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) 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 Proyecto Fondo Mundial Colombia: a national response to prevent HIV among IDY ……………….11 Goals and objectives Structure and operation 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 Conclusion …………………………………………………………………………………………………26 Recommendations ...............................................................................................………………………..…26

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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 ART AUC BCC CCM Acquired Immune Deficiency Syndrome Antiretroviral Treatment Autodefensas Unidas de Colombia (Self-Defense Forces of Colombia) Behavioral change and communication Country Coordinator Mechanism Civil society organizations Ejército de Liberación Nacional (National Liberation Army) Fuerzas Armadas Revolucionarias de Colombia (Revolutionary Armed Forces of Colombia) Family Planning Gross Domestic Income Gender-based Violence Global Fund to fight AIDS, Tuberculosis and Malaria Human Immunodeficiency Virus Internally Displaced Persons Internally Displaced Children Internally Displaced Youth United Nations International Conference on Population and Development Information, Education, Communication International Labor Organization International Organization for Migration Local executing partnerships Margaret Sanger Center International Ministerio de Protección Social (Ministry of Social Protection) Men who have sex with men Mother-to-child transmission Nongovernmental Organization Organization of American States United Nations Office for the Coordination of Humanitarian Affairs President’s Emergency Plan for AIDS Relief Planned Parenthood of New York City Associación Pro bienestar de la Familia Colombiana Reproductive Health Reproductive Health for Refugees Consortium Sexual and Reproductive Health Sexually Transmitted Infection Sexual violence Safe Youth Worldwide United Nations Joint United Nations Program on HIV/AIDS United Nations Development Program United Nations Population Fund United Nations High Commissioner for Refugees UN Children’s Fund UN Development Fund for Women United States Agency for International Development Voluntary Counseling and Testing World Food Programme World Health Organization Youth Friendly Services

CSOs
ELN FARC FP GDI GBV GFATM HIV IDPs IDC IDY ICPD IEC ILO IOM LEPs MSCI MPS MSM MTCT NGO OAS OCHA PEPFAR PPNYC PROFAMILIA RH RHRC SRH STI SV SYW UN UNAIDS UNDP UNFPA UNHCR UNICEF UNIFEM USAID VCT WFP WHO YFS

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 nongovernmental 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 postconflict, 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 youthfocused 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 UNdeveloped 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 youthfriendly 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. Onequarter 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.

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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

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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 pregnancyrelated 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.

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Table 1: Colombia HIV data HIV/AIDS People living with HIV/AIDS Adults aged 15 and up living with HIV Adults aged 15 to 49 HIV prevalence rate Men living with HIV/AIDS Women aged 15 and up living with HIV Deaths due to AIDS Source: Adapted from UNAIDS54

160 000 [100 000 – 320 000] 160 000 [100 000 – 320 000] 0.6 [0.3 – 2.5]% 118,000 45,000 [24 000 – 95 000] 8,200 [5200 – 12 000]

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

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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.

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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 wellknown 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
Population 10-24 years Population 10-24 years in poverty conditions Local executing partnerships – LEPs Activities conducted

Barrancabermeja
62,380 18,402 Displaced persons Displaced persons (10-24 years) 16,855 5,326

Corporación Obusinga Cafaba, Equipo de trabajo juvenil de la comuna 7 (ETJ7) - Fundación Gente en Acción • 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
Population 10-24 years Population 10-24 years in poverty conditions Local executing partnerships – LEPs Activities conducted

Bucaramanga
168,419 15,797 Displaced persons Displaced persons (10-24 years) 30,147 4,992

Proinapsa-UIS – Cidemus • 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

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City
Population 10-24 years Population 10-24 years in poverty conditions Local executing partnerships – LEPs Activities conducted

San Pablo
8,635 5,213 Displaced persons Displaced persons (10-24 years) 6,658 1,647

Corporación Nación - Corporación Boiti - Casa de los y las adolescentes de San Pablo • • • • 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
Population 10-24 years Population 10-24 years in poverty conditions Local executing partnerships – LEPs Activities conducted

Villavicencio
102,739 20,480 Displaced persons Displaced persons (10-24 years) 25,993 6,472

Asociación Sociocultural NACATSI - ANISA Colombia (Agencia Nacional de Intervención Social Mediante el Aprendizaje - Asociación de Líderes Juveniles OASIS • 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).

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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, “In this country poor people have fewer rights especially displaced youth, as subjects with citizenship rights in and they are not heard…among the poor, the the process of nation-building requires a much longer-term effort displaced have even fewer rights…and among that exceeds the goals of this project. A repeated concern that should be further explored is youth’s 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.”
the displaced, women, youth and children have less voice….” School teacher, San Pablo

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 practices. easy.” 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
Sandra, 16 years old, Barrancabermeja

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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

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relationship with UNHCR be strengthened, since that organization’s presence, logistical capability, and credibility in project locations were recognized and would guarantee protection of the rights of youth.

An additional issue arose in the discussion with beneficiaries and LEPs during the visits. Displaced youth insisted that 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.

“Where was the government when the paramilitary forces and the guerrillas forced us to leave [our land]? Why are they given the chance and the resources to reintegrate…while we, by contrast, as displaced youth do not have much future….” Carlos, displaced youth, Bucaramanga

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

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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 confidence in ourselves to participate in [the decisions that affect] our neighbourhood and community. Now the adults invite us to local community board meetings with voice and vote. Javier, 18 years old, Bucaramanga

LEPs’ staff recognized that peer training strategies to reach youth within and outside the educational system motivated active participation of youth in HIV prevention activities such as IEC campaigns in the community, promotion of VCT, etc. Although 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 selfesteem 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

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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

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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 YouthFriendly 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.

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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

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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.

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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 youthfriendly 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

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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.

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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

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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 inkind 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.

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• •

• •

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 incomegenerating 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.

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Appendixes

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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

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Contact Information Colombia
Proyecto Fondo Mundial Colombia – PFMC Dr. Angela González Puche Gerente Tel: +57 1 622 7774 Email: acgonzalez@oim.org.co Daniel Fernández Asesor en Ciencias Sociales Tel: +57 1 622 7774 dfernandez@oim.org.co Oliverio Huertas Asesor en Emprendimientos Productivos Asesor en Ciencias Sociales Tel: +57 1 622 7774 ohuertas@oim.org.co Franklyn Prieto Asesor en Salud Pública Tel: +57 1 622 7774 fprieto@oim.org.co Linda Eriksson Oficial de Programa Organización Internacional para las Migraciones (IOM) Tel: +57 1 622 7774 leriksson@oim.org.co Fernando González Ofical de Programas Fondo de Población de Naciones Unidas (UNFPA) fgonzalez@unfpa.org Dr. Ricardo García Bernal UNAIDS Country Officer Telephone: +571 646 7000, ext. 322 Email: ricardo.garcia@unodc.org Stefano Feliciani ACNUR (UNHCR) Tel: + 57 1 6 80600 Email: felicianist@unhcr.org Ricardo Luque, Dirección General de Salud Pública Ministerio Protección Social rluque@minproteccionsocial.gov.co Barrancabermeja Patricia Ferrin Corporación Obusinga Tel: +57 (7) 6213533 pafe28@gmail.com Malgareth Sánchez Corporación Obusinga Tel: +571 7 6213533 sinrumbo422@hotmail.com Bucaramanga Blanca Patricia Mantilla Proinapsa-UIS Tel: +57 7 6450006 bpmantil@uis.edu.co Jose Alfredo Echeverría Cidemus + 57 7 6701864 elciudadanojose@yahoo.es San Pablo Lidia Álvarez Corporación Boiti Tel: +57 7 6221587 Email: lialri@hotmail.com Henry Lozano Corporación Nación Tel: + 57 5 6221587 helogo70@terra.com Villavicencio Ana Patricia Cerón Asociación Sociocultural NACATSI Tel: +57 (8) 6829196 patricia@nacatsi.org

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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

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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

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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.

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Notes
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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.internaldisplacement.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 sociocultural. 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/cgibin/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

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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 (IIPFWHR). 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.

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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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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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