, and
education indicators for each participating municipality, KAP surveys (Knowledge, Attitudes and
Practices) of youth beneficiaries, and tools for monitoring the activities and the financial resources of the
executing agencies.

By December 2006, 58 baseline studies of the municipalities and boroughs of Bogotá participating in the
project had been undertaken. Most information in the baseline was disaggregated by gender and age and
sometimes the indicators provided information on displacement status. This information has been used to
develop local support plans for displaced youth. It was not possible to determine if comparative analyses
existed between cities or within a city on the same baseline information or action plans.

During 2005, the PFMC adapted and validated the KAP survey with assistance from experts and input
from previous surveys on youth sexual practices used in the country. The survey was done by youth
trained by the project on a sample of young people in each municipality. The results were consistent
among the different municipalities and showed some differences from the national survey on sexuality
applied to the general population.71 Although the national survey indicated 82.8% of the population
understood that condom use was an HIV prevention method, only 63.4% of youth surveyed in the PFMC
were aware of this method. Similarly, the perception of risk of acquiring HIV varied from 17.6% for the
general population to 10.5% in the surveyed youth population. This confirmed that youth, especially
displaced youth, required additional actions for HIV prevention like those carried out by PFMC.
Comparative analysis of the KAP survey results at the beginning and the end of the project indicated
positive changes in all areas. For example, awareness of HIV infection through contaminated needle use
increased from 34.6% to 76.7%; condom use at last intercourse, although still low, increased from
44.65% to 50.6%. Perhaps the most significant change involved access to voluntary HIV testing. In the
initial survey 7.7% of sexually active youth had taken the test, whereas in the final survey, the number of
youth who had taken the test rose to 22.1%. This could be due to the effect of the project itself, which
offered and promoted a VCT program.72

PFMC personnel noted that the 2005 survey in the first group of municipalities entering the project had
some deficiencies. Language was not adapted to the local culture, the executing agency failed to follow
standardized procedures in selecting subject population, there was a lack of instructions and field manuals
for the survey process, and there was a lack of monitoring and control from the national level. The
lessons learned from this survey were applied to the development of a new version of the survey that was
used in the second group of municipalities.

The PFMC has a monitoring system of project implementation indicators for tracking the execution of
activities in each municipality by each LEP. The LEPs had to deliver monthly data on technical
execution and quarterly financial reports. All the executing agencies interviewed mentioned that this

19
monitoring system run by PFMC’s management team and IOM staff was one of the strengths that
contributed to the success of the local projects.

In interviews with PFMC’s management team the mission team learned that, as of December 2006, there
was no clear plan yet for measuring medium and long-term project impact. Nor was there a definition of
health and social indicators that could inform them about changes in youth’s living conditions, whether
they overcome displacement and were integrated into society, and the decrease in SRH risks such as early
pregnancy and incidence of STIs and HIV. In December 2006, the team was working on designing a
framework for assessment of the social enterprise projects and the definition of indicators for
sustainability.

Coordination and Mainstreaming for a Multi-Sectoral Approach and Durable


Solutions
In accordance with the approach of the GFATM, the PFMC’s structure is based on strong coordination
and communication among sectors and agencies working on HIV/AIDS and IDY. There are three
institutional means for coordination: one country coordinating mechanism (CCM), a municipal
coordinating mechanism (MCM) in each project site, and intersectoral taskforce groups in each site.

The CCM, an intersectoral entity headed by the Ministry of Social Protection (MPS),73 is formed by
governmental agencies, non-governmental organizations, UN agencies, and academic institutions (see
Appendixes). In interviews with PFMC staff it became clear that although coordination among 12
entities could be complicated, the CCM has been instrumental in the design and implementation of the
project, thus assuring its integration with the National HIV/AIDS Strategic Plan. In addition, several
institutions involved in the CCM have complementary initiatives related to STIs/HIV/AIDS, displaced
populations, and sex education for youths. During the mission trip it was observed that United Nations
agencies such as UNAIDS, UNFPA and UNHCR play a very important role providing direct technical
support to the project or through the coordination and financing of complementary activities. UNAIDS,
which has supported HIV prevention projects throughout the country, coordinated a mother-to-child
transmission (MTCT) project with MPS; some of these activities complemented PFMC’s work. UNFPA,
which works with the juvenile population on prevention in SRH through several projects, has directly
supported PFMC with technical and financial resources through the project “Strengthening Youth-
Friendly Services for Sexual and Reproductive Health.”

In each of the municipalities where the PFMC is implemented, coordination between the local executing
partnerships (LEPs) and local stakeholders occurs in at least two venues: the MCM and the intersectoral
group.

There are 112 organizations collaborating to execute projects in 48 municipalities. Although reaching
agreements among members of some partnerships has not been easy and has occasionally limited the
development of the projects, all interviewees agreed that promoting coordination and collaboration among
local organizations has been one of the greatest successes of the PFMC. The diversity of these groups and
their missions, their knowledge of local realities, and the negotiation and cross-fertilization process
among them are enriching elements that should be considered in developing HIV prevention projects
among IDY, as well as for developing a capacity building model. Technical assistance provided by the
PFMC management team facilitated optimization and management of the executing agencies.
Nevertheless, questions remain about the sustainability of the organizations and their partnerships once
the PFMC reaches the end of its financing cycle.

20
Interview subjects noted that although the MCMs provide space and opportunity for coordinating efforts
and synergies among the LEPs and local actors, the MCMs might work better by becoming guarantors of
the intersectoral response and sustainability of the project. It was observed that there is variable
participation and commitment of the local authorities that head the MCMs. Some mayors inspired by the
project have led crusades to design and implement public policies that sustain efforts at prevention of HIV
in youth. In other cases the commitment is expressed with in-kind and financial support (co-financing),
and staff time. For example, during the MCM meeting in Barrancabermeja the mayor of the municipality,
through the departments of health and social development, dedicated resources and personnel to make
sure that VCT services were operating, made plans to include a SRH program for youth in the municipal
development plan for 2007-08, and pledged resources to expand financing for youth enterprise projects.
Despite these good examples, in several project sites the MCMs do not meet often and have not been
successful in securing the participation and commitment of the authorities in sustaining the activities
undertaken. This is due to multiple factors: local conditions of violence that create conflicting priorities,
disempowerment of the authorities, and the removal of several mayors due to corruption accusations. For
example, the MCM in the city of Villavicencio was run by a mayor appointed only 15 days before, due to
the removal of two previous mayors for corruption.

The project has helped form 53 intersectoral teams. Some interviewees reported that although some of
these teams are not working, many others have contributed positively to strengthening coordination and
synergy among different institutions and sectors. Since one of the PFMC’s objectives is to link the
education sector to the plans for youth HIV prevention, the mission team conducted interviews and focus
groups with educators in at least three of the four cities visited. In San Pablo, the local school participated
in the intersectoral team for the project with staff from the LEPs and from health agencies and other local
government entities. The administration and teachers were trained in the project subject areas and were
adept at managing the material. The visited school had a comprehensive sexuality education plan in its
institutional education plan (plan educativo institucional – PEI). In Bucaramanga, the focus group
indicated that PFMC had strengthened institutional capacity, encouraged links to other sectors, and
partnerships with local and international agencies. For example, the rural school “El Paulon” secured
support from World Vision for school supplies and from the mayor’s office to provide breakfasts for the
displaced children and adolescents who had recently enrolled in the school. Interviewees mentioned that
there is still a need to involve other sectors, political groups, and receiving communities to achieve
intersectoral comprehensive action to reduce the vulnerability of children and adolescents.

Evidence-based HIV programming


All subjects interviewed, including members of the CCM, PFMC management team, LEPs, and
benefitiaries agreed that one of the project’s main accomplishments was the design and implementation
of an integrated intervention that took into account the special conditions of young people under
conditions of displacement and high vulnerability to HIV. Since early stages of the project in 2004, and
the following three years, the CCM and the PFMC management team took on the best practices on HIV
programming addressing sexuality positively within the context of young people’s development from a
rights-based approach. PFMC developed tools and training to ensure that program staff, at all executing
agencies, had the updated knowledge and skills, in order to implement similar strategies while still
allowing for local adaptations that recognize youth’s cultural and social differences. Among the materials
that interviewes mentioned as key and helpful for HIV programming are the project’s “toolbox” and the
guidelines package.

The toolbox is a set of eight modules (booklets) that includes start-of-the-art and evidence-based
information related to HIV, youth development, and program management aimed at training program
staff and local authorities. Among other topics, the toolbox includes: sexual and reproductive rights;
sexual education; sexual and reproductive health; prevention of sexual abuse and commercial sexual

21
exploitation; youth-centered projects; team building; organizational capacity-building for youth
entrepreneurial projects; and monitoring and evaluation. A package of 15 guidelines further elaborates on
program issues such as: emergency contraception; youth-friendly sexual and reproductive health services;
voluntary counseling an testing; access to antiretroviral treatment; youth alternative projects; SRH and
HIV as part of the schools’ institutional plans and curricula; communication strategies; project operating
procedures; operational research; and project sustainability.

Many organizations contributed to develop and publish the toolbox: members of the CCM and the PFMC
management team, UN agencies (UNICEF, UNFPA), universities, and national consultants. The mission
team learned that this toolbox, along with the guidelines, is widely used despite the sense of the language
being too academic at times. Some staff members of LEPs interviewed would like PFMC to develop
additional material on IDY that could facilitate comprehension about issues that require further discussion
such as displacement, stigma and discrimination, HIV status disclosure, and security and protection for
people living with HIV.

The PFMC’s behavior change strategy was based on age-appropriate activities, including counseling,
information, education, and communication through multiple channels and mass media. The management
team at the national level and the executing agencies at project’ sites used traditional marketing tools to
promote an invite participation of youth and communities in different activities.

Early in 2006, PFMC conducted focal groups with youth to design a national social marketing campaign
on the prevention of STIs/HIV/AIDS and unwanted pregnancies. The final production of the campaign
“Estás en todo tu derecho” [“You Have Every Right”] was the responsibility of social communication
professionals with support and feedback from the CCM, the PFMC management team and the LEPs. The
campaign, nationally broadcasted through radio and TV clips, also included regional and national
contests for youth in painting, songs, and poetry. Winning works were widely disseminated through
postcards and CDs. The project also published 1,500 copies of a book of youth-written stories about their
experiences, fears and hopes of living their sexuality within conditions of vulnerability. In addition, PFM
and LEPs distributed thousands of posters, condom-holder key chains, bracelets, and banners at VCT and
YFS sites. The project was also able to successfully produce press releases and involve national and local
media during major international cultural and social events and partner with a well-known radio station to
manage an on-going program to promote safer sex and HIV prevention.

During project site visits, the mission team observed that las LEPs had adapted the campaign to the
regional contexts and learned about groups in other cities that had raised local funds to produce local
radio an TV clips to promote HIV prevention. In Barrancabermeja, govermenal agencies and NGOs, had
replicated the campaign and used the project’s IEC materials to create community awareness about HIV
during major events such as the “Youth’s Day”, the World’s Candlelight Memorial. In Villavicencio, the
mission team participated in a show and concert organizaded by the Alianza Juvenil Oasis (one of the
local executing agencies) to mark the AIDS World Day. During the event supported by the local
goverment, UNFPA, and PFMC, Oasis distributed thousands of condoms and raised awareness about
HIV prevention and stigma reduction.

Quality Services
One of the PFMC’s objectives is to secure the inputs necessary for the prevention, detection and treatment
of HIV in the beneficiary youth. By December 2006, the project had distributed more than 6 million
condoms to youth in 48 municipalities after an awareness-raising and information campaign through the
media and educational programs. Additionally, the project coordinated efforts with more than 120 health
centers (in process of becoming youth-friendly services), distributing more than 31,000 emergency
contraception kits.

22
In cooperation with local health authorities, the project trained 160 health workers in pre-test and post-test
counseling and HIV testing. At the time of the visit, 21,619 youth had been tested for HIV, of which 120
were positive (seropositivity 0.6%). Additionally, 514 young people with STIs had been treated.

The project designed an efficient structure for taking and referencing samples. In each municipality the
samples were drawn and then sent for analysis at a specialized center in Bogotá.74 The results were
returned to local health staff working with PFMC for decision-making. Young people with a positive
diagnosis can be referred to one of 22 centers services established by the project for follow-up and
comprehensive treatment of HIV and AIDS. PFMC covers ARV treatment for these youth until they
usually get health insurance subsidized through public funds.

Despite the success in distributing these supplies and in the detection


and treatment of HIV-positive youth, the establishment of youth-
friendly services (YFS) for sexual and reproductive health has been
variable and at times challenging. YFS are defined as comprehensive
services in which staff has the knowledge and skills to deliver SRH
services to youth with awareness of their biological and emotional
development and their cultural and social specificities. These services
include strategies for information, education and communication,
access to family planning methods (including emergency
contraception), initial treatment for domestic and sexual violence,
counseling for voluntary HIV testing and referrals for more
complicated services. The implementation of these centers has
encountered difficulties due to multiple factors: lack of personnel,
deficiencies in training and skills for comprehensive treatment of
adolescents, lack of commitment by local health authorities, etc.

In spite of the efforts of the LEPs and the PFMC management team to organize and involve the health
system at the national and departmental level for coordinated HIV prevention in the displaced population,
actions at the local level occur in a separate sphere that does not always follow central directives.
Although it is not the case in all municipalities, generally, YFS implementation requires additional efforts
of coordination among PFMC, LEPs and local stakeholders to strengthen the public health system. This
requires developing staff skills in comprehensive care and assisting local hospitals managers to attain
sustainable youth programs within a profit-oriented health system.

During the visit to Barrancabermeja, the Secretary of Health acknowledged the difficulties of
implementing YFS in the municipality through the public system. The local hospital is politically and
administratively dependent on the governor of Santander department, rather than the mayor of
Barrancabermeja. The hospital chose not to participate as a YFS in the project and did not support HIV
testing, pleading lack of staff and financing – although it was understood that the motivation may have
been political differences between the hospital director and the mayor. Thus, the mayor’s office
attempted to establish youth-friendly centers of its own. At the time of the visit, there was only one
center in operation part-time in the afternoons, and given the complexities of staff contracting, it was at
risk of closing in 2007. In all the health institutions visited, staff reported work instability due to short
contract periods without benefits, which affected staff morale and the continuity of services offered to
youth as part of the project. This is a chronic structural problem in the Colombian health system, which
places emphasis on profits and cost reduction at the expense of quality. This is even more complex in the
public sector due to the politicization and, at times, corruption in health institutions.

While in many cases, HIV-positive patients still need judicial orders to make hospitals accountable for
their care, PFMC is working with providers to promote a rights-based approach and define institutional

23
networks that guarantee access and comprehensive treatment to youth at all levels of the public health
system. Access to medicines is an important aspect of this approach; the social security health system
currently only guarantees access to medicines to approximately 50% of confirmed cases of HIV. In
Barrancabermeja it was concluded that the demand for voluntary testing and STI diagnoses generated by
the PFMC would go unsatisfied given that many young people do not have health insurance and the local
healthcare syetem is in crisis.

Thanks to the financial and technical assistance of the local UNFPA mission, in 2007 the PFMC will
develop a strategy for training and technical support for more than 140 health institutions countrywide.
The project “Strengthening Youth-Friendly Services in Sexual and Reproductive Health” will support the
implementation of quality and sustainable services that meet the health needs of all youth, especially
those who are highly vulnerable, such as IDY.

Training and Capacity Building


The PFMC developed a strategy for capacity and skills building for program implementers and young
people. Based on previous national experiences with youth, the general content of the training and
empowerment program was designed and prepared according to the development stages of adolescence
and youth, with an emphasis on reducing their vulnerability to STIs, HIV and AIDS, and adapted to the
particularities of each municipality. Using the program tools mentioned above, the project trained local
authorities, workers in the education and health sectors, and youth beneficiaries through a peer-to-peer
strategy.

As of December 2006, 885 health workers were trained (of whom 160 received additional training in
VCT) and 1,394 educators from 315 primary and secondary schools received training. By this time, 195
of these schools had already developed institutional educational plans and programs for sexual education.

In the two years prior to the visit, the PFMC and its LEPs trained more than 200,000 youth leaders in
regional, local, and replication workshops. 75 The strategy of identifying and involving youth leaders and
reinforcing networks to advance peer-to-peer activities resulted in a successful cascade training and
empowerment program. In December 2006, many project sites were in the final stage of the peer
educational process consisting of informal activities carried out by those who participated in the
replication workshops. It is hoped that each youth will share the information learned with his or her
closest social group, with a minimum of five peers.

In all the municipalities visited the number trained exceeded expectations. One of the explanations for this
outcome was the success of many LEPs in involving local organizations in replicating the training. Local
government agencies, schools and other community organizations participated in this effort. In
Barrancabermeja, for example, the police and international organizations extended the training and
support to youth organizations from communities that originally did not participate in the project.

The beneficiaries and the LEPs observed that despite having exceeded the objective for number of
persons trained, there is still a need to extend training to other vulnerable zones as well as retraining for
health workers in management and treatment of HIV, counseling, and gender-based violence. It was also
suggested that if the YFS program is extended, health workers should be trained in improving quality,
reducing stigma and discrimination, sexual and reproductive rights, etc.

The PFMC recognizes that training is a key element not only for disseminating information to youth on
diverse aspects of programs for HIV prevention in the displaced population, but also for developing skills
in local staff that run these programs. However, as mentioned above regarding evaluation, the PFMC does
not have information that allows assessment of the medium- and long-term impact of training on changes
in the behavior of beneficiaries as well as health workers.

24
Resource Mobilization, Collaborative Partnership, and Advocacy
Although there is no exact accounting of the additional resources (financial and in-kind) contributed to
the project by international organizations, national, regional and local governmental agencies, and civil
society organizations, some informants estimated that the amount could be greater than the slightly more
than US$8.5 million originally provided by GFATM.

Some UN agencies, such as PAHO, UNAIDS, UNHCR, UNFPA, UNICEF and WFP not only
contributed as members of the country coordinating mechanism; they also used their experience and
resources to facilitate implementation of activities. UNHCR has been a great ally on advocating for
IDY’s rights and facilitating the protection of LEPs staff in armed conflict zones. UNAIDS provided staff
time for technical support of key project activities. At the beginning of the project in 2004, UNICEF was
instrumental in its dissemination and positioning, supporting 6 awareness-raising regional fora. It also
contributed significantly to the production of one of the toolbox modules. In 2006, PAHO supported
training for health workers in 48 municipalities and strengthening of a network of healthcare institutions
offering care and treatment for people living with HIV. UNFPA assisted the PFMC throughout its three
years of operation. This agency contributed to the production of the toolbox and provided financial
support for the execution of at least two complementary projects: “National Project for Sexuality
Education and Citizenship Building,” (in collaboration with the Ministry of Education) and
“Strengthening Youth-Friendly Services for Sexual and Reproductive Health.” 76 In addition, PFMC staff
estimated that thanks to a partnership with UNFPA, the project managed to save approximately one third
of the projected cost for purchasing condoms.

As the head of the CCM, the Ministry for Social Protection supported coordination with other national
and departmental government agencies to ensure that project actions integrated with the National Program
on HIV/AIDS. The Ministry of Education also collaborated on intersectoral activities and facilitated
coordination with departmental secretaries of education.

At the local level, the PFMC and its LEPs established 54


municipal coordinating mechanisms (MCMs) and mobilized
significant resources. For example, in Barrancabermeja where
the PFMC provided approximately US$35,000 through the local
executing partnership, the local government estimated its
contribution was slightly more than US$75,000 including staff
time (US$60,000) for direct project actions and logistical support
for 12 workshops. In Villavicencio, the MCM meeting, observed
by the mission team, reported local government resources of
approximately US$27,000 to support microenterprise projects
for IDY linked to the PFMC. Despite the effort of the LEPs to
coordinate with other projects that focus on IDY, interviewees
requested greater coordination among programs managed at the
national level that focus on displaced youth. For example, in San Pablo, in addition to PFMC, there are at
least three other IDY projects, some of which are financed with international resources: Proyecto Alianza
PILAS (PADF/IOM/USAID) 77, the “Centro de Pensamiento Juvenil” [Center for Youth Ideas] run by
Red de Gestores Sociales and the Municipal Youth Councils “Colombia Joven” organized by the office
of the President of the Republic. All of these projects, which are still not coordinated, usually include
trainings in similar areas for the same youth leaders.

Many interviewed subjects mentioned that these types of “vertical” projects, including the PFMC should
make an effort to understand and respect local dynamics and to navigate the political agenda of municipal

25
and regional governments to attain their full participation in sustainability of social development
initiatives through the allocation of funds and the implementation of long-term public policies.
Informants observed that the project could have benefited if it had designed a clear strategy for
consensus-building and awareness-raising for civil authorities in order to obtain their political
commitment and active participation in developing the different phases of the project. It was suggested
that international cooperation projects such as the PFMC be designed with participation of local
governmental and community actors and that they be executed for at least three years so that their impact
can be evaluated.

As mentioned above, the PFMC promoted partnerships among non-governmental and community
organizations to execute the project in 48 municipalities. Through these partnerships, they were able to
involve an additional 947 CSOs. Almost all interviewees reported that although the collaborations among
executing agencies and the project’s linkages to multiple social networks was one of the fundamental
aspects of the PFMC, there is still very little understanding of how these collaborations and networks
operated and how to systematically measure outcomes. It is estimated, for example, that the time and in-
kind resources provided by youth, volunteers and communities is “incalculable,” and if it could be
established, would translate into “millions” of dollars. Additionally, some interviewees observed that the
PFMC could have benefited from private sector partnerships through social responsibility programs, but
there was no strategy to attract and involve this collaboration in a more aggressive manner.

5. CONCLUSION

Working within the enormous challenge of armed conflict, poverty, and political and social fragility
in Colombia, the CCM, GFATM, and IOM successfully implemented a comprehensive initiative to
reduce the vulnerability of IDY to HIV. Although data collection to confirm changes created by this
initiative is still underway, the project can already claim accomplishments regarding increased social
awareness about HIV and the special vulnerability of young people (particularly IDY); improved
coordination among international donors, governmental agencies, and CSOs; and build up the capacity
and skills of thousands of young leaders, local authorities, health providers, teachers, and local executing
agencies. Although the MSCI assessment found that there was potential for improvement in various areas,
the project is a “must see” initiative in which agencies such as UNFPA could gather information and learn
lessons to inform projects in other countries supporting HIV prevention and care among youth displaced
due to emergencies and conflict.

6. RECOMMENDATIONS

• The PFMC and its CCM should advocate and foster national responsibility and commitment among
all governmental agencies for reducing IDY’s vulnerability to HIV while addressing their broader
needs. Equally, the Colombian government should provide significantly more financial and technical
support for reproductive health, including HIV prevention and care filling in the loopholes of the
insurance-based health system.
• Linkages between all projects serving IDY should be strengthened particularly PFMC, the
presidential programs (Acción Social, Colombia Joven, etc.), and projects funded by UNFPA and
USAID, among others.
• The MOH and the CCM director should continue further coordination among key organizations
serving IDY when the PFMC’s terminates its current funding cycle.

26
• PFMC and the CCM should continue strengthening local executing agencies, and community
networks (especially youth organizations), through technical cooperation and training so they will
have the capacity to develop strategic partnerships for a timely and efficient response to local needs.
• UN agencies, PFMC, and LEPs should do more to advocate for and encourage local governments to
implement national policies relating to IDPs, so all sectors (health, education, etc.) join efforts.
• The UN agencies, primarily UNAIDS, UNFPA, UNHCR, and UNICEF, should scale up their own
efforts and support to PFMC and civil society organizations in raising awareness of IDY and IDPs’
rights and reduction of stigma for people living with HIV and AIDS. In addition, UN agencies should
ensure that these rights and the need to reduce youth’s vulnerability to HIV are included in each
agenda for peace talks between the government and armed groups.
• PFMC should coordinate more closely with UNHCR to encourage and support improved protection
to youth leaders, program staff, and human rights activist supporting the implementation of the
project. UNHCR should provide further assistance to PFMC in areas of human rights and reduction of
stigma and discrimination for people living with HIV and AIDS, homosexuals, MSM, and
commercial sex workers.
• The PFMC should raise awareness about GBV and other human rights violations that make youth
more vulnerable to poor sexual and reproductive health and violence, and should encourage
participation of boys and young men in activities working to reduce violence against women.
Similarly, LEPs should promote community information and education about GBV and encourage
local authorities and health providers to verify, register, and offer care to survivors of violence
(including provision of post exposure prophylaxis for victims of sexual violence).
• UN agencies and the GFAMT should closely review lessons learned from the implementation of
PFMC as a model to address HIV prevention and care for IDY.
• PFMC should bring national and international attention to its experience implementing HIV
prevention and care programs for IDY ensuring documentation and dissemination of its activities and
sharing lessons learned. This can be achieved by participating in international conferences, writing
project materials and journal articles (in English and Spanish), and involving the media.
• PFMC and UNFPA, in coordination with the MSP, must make every effort to ensure that all health
institutions participating in the youth-friendly services initiative have the technical and administrative
skills to be able to offer sustainable quality services for youth, including SRH education, family
planning, VCT, and ART.
• PFMC and the Ministry of Social Protection should advocate for access to the best ART for people
living with HIV and AIDS, especially among IDPs. MSP should promote and enforce policies and
guidelines among health providers to ensure confidential quality services.
• PFMC and CCM should advocate with government agencies and churches to increase condom use as
part of a protection strategy, particularly among IDPs, and coordinate efforts with international
agencies to make them available at the lowest cost possible.
• PFMC should advocate with the Ministry of Education to accelerate the implementation of sexual
education across all levels of the education system ensuring the right of youth to be given accurate
and comprehensive information.
• PFMC should secure and improve a monitoring and evaluation system that includes a comprehensive
package of indicators capable of identifying behavioral changes among youth, as well as impact of
their income-generating projects to improve life conditions.
• The PFMC should make a detailed analysis of the means for sustainability of youth income-
generating projects over the medium and long term, and the potential linkages to government and
private initiatives for training, labor market skills development, microfinance, and other kinds of
financial support.

27
Appendixes

28
List of organizations that have participated in the Country
Coordinating Mechanism (CCM)
Government Organizations
• Ministerio de Protección Social – MPS [National Ministry of Social Protection – MSP, formerly Minstry of Health]
• Minsterio de Educación Nacional [National Ministry of Education]
• Acción Social (formerly Red de Solidaridad Social - Social Solidarity Network]
• Instituto Nacional de Salud [National Institute of Health]
• Programa Colombia Joven de la Presidencia de la República [Young Colombian Program of the Office of the President of
the Republic]

Academic Organization
• Gender Faculty of the National University of Colombia
Non-Government Organizations
• Consultoría para los Derechos Humanos y el Desplazamiento [Consultancy for Human Rights and Displacement]
• Asociación Pro Bienestar de la Familia Colombiana/ Profamilia [Association for the Welfare of Colombian Families]
• Red Colombiana de Personas que Viven con el VIH/SIDA - RECOLHIV [Colombian Network of People Living with
HIV/AIDS]
• Colombian Red Cross
• DARSE Foundation
Inter-agency and Intergovernmental bodies
• International Organization for Migration – IOM
• Panamerican Health Organization - PAHO
• UNAIDS
• UNDP
• UNHCR
• UNICEF
• UNFPA

29
Contact Information Colombia
Proyecto Fondo Mundial Colombia – PFMC Ricardo Luque,
Dr. Angela González Puche Dirección General de Salud Pública
Gerente Ministerio Protección Social
Tel: +57 1 622 7774 rluque@minproteccionsocial.gov.co
Email: acgonzalez@oim.org.co
Barrancabermeja
Daniel Fernández Patricia Ferrin
Asesor en Ciencias Sociales Corporación Obusinga
Tel: +57 1 622 7774 Tel: +57 (7) 6213533
dfernandez@oim.org.co pafe28@gmail.com

Oliverio Huertas Malgareth Sánchez


Asesor en Emprendimientos Productivos Corporación Obusinga
Asesor en Ciencias Sociales Tel: +571 7 6213533
Tel: +57 1 622 7774 sinrumbo422@hotmail.com
ohuertas@oim.org.co
Bucaramanga
Franklyn Prieto Blanca Patricia Mantilla
Asesor en Salud Pública Proinapsa-UIS
Tel: +57 1 622 7774 Tel: +57 7 6450006
fprieto@oim.org.co bpmantil@uis.edu.co

Linda Eriksson Jose Alfredo Echeverría


Oficial de Programa Cidemus
Organización Internacional para las Migraciones + 57 7 6701864
(IOM) elciudadanojose@yahoo.es
Tel: +57 1 622 7774
leriksson@oim.org.co San Pablo
Lidia Álvarez
Fernando González Corporación Boiti
Ofical de Programas Tel: +57 7 6221587
Fondo de Población de Naciones Unidas (UNFPA) Email: lialri@hotmail.com
fgonzalez@unfpa.org
Henry Lozano
Dr. Ricardo García Bernal Corporación Nación
UNAIDS Country Officer Tel: + 57 5 6221587
Telephone: +571 646 7000, ext. 322 helogo70@terra.com
Email: ricardo.garcia@unodc.org
Villavicencio
Stefano Feliciani Ana Patricia Cerón
ACNUR (UNHCR) Asociación Sociocultural NACATSI
Tel: + 57 1 6 80600 Tel: +57 (8) 6829196
Email: felicianist@unhcr.org patricia@nacatsi.org

30
List of global organizations with experience on youth, HIV,
and internal displacement

• African Medical and Research Foundation


• American Refugee Committee
• CARE
• Centre for Research on the Epidemiology of Disasters
• Centro de Capacitación en Ecología y Salud para Campesinos
• Center for Population and Family Health -- Columbia University Mailman School of Public Health
• Family Health International
• Internal Displacement Monitoring Centre - Norwegian Refugee Council
• International Centre for Migration and Health
• International Federation of the Red Cross and Red Crescent Societies
• International Planned Parenthood Federation
• International Rescue Committee
• International Organization for Migration
• JSI Research and Training Institute
• London School of Hygiene and Tropical Medicine
• Marie Stopes International
• Médecins du Monde
• Médecins sans Frontières
• MERLIN (Medical Emergency Relief International)
• Population Council
• Save the Children Fund UK
• United Nations Children's Fund - UNICEF
• United Nations High Commissioner for Refugees - UNHCR
• United Nations Joint Programme on AIDS - UNAIDS
• United Nations Fund for Population Activities - UNFPA
• United Nations Office for the Coordination of Humanitarian Affairs - OCHA
• U.S. Agency for International Development - USAID
• U.S. Centers for Disease Control and Prevention - CDC
• Women's Commission for Refugee Women and Children
• World Health Organization - WHO

31
Annotated bibliography related to HIV, youth and Internal
displacement
Benjamin, J. (1998). AIDS Prevention for Refugees; The Case of Rwandans in Tanzania. Retrieved 1/05/07
from: http://www.fhi.org/en/HIVAIDS/pub/Archive/aidscapreports/finalreportAIDSCAPrwanda/index.htm
Final Report by Family Health International on the AIDSCAP HIV prevention project (1993-1997). The report
details the four major components of the program; condom promotion and acceptance, community based
education, STI testing and counseling through expanded activities such as sports and health fairs. The project
was implemented both with internally displaced Rwandans and those living in refugee camps in Tanzania.

Care International. (2007). BIH Youth Initiative for Combating HIV/AIDS. Retrieved 1/18/07 from:
http://www.care.org/careswork/projects/BIH055.asp Situation assessment regarding the reproductive health
needs, GBV and HIV among adolescents in Bosnia & Herzegovina and in the Western Balkans. Little
information regarding details of the project is available.

Girard, F. and Waldman, W. (2000). Ensuring the Reproductive Rights of Refugees and Internally Displaced
Persons: Legal and Policy issues. International Family Planning Perspectives 26(4), p. 167–173. Retrieved
2/08/07 from: http://www.a gi-usa.org/pubs/journals/2616700.html This article provides information regarding
the international legal framework (Refugee law, International Human Rights Law) for providing reproductive
health services to refugees and displaced people. Included is a review of recommendations from human rights
treaties that of the Women’s Convention, the International Covenant on Economic, Social and Cultural Rights
and the Geneva Convention. Also provided is a list of definitions related to classification of IDPs, asylum
seekers and refugees. Noted as a particular concern for agencies providing reproductive healthcare to IDPs is
internal governmental denial and disinterest of the challenges and disruption of humanitarian efforts.

Mcginn, T. et al. (2001). Forced Migration and Transmission of HIV and other STI: Policy and
Programmatic Responses. Retrieved 1/04/07 from: http://hivinsite.ucsf.edu/InSite?page=kb-08-01-08#S6X
This article includes background information regarding the impact of forced migration on STI/ HIV
transmission. Although the focus is neither adolescents nor Latin America, profiles/ case studies of successful
prevention programs in various settings are included. A relatively thorough literature review is presented as
well, most notably including an explanation of international legislation related to people affected by armed
conflict. Recommendations for governmental and organizational programmatic responses are noted.

Ospina,P. and A. Vega. (2002). Capacitación y Servicios de Salud Reproductiva para Jóvenes Desplazados en
Colombia. Retrieved 1/18/07 from: http://www.migracionesforzadas.org/pdf/RMF15/RMF15_7.pdf
Description of Profamilia programs in 6 informal settlements throughout Cartagena and Barranquilla. Also
described are the results of a survey of youth knowledge of contraception as well as level/frequency of use.
Profamilia concluded that although knowledge of protective measures was widespread, actual utilization
remained low (14%). Also noted was the lack of awareness regarding HIV as the preceding cause of AIDS and
common perception of low susceptibility to infection. Recommendations for increased access include mobile
SRH units specifically for adolescents.

PATH. (2006) Refugee Reproductive Health Program Examples: HARP. Retrieved 1/04/07 from:
http://www.rho.org/html/refugee_progexamples.htm#africa "UNFPA, Family Health International (FHI) and
the World Association of Girl Guides and Girl Scouts (WAGGGS) began implementing the Health of
Adolescent Refugees Project (HARP) in August 1997. HARP uses the Girl Guide/Girl Scout method to bring
basic health education to girls and young women living as refugees. As part of this innovative peer education
program, adolescent refugees form Girl Guide groups; earn an Adolescent Health Badge by learning about their
own physical, emotional, and mental health needs; and then share this information with their peers."
Implemented in Egypt, Uganda, and Zambia with 10 -18+ years old.

RHRC. (2002). Work with Young Refugees to Ensure Their Reproductive Health and Well-being: It’s Their
Right and Our Duty, A Field Resource for Programming With and For Refugee Adolescents and Youth.
Retrieved 1/08/07 from: http://www.rhrc.org/pdf/unhcr_paper_new.pdf

32
Field manual to be used by local program developers and direct service providers in various cultural contexts.
Includes comprehensive checklists to evaluate existing programs, conduct needs assessment, develop new
programs and curriculum and train staff to better meet the needs of displaced young people.

RHRC. (2003). Displaced and Desperate: Assessment of Reproductive Health for Colombia's Internally
Displaced Persons. Retrieved 1/08/07 from: http://www.womenscommission.org/pdf/co_rh.pdf This document
includes information gathered through a nationwide needs assessment in conjunction with Profamilia. The
discrepancy between what SRH services are needed by IDP and those provided is detailed. Moreover, the report
includes recommendations for better addressing and meeting those needs. Contact information for related
domestic and international organizations is provided, as are statistics of STI/ HIV, teen pregnancy prevalence,
GBV etc.

Spiegel, P. (2006). HIV/AIDS and Internally Displaced Persons in 8 Priority Countries. Retrieved 1/08/07
from: http://www.unhcr.org/home/RSDLEGAL/4414462d4.pdf This document includes background
information regarding HIV morbidity within IDP communities in 8 countries, including Colombia, as well as
recommendations for the UNHCR. The author outlines programmatic and logistical challenges particular to
working with IDP. Particular attention is lent to the necessity of media surrounding issues of SRH needs of IDP.

Vernon, R; et.al. (1990) Incorporating AIDS Prevention Activities into a Family Planning Organization in
Colombia. Studies in Family Planning, 21(6) p. 335-343. Review of Profamilia initiative in Colombia using
three public education campaigns; informative talks in both formal and informal settings, establishment of
condom distribution posts for specific target groups and mass media campaigns. Noted as a primary goal was
the destigmatization of condom use. The effectiveness of community outreach workers as health promoters is
noted, particularly for the marginalized. This article offers insight into past successes and challenges of HIV
prevention in a Colombian context, although not specific to internally displaced people.

WHO. (2006). Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing
Countries. Retrieved 1/05/07 from: http://www.unfpa.org/upload/lib_pub_file/633_filename_preventing.pdf
Although not specific to refugee or displaced adolescents, the report offers insight into various types of
interventions and the context in which they were implemented. A thorough bibliography is included. Also
included is a chapter focused on the evaluation of programming and interventions through specific criteria.
Meeting the needs of particular sub-populations if youth i.e. IDYP, MSM, etc is not addressed, as the document
is a broad overview.

33
Notes
1
OCHA. Guiding Principles on Internal Displacement. 1998. http://www.brook.edu/fp/projects/idp/resources/GPSenglish.pdf.
Last accessed December 23, 2006.
2
Eschenbächer, Jens-Hagen (editor). Internal Displacement: Global Overview of Trends and Developments in 2005. Published
by the Internal Displacement Monitoring Centre. Norwegian Refugee Council. March 2006.
3
IDMC. Internal Displacement Monitoring Centre. http://www.internal-
displacement.org/8025708F004D404D/(httpSectionHomepages)/$first?OpenDocument&count=1000
4
UNHCR. Reproductive health in refugee situations. An inter-agency field manual High Commissioner for Refugees. 1999.
Available at http://www.unfpa.org/emergencies/manual/8.htm
5
IAWG. Reproductive Health Services for Displaced Persons: A Decade of Progress. IAWG, Inter-Agency Working Group on
Reproductive Health in Refugee Situations. Video. 2005. http://www.unfpa.org/emergencies/iawg/iawg.htm
6
World Youth Report. Report of the United Nations Secretary General, 2005.
7
John Borton, Margie Buchanan-Smith, Ralf Otto (2005). Support to Internally Displaced Persons – Learning from Evaluations.
Synthesis Report of a Joint Evaluation Programme. Published by SIDA. http://www.sida.se/publications
8
Gender-based violence (GBV) is an umbrella term for any harm perpetrated against a person’s will, and that results from power
inequities that are based on gender roles. The term is often used interchangeably with the term "violence against women"
(VAW) because this type of violence always has a greater negative impact on women and girls. However, in some cases men
and boys may also be victims of gender-based violence. Violence may be physical, sexual, psychological, economic, or socio-
cultural.
9
Margaret Sanger Center International. Scaling up HIV Prevention Programs for Youth: the Essential Elements Framework in
Action. Safe Youth Worldwide, A Global Initiative to Strengthen HIV Prevention among Youth. New York. 2005.
10
UNFPA and UNICEF. Experts Group Meeting on Young People in Emergency and Transitional Situations. 11-13 December
2006. New York. Unpublished document.
11
OCHA. Guiding Principles on Internal Displacement. 1998. http://www.brook.edu/fp/projects/idp/resources/GPSenglish.pdf.
Last accessed November 10, 2006.
12
Spiegel, Paul and Hélène Harroff-Tavel. HIV/AIDS and Internally Displaced Persons in 8 Priority Countries. United Nations
High Commissioner for Refugees (UNHCR) in collaboration with the Inter-Agency Internal Displacement Division,. United
Nations Office for the Coordination of Humanitarian Affairs. January 2006. www.unhcr.org/cgi-
bin/texis/vtx/protect/opendoc.pdf?tbl=PROTECTION&id=43eb43be2 Last accessed November 12, 2006.
13
Margaret Sanger Center International. Scaling up HIV Prevention Programs for Youth: the Essential Elements Framework in
Action. Ibid.
14
Colombia. Departamento Administrativo Nacional de Estadística (DANE). http://www.dane.gov.co/
15
The World Bank. Colombia data profile.
http://devdata.worldbank.org/external/CPProfile.asp?SelectedCountry=COL&CCODE=COL&CNAME=Colombia&PTYPE=
CP Last accessed February 2, 2007.
16
The World Bank. World Development Report 1998-1999. Washington, D.C: The World Bank, 1999.
http://www.worldbank.org/wdr/wdr98/contents.htm
17
Calculations of the National Planning Department DNP-UDS-DIOS, based on data of the National Statistics Department DANE. SISD.
Bulletin N° 26 of 2001. Cited in: The Global Fund to Fight AIDS, Tuberculosis and Malaria. Colombia and the Global Fund, Original
Proposal. http://www.theglobalfund.org/search/docs/2COLH_155_0_full.pdf Last accessed February 2, 2007.
18
The Global Fund to Fight AIDS, Tuberculosis and Malaria. Colombia and the Global Fund, Original Proposal.
19
Marie Stopes International and Women’s Commission for Refugee Women and Children. Displaced and Desperate:
Assessment of Reproductive Health for Colombia’s Internally Displaced Persons. New York: Reproductive Health for
Refugees Consortium & Women’s Commission for Refugee Women and Children, 2003.
http://www.womenscommission.org/pdf/co_rh.pdf Last accessed November 18, 2006.
20
Human Rights Watch. The Plight of Internally Displaced Persons in Bogotá and Cartagena. October 2005 Vol. 17, No. 4(B).
http://hrw.org/reports/2005/colombia1005/ Last accessed February 5, 2007.
21
ReliefWeb. Colombia: Discurso del Alto Comisionado para la Paz, Luis Carlos Restrepo, durante la ceremonia de
desmovilización y entrega de armas de la segunda fase de integrantes del bloque Elmer Cárdenas de las autodefensas
campesinas. Source: Government of Colombia. 30 April 2006.
http://wwwnotes.reliefweb.int/w/rwb.nsf/6686f45896f15dbc852567ae00530132/199bcdc0cdd70482c12571610042e925?Open
Document Last accessed February 5, 2007.
21
CODHES (Consultoria para los Derechos Humanos y el Desplazamiento). CODHES Informa, Human Rights and
Displacement Consultancy. Press Bulletin. Cartagena, Colombia. 1 February 2006.
http://www.codhes.org/Publicaciones/infocartagena.pdf Last accessed February 12, 2007.
22
Ibid.
23
US Committee for Refugees. World Refugee Survey 2004, Country Report – Colombia. 2004.
http://www.refugees.org/countryreports.aspx?area=investigate&subm=19&ssm=29&cid=1306
24
Human Rights Watch. In: Global IDP Database, ‘Colombia - Causes and Background of Displacement,’ December 2001.
http://www.db.idpproject.org

34
25
CODHES (Consultoria para los Derechos Humanos y el Desplazamiento). Displacement and Violence, Prevention or Cure?,
CODHES Informa, Human Rights and Displacement Consultancy Bulletin Number 33. 7 de diciembre de 2000.
http://www.db.idpproject.org/Sites/idpSurvey.nsf/wCountries/Colombia Last accessed Febreruary 6, 2007.
26
Internal Displacement Monitoring Centre. Colombia: Government "peace process" cements injustice for IDPs. Norwegian
Refugee Council, 30 June 2006. http://www.internal-displacement.org/countries/colombia Last accessed February 8, 2007.
27
Borton, J., Buchanan-Smith, M., and Ralf Otto. Support to Internally Displaced Persons – Learning from Evaluations.
Synthesis Report of a Joint Evaluation Programme. Published by SIDAS, 2005. www.sida.se/publications Last accessed
February 8, 2007.
28
SC–US (Save the Children–US) (2001) ‘Senior Inter-Agency Network on Internal Displacement,Mission to Colombia 16–24
August 2001, Findings and Recommendations’, SC–US. http://www.reliefweb.int/idp/docs/reports/Colombiaiarepaug2001.pdf
Last accessed February 8, 2007.
29
NRC (Norwegian Refugee Council). Global IDP Project – Global Overview, Norwegian Refugee Council. 15 March 2002.
http://www.db.idpproject.org/global_overview.htm Last accessed February 7, 2002.
30
Hines, Deborah and Raoul Balletto, Assessment of Needs of Internally Displaced Persons in Colombia. Working Paper 189.
London: Overseas Development Institute, December 2002. http://www.odi.org.uk/Publications/working_papers/wp189.pdf
Last accessed February 7, 2007.
31
Sexual violence against girls and women in Colombia is a tactic of war. See: Amanesty International.
Colombia: Scarred bodies, hidden crimes. Sexual Violence against women in the armed conflict. 13 October 2004.
http://web.amnesty.org/library/pdf/AMR230402004ENGLISH/$File/AMR2304004.pdf Last accessed November 15, 2006.
32
Thematic Group on Internal Displacement, Internal Displacement Situation, Colombia, August 2001.
33
Human Rights Watch. Colombia: Displaced and Discarded. The Plight of Internally Displaced Persons in Bogotá and
Cartagena. October 2005 Vol. 17, No. 4(B). http://hrw.org/reports/2005/colombia1005/colombia1005.pdf Last accessed
November 16, 2006.
34
UN News Centre. Reports that displaced youth are abused and exploited in Colombia’s cities concern UN. 17 May 2005.
http://www0.un.org/apps/news/story.asp?NewsID=14303&Cr=Colombia&Cr1= Last accessed February 9, 2007.
35
CODHES (Consultoria para los Derechos Humanos y el Desplazamiento). Guerra y Diaspora (War & Diaspora). Codhes
Informa, No. 39, Colombia, November 2001.
36
PAHO/WHO & the Colombian Ministry of Health, Cartilla básica para la atención en salud de la población en condiciones de
desplazamiento (Basic blueprint for health provision to displaced people), Colombia, 2000.
37
This problem is also related to the lack of registration of IDPs with Accion Social (formerly Social Solidarity Network – SSN),
the governmental agency coordinating support to IDPs.
38
Sanabria P, Prada MF; Muñoz AM. Seguridad social en salud: la inclusión social de los jóvenes – Informe Final.
39
Profamilia is the Colombian affiliate of the International Planned Parenthood Federation, Western Hemisphere Region (IIPF-
WHR). It is the largest provider of family planning and other sexual and reproductive health services. Profamilia is also an
executing agency in some municipalities under PFMC. www.profamilia.org.co
40
Myers, Holly and Marc Sommers. A Charade of Concern: the Abandonment of Colombia’s Forcibly Displaced. New York:
Women’s Commission for Refugee Women and Children, 1999. http://www.womenscommission.org/pdf/co1.pdf Last
accessed January 16, 2007.
41
Marie Stopes International and Women’s Commission for Refugee Women and Children. Displaced and Desperate:
Assessment of Reproductive Health for Colombia’s Internally Displaced Persons. Op. Cit.
42
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women), Profamilia Survey 2000, Bogotá, Colombia: 2000.
http://www.profamilia.org.co/encuestas/04desplazadas/resumen/2000.htm
43
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women), Profamilia Survey 2005. Bogotá, Colombia:
Profamilia, 2005. http://www.profamilia.org.co/encuestas/04desplazadas/pdf2005/resumen_desplazadas_2005.pdf
44
Human Rights Watch interview with Patricia Ospina (Profamilia), July 27, 2004. Cited in: Human Rights Watch. Colombia:
Displaced and Discarded. The Plight of Internally Displaced Persons in Bogotá and Cartagena. October 2005 Vol. 17, No.
4(B). http://hrw.org/reports/2005/colombia1005/colombia1005.pdf Last accessed November 16, 2006.
45
Profamilia. Salud Sexual y Reproductiva en Colombia (Sexual and Reproductive Health in Colombia), National Demographic
Health Survey. Bogotá, Colombia: Profamilia, 2000.
http://www.profamilia.org.co/encuestas/01encuestas/2000resultados_generales.htm
46
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women), Profamilia Survey 2000. Op. Cit.
47
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women). Profamilia Survey 2005. Op. Cit.
48
PAHO. Health in the Americas: Colombia, 1998. http://www.paho.org/English/HIA1998/Colombia.pdf
49
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women), Profamilia Survey 2000. Op. Cit.

35
50
Interview with representative of Working Group, Women and Armed Conflict, Bogotá, November 14, 2001. Cited in: Marie
Stopes International and Women’s Commission for Refugee Women and Children. Displaced and Desperate: Assessment of
Reproductive Health for Colombia’s Internally Displaced Persons. Op. Cit.
51
UNFPA. Assisting Internally Displaced Youth in Colombia. Chaim Litewski for UNTV, 2004
http://www.unfpa.org/video/2004.htm
52
The Center for Reproductive Law and Policy. Women’s Reproductive Rights in Colombia (CRLP), A Shadow Report. New
York: CRLP. December 1998. http://www.reproductiverights.org/pdf/sr_col_1298_eng.pdf Last accesed January 23, 2007.
53
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women). Profamilia Survey 2005. Op. Cit.
54
http://www.unaids.org/en/Regions_Countries/Countries/colombia.asp Last accessed February 26, 2007.
55
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women). Profamilia Survey 2005. Op. Cit.
56
Profamilia. Salud Sexual y Reproductiva en Zonas Marginadas - Situación de las Mujeres Desplazadas (Sexual and
Reproductive Health in Marginal Areas - The State of Displaced Women), Profamilia Survey 2000, Op. Cit.
57
The Global Fund to Fight AIDS, Tuberculosis and Malaria. Colombia and the Global Fund, Original Proposal.
http://www.theglobalfund.org/search/docs/2COLH_155_0_full.pdf Last accessed February 2, 2007.
58
El Sistema de Registro Unico - SUR (in Spanish) is the official system that manges all data related to forced displacement. It is
currently housed at “Accion Social,” the Presidential Agency for Social Accion and International Cooperation.
http://www.accionsocial.gov.co/portal/default.aspx
59
Consultoria para los Derechos Humanos y el Desplazamiento (CODHES). http://www.codhes.org/ Last accessed February 12,
2007.
60
Amnesty International. Colombia: Scarred bodies, hidden crimes. Sexual Violence against women in the armed conflict. 2004.
http://web.amnesty.org/library/index/engamr230402004 Last accessed December 16, 2006.
On the effect of armed conflict and displacement on women and girls see also: Red Nacional de Mujeres. Violencias Cruzadas.
Informe Derechos de las Mujeres Colombia 2005. http://www.observatoriomujeresyderechos.org/html/documentos.html Last
accessed December 16, 2006.
61
This is also the case in other countries. See: Beth, Vann. Gender-Based Violence: Emerging Issues in Programs Serving
Displaced Populations. GBV Global Technical Support Project. JSI Research and Training Institute on behalf of the
Reproductive Health for Refugees Consortium. September 2002.
62
UN News Centre. Reports that displaced youth are abused and exploited in Colombia’s cities concern UN. May 2005.
http://www0.un.org/apps/news/story.asp?NewsID=14303&Cr=Colombia&Cr1=
63
According to UNHCR, armed groups are known to have imposed curfews in some cities and banned behaviour they dislike.
People who disobey these orders risk violent death. In 2006 unknown armed men killed two boys, aged 14 and 16, in Altos de
Cazuca, an area close to the Colombian capital, Bogotá, which is home to more than 20,000 IDPs. See: UN News Centre.
Reports that displaced youth are abused and exploited in Colombia’s cities concern UN. May 2005.
http://www0.un.org/apps/news/story.asp?NewsID=14303&Cr=Colombia&Cr1=
64
Comisión Colombiana de Juristas. La Corte Constitucional protege los derechos de las víctimas y de la sociedad colombiana a
la verdad, la justicia y la reparación. Bogotá, mayo 19 de 2006.
http://www.icj.org/IMG/pdf/Comunicado_CCJ_sobre_85C94.pdf. Last accessed February 2, 2007.
65
This percentage was supplied anecdotally by administrative personnel interviewed. It was not possible to determine the exact
number of these organizations based on the documents reviewed.
66
PFMC. Presentation by the Proyecto Fondo Mundial Colombia. Event: National Forum for Technical Assistance in the
National Response to HIV/AIDS. Dissemination of the Guide to Comprehensive Assistance. Bogotá, November 23 and 24,
2006.
67
In Spanish “emprendimientos juveniles.”
68
PFMC. Presentation by the Proyecto Fondo Mundial Colombia. Event: National Forum for Technical Assistance in the
National Response to HIV/AIDS. Dissemination of the guidelines for comprehensive care. Bogotá, November 23 and 24,
2006.
69
A wide range of enterprises were visited, including arts projects, sports, a movie theater, Internet café, community store, etc.
70
Jacobsen, Karen. The Alchemy Project. Final Report 2001 – 2004. Refugees & Forced Migration Program, Feinstein
International Famine Center. Medford, MA: Tufts University, 2004.
http://fic.tufts.edu/downloads/alchemy_3year_report_on_microcredit.pdf Last accessed February 6, 2007.
71
Profamilia. Encuesta Nacional de Sexualidad. Bogota, 2005.
72
PFMC. Presentation by the Proyecto Fondo Mundial Colombia. Event: National Forum for Technical Assistance in the
National Response to HIV/AIDS. Dissemination of the Guidelines for comprehensive care. Bogotá, November 23 and 24,
2006.
73
MPS: Ministerio de Proteccion Social. This ministry oversees labor- and health-related issues.
74
Se utilizaron las tecnicas Umelisa HIV y Western blot en papel de filtro.
75
PFMC. Presentación Proyecto Fondo Mundial Colombia. Evento: Foro Nacional de asitencia técnica en la respuesta nacional
al VIH/SIDA. Divulgación de la Guía de Atención Integral. Bogotá D.C., Noviembre 23 y 24 de Noviembre de 2006.
76
Apoyo a PFMC a traves de Proinapsa, a university-affiliated executing agency.

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77
Alianza PILAS is a partnership between the Panamerican Development Foundtion (PADF) and the International Organization
for Migrations (IOM) with the support of USAID.

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