Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood

Every day, an estimated 2500 young people are newly infected with HIV, according to a global report on HIV prevention launched today. While HIV prevalence has declined slightly among young people, young women and adolescent girls face a disproportionately high risk of infection due to biological vulnerability, social inequality and exclusion.

For the first time, Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood, presents data on HIV infections among young people and highlights the risks adolescents face as they transition to adulthood. A joint publication by UNICEF, UNAIDS, UNESCO, UNFPA, ILO, WHO and The World Bank, the report identifies factors that elevate their risk of infection as well as opportunities to strengthen prevention services and challenge harmful social practices.

“For many young people HIV infection is the result of neglect, exclusion, and violations that occur with the knowledge of families, communities, social and political leaders. This report urges leaders at all levels to build a chain of prevention to keep adolescents and young people informed, protected and healthy,” said UNICEF Executive Director Anthony Lake. “UNICEF is committed to this cause. We must protect the second decade of life, so that the journey from childhood to adulthood is not derailed by HIV – a journey that is especially fraught for girls and young women.”

According to the report, people aged 15-24 accounted for 41 per cent of new infections among adults over the age of 15 in 2009. Worldwide, an estimated 5 million (4.3 million to 5.9 million) young people in that age group were living with HIV in 2009. Among the 10 to 19 year age group, new data shows, an estimated 2 million adolescents (1.8 million to 2.4 million) are living with HIV. Most of them live in sub-Saharan Africa, most are women, and most do not know their status. Globally young women make up more than 60 per cent of all young people living with HIV. In sub-Saharan Africa that rate jumps to 72 per cent.

"Our success with improving access to antiretrovirals means more young people are surviving with HIV, but many are still unaware of their status,” said World Health Organization Director-General, Dr. Margaret Chan. “WHO is committed to helping improve adolescents' access to HIV testing and counseling and to making sure that health services address their needs for prevention, treatment, care and support."

Early adolescence is a window of opportunity to intervene, before most youth become sexually active and harmful gender and social norms that elevate the risk of HIV infection are established. Communities, leaders and young people all have a role to play in changing the behaviours that place young people at risk and creating an environment where they may thrive. In southern Africa, for example where HIV infections are high in older age groups, sex with multiple partners and age-disparate relationships are fuelling HIV transmission among young people, particularly young women. But progress can be made. Community-led efforts to change such norms have been effective in communities in Tanzania, where the image of men seeking relations with younger women and girls was effectively turned into an image of ridicule.

"As the report says, too many adolescent girls become pregnant before they are ready, and have children while they are still children themselves," said UNFPA Executive Director, Dr. Babatunde Osotimehin. "This puts their own health and their children’s health at risk and limits their opportunities and potential. To achieve the MDGs, it’s absolutely critical to improve access to comprehensive sexuality education and integrated reproductive health services, including family planning and male and female condoms. Evidence shows that sexual and reproductive health information and services do not lead to more frequent sexual relations or high-risk behavior, but rather to fewer unintended pregnancies, reduced HIV infections and better health."

Certain high-risk behaviours – such as early sexual debut, pregnancy and drug use – are all signs of things going wrong in the environment of the young adolescent, and may be associated with violence, exploitation, abuse and neglect. Yet social protection systems that are HIV-sensitive can contribute to the financial security of vulnerable families, improve access to health and social services and ensure that services are delivered to marginalized youths.

“The world desperately needs new HIV prevention strategies; for every two people who receive life-saving AIDS treatment, another five become newly infected, which is an impossible situation for many poor countries and their communities,” says the World Bank’s Managing Director, Dr. Mahmoud Mohieldin. “Existing prevention strategies have had limited success, so we have to look for creative new approaches to reverse the HIV/AIDS epidemic. These must address people’s very basic needs for education, economic security, inclusion, dignity, and human rights. These issues are particularly crucial when we consider the health and well-being of adolescent girls, mothers and children, and socially marginalized groups.”

Family members, teachers, community leaders have a role to play in setting norms for responsible behaviour, and in advocating for the full range of services needed for young people to stay healthy. Indeed, reducing the level of HIV incidence requires not one single intervention, but a continuum of prevention that provides information, support and services throughout the life cycle. Yet many adolescents lack access to basic HIV and prevention information, commodities and testing services.

“Young people need to have access to comprehensive knowledge and services in order to make safe choices about their health and relationships”, said UNESCO Director-General, Irina Bokova. “We are fully committed to this effort, leading the evidence-based push to scale up sexuality education and supporting the different needs of young people as they transition from early adolescence to adulthood. We must work together to ensure that all young people, especially girls and vulnerable populations, receive the education, support and protection necessary for preventing HIV and promoting their overall well-being”, she added.

Worldwide many young people driven by economic duress, exploitation, social exclusion and lack of family support turn to commercial sex and injecting drug use. They face an extremely high risk of infection as well as general stigma and discrimination for engaging in such behaviors. The very same young people most often lack access to HIV prevention and protection services. For national HIV responses to be effective, governments need to address the underlying problems of poverty, exclusion and gender inequality that threaten the health of future generations. Using equity as a guidepost helps to ensure those hardest to reach are not last in line, and that services are available to them and used by them.

“Nearly one of every two new adult HIV infections occurs among 15 to 24 year olds. The ILO Recommendation on HIV and AIDS and the World of Work calls for a special focus on young people in national policies and programmes on HIV and AIDS and highlights the role of education and training systems and youth employment programmes and services as critical channels for mainstreaming information about HIV,” said Juan Somavia, Director-General of the International Labour Organization (ILO). “Already young people often bear a disproportionate share of the burden of unemployment, underemployment and poverty, a situation aggravated by the global recession. We must enable young people to realize their full potential. Their strength is the strength of communities, societies and economies.”

As the report points out, there are opportunities to use proven prevention strategies in all epidemic contexts. In countries with generalized epidemics there are opportunities to encourage healthy attitudes and behaviours, ensure greater gender equality and allow protection to become the new norm. In sub-Saharan Africa, for example, the same social norms that tolerate domestic violence also prevent women from refusing unwanted sexual advances, negotiating safe sex, or criticizing a male partner’s infidelity – all of which threatens the goal of achieving an AIDS-free generation. And in countries with low-level and concentrated epidemics, where HIV infections among youth are driven by injecting drug use, sex work, or male to male sex, there are opportunities to reshape the legal and social milieu that compounds vulnerability and to empower young people with knowledge, prevention services and health care.

“Young people are not only tomorrow’s leaders, they are the leaders of today,” said Michel Sidibé, Executive Director of UNAIDS. “If young people are empowered to protect themselves against HIV, they can lead us to an HIV free generation.” (June 2011)

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Opportunity in Crisis Preventing HIV from early adolescence to young adulthood.pdf