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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.
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Ch.Dhanunjaya Rao
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