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More than twenty five years into the HIV/AIDS pandemic, it remains one of the most serious challenges to global public health. Almost a quarter of people living with HIV are under the age of 25. Young people ages 15-24 represent 45 percent of all new HIV infections.[1] At least 95 per cent of all new infections occur in less developed countries—sub-Saharan Africa is the hardest hit region, followed by the Caribbean.[2] Eastern Europe and central Asia are experiencing some of the fastest growing HIV prevalence rates.[3] In Eastern and southern Asia, the numbers of infected people are staggering—in India alone, 2.4 million are infected with HIV.[2] Throughout the world, almost 3500 youth ages 15 to 24 are infected with HIV each day.[2] Young women are more vulnerable to the HIV epidemic than are men – young women comprise 57 percent of all young people with HIV, and in the hardest-hit region, Sub-Saharan Africa, young women comprise 76 percent of cases among young people.[3]

Young People in Every Region are Infected with HIV

• In sub-Saharan Africa, nearly 3.3 million youth are living with HIV/AIDS, and 76 percent of these youth are young women.[3] South Africa is the country in the world with the most HIV infections.[2]
• In North Africa and the Middle East over 80,000 youth are infected.3 Sexual intercourse and injection drug use are the major routes of transmission in the region.[3]
• In Latin America and the Caribbean, about 420,000 young people are HIV-infected.[3] Brazil, the region’s most populous nation, accounts for about one third of HIV infections in Latin America. Unprotected sex between men remains an important factor in the pandemic.[3]
• AIDS remains one of the leading causes of death in the Caribbean among people aged 25 to 44 years.[1] HIV prevalence is highest in the Dominican Republic and Haiti, which together account for nearly three quarters of all people living with HIV in the Caribbean.[2] Haiti survey data show a drop in the number of sexual partners, while condom use increased, especially during sex with non-regular partners.[3]
• Eastern Europe and Central Asia have over one third of a million HIV-infected youth.[3]
  • Injection drug use accounts for 62 percent of new infections in the region.[1]
  • In Russia and other countries of Eastern Europe and Central Asia, more than 80 per cent of those living with HIV are under the age of 30, a majority of them young men.[4]
  • Nearly 66 percent of new infections occurred in the Russian Federation.[3]
  • Ukraine has the highest adult HIV prevalence of any country in Europe or central Asia, with annual HIV diagnoses doubling since 2001.[3]
  • Newly reported HIV diagnoses are rising in other countries, including Uzbekistan, which now has the largest epidemic in Central Asia.[3]
• In South Asia over 700,000 young people are HIV infected, second only in volume to sub-Saharan Africa.[3] HIV prevalence is highest in South-East Asia, with wide variation in epidemic trends between different countries—Myanmar, Thailand and Cambodia show declines in prevalence, but the epidemic is growing at a particularly high rate in Indonesia and Viet Nam.[3]
• New and more accurate estimates of HIV indicate that approximately 2.4 million people in India are living with HIV.[3]
• In industrialized countries, almost a quarter of a million youth are living with HIV or AIDS.[5] Higher rates of sexually transmitted infections (STIs) signal a rise in unsafe sex and highlight the need for renewed prevention efforts, especially among youth.[5]
• Leading factors behind the epidemic in industrialized countries vary from injection drug use in Spain and Portugal; to sex between males in Italy, France, the United States, and the United Kingdom; and transmission among disadvantaged men and women in the United States.[3]

Young Women and Girls Are Especially Vulnerable, but Young Men Are Also at High Risk

• An estimated 7.3 million young women are living with HIV or AIDS, compared to 4.5 million young men.[5]
• Of the 5.4 million HIV-positive youth worldwide, over three million are female.[3] The virus is more easily passed to young women because of their immature vaginal tracts and easily torn tissues; meanwhile gender inequalities in many countries prevent young women from negotiating safer sexual practices including condom use.[4]
• The common practice of child and adolescent marriage is an increasingly important factor in the HIV/AIDS epidemic. Married adolescents know less about HIV, are less able to negotiate condom use, and are much more likely to use no method of protection from HIV than are their unmarried peers.[6,7] For example, a study in Uganda showed that HIV prevalence was 28 percent for married and 15 per cent for single girls.[8] This study noted that the age difference between the men and their wives was a significant HIV risk factor for the wives.[8]
• In sub-Saharan Africa, women ages 15 to 24 are three times more likely to be infected than young men their age and 76 percent of HIV-infected youth are young women.[3]
• Young women and girls in sub-Saharan Africa are especially vulnerable to HIV infection due to cultural beliefs and practices such as the “sugar daddy” (a relationship where sex is exchanged for material goods and protection by an older man), and the belief that an infected male can “cure” himself by having sex with a virgin.[4]
• In industrialized nations, HIV infection remains more common among young men than young women.[3,5] In these countries and in parts of Latin America and Asia, cases occur mostly among men who have sex with men; in other regions cases occur mostly among men who use injection drugs.[3]
• In Eastern Europe and Central Asia, men are by far those most infected with HIV although infection rates among women are on the rise. It is estimated that men accounted for 74 per cent of adults with HIV in 2007 compared with 76 per cent in 2001, while in Asia that proportion reached 71 per cent in 2007 compared with 74 per cent in 2001.[3]
• In the Caribbean, women are increasingly prone to HIV infection through unprotected sexual intercourse.[3] In that region 43 per cent of adults living with HIV in 2007 were women, compared with 37 per cent in 2001.[3] The primary mode of HIV transmission in this region is sexual intercourse, with unprotected sex between sex workers and clients being a significant factor in the transmission of HIV.[3] For example, HIV prevalence of 3.5 per cent among sex workers has been found in the Dominican Republic, 9 per cent in Jamaica and 31 per cent in Guyana.[3]
• The proportions of women living with HIV in Latin America, Asia, and Eastern Europe are slowly growing, as HIV is transmitted to the female partners of men who are likely to have been infected through injecting drug use or during unprotected paid sex or sex with other men.[3]

Lack of Information, Skills, and Access to Services for Youth Fuel the Epidemic

• In 2007, national surveys found that 40 percent of young men and 36 percent of young women had accurate knowledge of HIV.[1]
• Both in sub-Saharan Africa and globally young women had lower levels of basic HIV knowledge than did males.[1]
• Most young men and women are aware that being in a monogamous relationship with a person of the same sero-status is an effective prevention strategy.[1]
• Among countries with generalized epidemics, fewer than 70 percent have implemented school-based HIV education in most or all districts, and 61 percent have put in place HIV prevention programs for out-of-school youth. Where programs exist, their quality has often not been evaluated.[1]
• Most young people do not have access to sexual health advice, condoms and other forms of contraception, or voluntary counseling and testing services for HIV and other STIs. Reproductive health services are seldom geared towards the needs of young people, who therefore tend to avoid them—putting themselves and their sexual partners at risk of HIV infection.[9]

Programs and Policies Can Help Protect Young People

• In Namibia, life-skills based HIV education is now taught in 79 percent of secondary schools, a national campaign was launched on HIV risk and alcohol abuse, and more than 25 million male condoms are distributed free of charge every year. Levels of knowledge about HIV and condom use have increased; rates of sex before the age of 15 and sex with more than one partner in the last 12 months have decreased; and HIV prevalence in young women attending antenatal clinics declined from 18 percent in 2003 to 14 percent in 2007.[1]
• In Nicaragua, a communications for social change strategy to promote HIV stigma reduction, gender equity, and HIV prevention among youth called Somos Diferentes, Somos Iguales, resulted in a significant reduction of stigmatizing and gender-inequitable attitudes, an increase in knowledge and use of HIV-related services, and a significant increase in interpersonal communication about HIV prevention and sexual behavior. [10]
• In Brazil, an integrated response to the epidemic which funds health care systems; promotes racial, gender, ethnic, and sexual orientation equality in access to information and treatment; and includes public education campaigns and condom promotion, has led to increased safer sex practices among young people and has stabilized the country’s epidemic.[11]
• Research around the world has found that comprehensive school and community-based HIV prevention programs and access to contraceptive supplies and services help reduce HIV rates and improve risk behaviors among all people, including young people.[1,12]

References

1. Joint United Nations Programme on HIV AIDS (UNAIDS). 2008 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2008.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). “Estimated number of people living with HIV by country.” 2008 Report on the Global AIDS Epidemic. Accessed from http://data.unaids.org/pub/GlobalReport/2008/20080818_gr08_plwh
   _1990_2007_en.xls on October 27, 2008.
3. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2007 AIDS Epidemic Update. Geneva, Switzerland: UNAIDS, 2007.
4. United Nations Population Fund. State of World Population 2005. “The Unmapped Journey: Adolescents, Poverty, and Gender.” UNFPA, 2005.
5. United Nations Population Fund. “Population Issues: Supporting Adolescents & Youth: Fast Facts.” Accessed from http://www.unfpa.org/adolescents/facts.htm on October 27, 2008.
6. Lary H et al. Exploring the Association Between HIV and Violence: Young People's Experiences with Infidelity, Violence and Forced Sex in Dar es Salaam, Tanzania. International Family Planning Perspectives 2004; 30: 200-6.
7. Clark S, Bruce J, Dude A. Protecting Young Women from HIV/AIDS: The Case Against Child and Adolescent Marriage. International Family Planning Perspectives 2006; Jun; 32(2):79-88.
8. CDC. Health Consequences of Child Marriage in Africa. Nawal M. Hour. Vol. 12, Number 11. November 2006
9. UNAIDS. HIV/AIDS and Young People: Hope for Tomorrow. UNAIDS. 2003. Accessed from http://data.unaids.org/publications/IRC-pub06/jc785-youngpeople_en.pdf on October 27, 2008.
10. Solórzano, Irela, Amy Bank, Rodolfo Peña, Henry Espinoza, Mary Ellsberg, and Julie Pulerwitz. “Catalyzing individual and social change around gender, sexuality, and HIV: Impact evaluation of Puntos de Encuentro´s communication strategy in Nicaragua,” Horizons Final Report. Washington, DC: Population Council.
11. Brazilian Ministry of Health. Targets and Commitments Made by the Member States at the United Nations General Assembly Special Session on HIV/AIDS. Brazil: Country Progress Report. UNAIDS, 2008. Accessed from http://data.unaids.org/pub/Report/2008/brazil_2008_country_
    progress_report_en.pdf on October 27, 2008.
12. Kirby, D., Laris, B., & Rolleri, L. (2007). Sex and HIV Education Programs: Their Impact on Sexual Behaviors of Young People Throughout the World. Journal of Adolescent Health, 40, 206-217.

Updated by Nickie Imanguli, 2008
Updated by Lylyana Bogdanovich, 2006
Written by Nicole Cheetham, 2003
© Advocates for Youth