The HIV/AIDS epidemic is reaching beyond high risk groups into general population with latest data suggesting that Andhra Pradesh has one of the fastest growing trends in the country (with infections doubling over 3-4 years in same areas). Despite the evidence that over half of the new infections are occurring among the young people under 25 years of age. There is still some people believe that young people do not get HIV epidemic. However, young people’s vulnerability is closely connected to their experiences of faster rates of physical growth, modernization and the influence of media, which largely provokes them to experiment. The vulnerability is further enhanced by the lack of reliable information and guidance on how to protect them-selves from HIV. They share their misconceptions with peers and often follow misleading or plain myths. They have less access to official information and media. The ‘knowledge gap’ among young women 15-19 years old varies across the districts. In high HIV prevalence districts such as Warangal, overall awareness about HIV/AIDS is high (80%) but only 46.5% know 2 methods of HIV prevention. In lower prevalence district such as Medak, overall levels of awareness of HIV/AIDS in the same age group are much lower (51.1%). Of these, only 15.8 % know 2 methods of prevention.
There has been a major effort to launch targeted interventions for HIV prevention with groups that are known to practice high-risk behaviour (truck drivers, sex workers and their client’s etc). Relatively few interventions however have been aimed at Young People. Yet evidence from around the world suggest that bringing about change among young people is vital in ensuring that future cohorts of young adults have the information and skills needed to protect themselves from infection. This goes beyond information and involves issues closely related to growing up (self esteem; the ability to make sound decisions; resist peer pressure; and more broadly self-determination).
HIV/AIDS has become a disease of young people, with young adult’s aged 15-24 accounting for half of the some 5 million new cases of HIV infections identified worldwide each year. Yet, young people often lack the information, skills, and services they required protecting themselves from HIV infection. Providing these is crucial to reverse the epidemic.
• Towards the end of 2001, an estimated 11.8 million young people aged 15-24 were living with HIV/AIDS, one third of the global total of people living with HIV/AIDS.
• Only a small percentage of these young people knew that they are HIV-positive.
• The United Nations Population Fund’s State of World Population 2003 reports that nearly half of the world’s six billion people are under the age of 25, including subsets of 1.2 billion adolescents (those aged 10 to 19) and one billion youth (those aged 15 to 24).
Today’s young people run the highest risk of HIV infection, and represent the greatest challenge for the prevention of new infections. Currently, half of all new HIV infections occur in people between the ages of 15 and 24, which translate to 6 young people becoming infected by HIV every minute which comes to a total of nearly 12 million young people living with HIV/AIDS. Many are likely to die of AIDS before they reach 35. If young people are still the “hope of the future,” they clearly need to be major beneficiaries of efforts to prevent and respond to HIV/AIDS.
Definition of Young People
The World Health Organisation (WHO) defines “young people” as those aged 10 to 24. This article will generally refer to the subset of young people between the ages of 15 and 24.
Contributing Factors
A combination of social, Culture, Biological, and Economic factors help fuel the AIDS pandemic:
Vulnerability
Young people’s vulnerability is an important reason for focusing HIV prevention and care efforts on those under the age of 25. Most people begin sexual activity during adolescence, with many having sex even before the age of 15. For example, in studies conducted recently in Brazil, Hungary, and Kenya, indicates more than 25 percent of boys aged 15 to 19 reported to have engaged in sexual activity before turning 15. A study carried out in Bangladesh revealed that 88 per cent among unmarried boys and 35 percent among unmarried girls in urban areas had sex before the age of 18. The risk of HIV transmission is linked not just to the fact that young people are having sex, but to their lack of knowledge, skills and their lack of access to condoms in protecting themselves. Lack of experience also increases incidence of young people’s vulnerability to HIV infection. In Thailand, 43 per cent of young women participating in a study reported having had sexual intercourse, beginning on average at the age of 17. Many of the women reported having unprotected intercourse, undergoing coerced sex, low usage of contraceptives, and high usage of drugs and alcohol. Despite clear evidence of sexual activity among young people, traditional biases commonly preclude them from discussing sex with their parents, relatives, friends, teachers, or counsellors. For this reason, they often hold misconceptions about how to protect themselves against HIV infection and how the virus is transmitted. Drug use often begins during adolescence, and constitutes a further vulnerability to HIV infection. Half of Nepal’s injecting drug users are between 16 and 25 years of age. The incidence of HIV among injecting drug users in Nepal increased from 2 percent in 1995 to almost 50 percent in 1998. The Russian Federation and China also have high rates of HIV infection among those who inject drugs.
Girls and Young Women
The vulnerability of girls and young women to HIV infection deserves particular emphasis. Of the nearly 12 million young people living with HIV/AIDS, 62 percent were young women, and in 20 African countries 5 per cent or more females aged 15 to 24 are infected. Of newly infected young people aged 15 to 19 in sub-Saharan Africa, two-thirds were females. In western Kenya, one in four girls aged 15 to 19 is living with HIV/AIDS, whereas only one in 25 boys of the same age group is infected. Six times as many girls as boys are infected in rural Uganda, in Zambia; the ratio is 16 girls to 1 boy. One reason for this vulnerability is biological: girls’ vaginal tracts are immature and tear easily during sexual intercourse. But cultural and economic factors are equally responsible: older, more sexually experienced men frequently seek out young girls for sex, often with the belief that younger partners are less likely to be infected with HIV. Some adolescent girls engage in sexual relations with older men in exchange for gifts; others offer sex in exchange for money to pay their school fees or to help support their families. Cultural norms dictate that girls in such relationships have little power to determine the way in which sex occurs, including the use of condoms.
Reproductive Health
In many places young people also lack access to reproductive health services in general. Young people tend to know very little about sexually transmitted infections (STIs), yet treating other STIs can help reduce sexual transmission of HIV, and more than 100 million new cases of STIs occur each year among those under 25. Although the occurrence of STIs exposes young people to chronic pain, infertility and other serious reproductive health repercussions, even those who think they may be infected are often reluctant to seek medical care. Young people feel embarrassed or guilty about their infections, fear a violation of their privacy, lack of transportation, or free time to access services, or are unable to access services due to provider bias. Even those young people who receive treatment for STIs are more likely than adults to become re-infected, for the reasons explained above. While data on STIs in developing countries are scarce, particularly for young people, WHO estimates that at least a third of the more than 333 million new cases of curable STIs each year occur among people under age 25. Young people are also substantially more likely than adults to become re-infected after having been treated.
Education
Since future generations of young people are continually joining the world population, efforts to educate adolescents about HIV infection are never complete and require constant renewal. Peer education focusing on decision-making and negotiation skills can help young people ward off undesirable sexual relationships, exploitation, and violence, in addition to encouraging the use of condoms, when they choose to be sexually active. Effective education about HIV/AIDS depends on the existence or development of an enabling environment. In Indonesia, for example, several obstacles have impeded efforts to educate young people about HIV/AIDS. Cultural taboos exist that discourage communication about sex, particularly between men and women. A “culture of shame” inhibits addressing the sexual and reproductive health needs of young people in Indonesia.
Poverty
HIV/AIDS is a disease highly associated with poverty. A World Bank study of 72 countries shows that both low per capita income and high-income inequality were linked to high national HIV infection rates, and a $2,000 increase in per capita income was associated with a 4 per cent reduction in infections. The 2001 United Nations General Assembly Special Session on HIV/AIDS recognized that “poverty, underdevelopment and illiteracy are among the principal contributing factors to the spread of HIV/AIDS”.
Lack of Information and Life Skills for Protection
Because sex is a taboo topic in many countries, large numbers of young people do not get sufficient information—or the skills—to refuse sex or negotiate safer sex practices. While most young people have heard about HIV/AIDS, few know enough to protect themselves against infection.
Feeling of Invincibility
Adolescents tend to underestimate, downplay, or deny their risks of HIV infection. Case studies by the World Health Organization (WHO) indicate that only between one fifth and one third consider themselves at risk. Many young people do not recognize that their partner’s behaviour also puts them at risk.
Alcohol and Drug Use
Sharing needles for drug use is a highly efficient means of spreading HIV because the virus is injected directly into the blood stream. Mixing drug use with sex for money provides a bridge for HIV from injecting drug users to the wider community.
Empowering Young People
Protecting young people from HIV/AIDS means empowering them against potential threat. This involves mobilizing general support for HIV/AIDS prevention, addressing cultural and social norms that put young people at risk, and promoting the use of condoms to prevent HIV and other sexually transmitted infections, as well as unwanted pregnancies. Protecting a young person also means offering education and communication programs that impart knowledge and build skills to use this knowledge. Young people need to access to health care services without fear of criticism or discrimination. They must also be substantively involved in HIV/AIDS prevention efforts, particularly those that focus on young people.
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