HIV/AIDS seriously affects adolescents throughout the world. One-third of all currently infected individuals are youth, ages 15 to 24, and half of all new infections occur in youth the same age.¹ More than five young people acquire HIV infection every minute; over 7,000, each day; and more than 2.6 million each year.¹

About 1.7 million new adolescent HIV infections—over half of the world's total—occur in sub-Saharan Africa.¹ In fact, nearly 70 percent of people living with HIV/AIDS live in sub-Saharan Africa, and over 80 percent of AIDS deaths have occurred there.^2,3 Although HIV/AIDS rates vary considerably throughout sub-Saharan Africa—generally lower in western Africa and higher in southern Africa—the epidemic has had a devastating effect on most African youth who often lack access to sexual health information and services. In particular, unmarried youth have great difficulty getting needed sexual health services. At the same time, cultural, social, and economic norms and pressures often put young African women at excess risk for HIV infection.

Leaders of some African nations, once unable to acknowledge the presence of HIV/AIDS, now publicly address HIV prevention and appoint task forces to mobilize and coordinate efforts against the epidemic.³ In addition, business coalitions and non-governmental organizations (NGOs) often lead in utilizing peer education, advocacy, youth-friendly service delivery, and social marketing to battle HIV infection in sub-Saharan African nations.⁴ Some NGOs encourage youth to get involved in finding and implementing ways to stop the spread of HIV.

African Youth Face Fast Growing Rates of Infection with HIV and Other STDs.

• Experts estimate that half a million African youth, ages 15 to 24, will die from AIDS by the year 2005.⁵ In African countries with long, severe epidemics, half of all infected people acquire HIV before their 25th birthday and die by the time they turn 35.⁶
• The epidemic means that African youth face a bleak future. In 1997 in Zimbabwe, half of all 15-year-old males could expect to die before age 50 compared to 15 percent in 1983. Between 1983 and 1997, 15-year-old females' risk of death prior to age 40 quadrupled from 11 to over 40 percent.⁶
• Infection with a sexually transmitted disease (STD), especially one that causes genital ulcers, such as herpes or syphilis, puts one at increased risk for HIV infection, and sexually active youth in sub-Saharan Africa are at high risk for STD infection.⁷ For example, 10 to 20 percent of the sexually active population of sub-Saharan Africa is infected with gonorrhea.⁵

Young Women Are Disproportionately Affected by HIV/AIDS.

• Half of all HIV infections worldwide occur in women in Africa.²
• In seven of 11 studies in Africa, at least one woman in five, ages 20 to 25, was HIV infected; most HIV-infected young women will not live to age 30.⁶ In one city in South Africa, six out of 10 women, ages 20 to 25, were HIV infected; among youth in their early 20's, women's rates were three times higher than men's.⁶ In Malawi, HIV incidence in teenage women is six percent compared to less than one percent in women over age 35.¹
• Throughout sub-Saharan Africa, HIV infection rates among teenage women are over five times higher than rates for teenage males. In Kenya, nearly one teenage woman in four is living with HIV, compared to one teenage male in 25.¹
• The physical immaturity of younger women and women's lower status in society may contribute to disproportionate HIV infection rates. Women's lower status may prevent them from having control of their sexual relationships. For example, studies on women's first sexual experience show that over half of young women in Malawi and over 20 percent of young women in Nigeria experienced forced sexual intercourse.^6,7

Inadequate Sexual Health Information and Limited Access to Health Care Are Obstacles to Lowering Adolescent HIV/STD Infection Rates.

• African adolescents cite lack of knowledge, inaccessibility, and safety concerns as primary reasons for not using contraception. For example, one study showed that less than 50 percent of youth in Madagascar and Nigeria know about contraception. Limited resources also make contraceptive use lower in Africa than in other world regions.⁵
• Many African health services workers feel it is inappropriate to provide contraceptives to adolescents, often making it difficult or impossible for youth to obtain condoms and other contraception.⁸ For example, a study in Kenya found that three-fourths of family planning workers were unwilling to provide contraceptives to young women who had not given birth.⁸
• In sub-Saharan Africa, only half of the population has easy access to health care. Africa has one-third as many nurses per capita as the rest of the world. Moreover, the current ratio of doctors is lower than one per 10,000 population; the world average is one per 800.⁸ Limited budgets, problems imposed by the HIV epidemic, and few health care providers mean that improving reproductive health services is a challenge for most sub-Saharan African countries.⁸

Sexual Health Attitudes and Behaviors Greatly Affect Adolescents' Risk of Infection.

• In sub-Saharan Africa, as in other regions of the world, a culture of silence surrounds most reproductive health issues. Many adults are uncomfortable talking about sexuality with their children. Others lack accurate sexual health knowledge.⁵
• Many Africans feel unable to discuss sexuality across perceived barriers of gender and age differences.³ Many Africans are also reluctant to provide sexually active adolescents with condoms.³
• In several African countries, some people believe that men are biologically programmed to need sexual intercourse with more than one woman. Polygamy is a central, social institution that reinforces this belief. Moreover, some men believe that this "biologically programmed need" makes high-risk sex unavoidable.³
• In some impoverished communities, high HIV infection rates may be partly explained by early sexual initiation, consensual or coerced. For example, in a survey of 1,600 urban Zambian youth, over 25 percent of 10-year-old children and 60 percent of 14-year-old youth reported already having sexual intercourse.⁶
• One study of adolescents in 17 African countries showed that those with more education were far more likely to experience casual sex and to use condoms for casual sex when compared to less educated youth.⁶

Cultural, Social, and Economic Factors also Fuel the HIV Epidemic.

• Some faith traditions in Africa teach that AIDS is a shameful disease and a punishment for those who have been sexually promiscuous, and many adults are reluctant to admit to a disease that seems to imply promiscuity.³ One study showed three quarters of Nigerian Christian leaders believe that AIDS is a divine punishment.³
• Poverty and HIV transmission are linked in a variety of ways. Poverty often leads to prostitution or to trading sexual favors for material goods. Young women may be especially vulnerable due to societal practices that deny them education and work opportunities. Poverty also leads to poor nutrition and a weakened immune system, making poor people more susceptible to tuberculosis and to STDs.^2,6,8
• The costs of providing treatment for people with AIDS drains resources from education, agriculture, and other domains important to gross national product. By 2005, AIDS treatment costs are expected to account for more than one third of Ethiopia's government health spending, more than half of Kenya's, and nearly two-thirds of Zimbabwe's.⁹
• In sub-Saharan Africa nearly eight million children, ages 14 and under, had been orphaned by AIDS by the end of 1997. Many of these youth must drop out of school.^1,6

References:

1. UNAIDS. Listen, Learn, Live! World AIDS Campaign with Children and Young People: Facts and Figures. Geneva: UNAIDS, 1999.
2. Akukwe C. HIV/AIDS in African children: a major calamity that deserves urgent global action. J HIV/AIDS Prev Educ for Adolesc & Children 1999; 3(3):5-24.
3. Caldwell JC. Rethinking the African AIDS epidemic. Popul Develop Review 2000; 16:117-135.
4. Population Reference Bureau [and] Population Services International. Social Marketing for Adolescent Sexual Health: Results of Operations Research Projects in Botswana, Cameroon, Guinea, and South Africa. Washington, DC: The Bureau, 2000.
5. Pathfinder International, Africa Regional Office. Adolescent Reproductive Health in Africa: Paths into the Next Century. Nairobi, Kenya: The Office, 1999.
6. UNAIDS. Report on the Global HIV/AIDS Epidemic. Geneva: UNAIDS, 2000.
7. UNAIDS. Force for Change: World AIDS Campaign with Young People: 1998 World AIDS Campaign Briefing Paper. Geneva: UNAIDS, 1998.
8. Rosen JE, Conly SR. Africa's Population Challenge: Accelerating Progress in Reproductive Health. [Country Study Series, no. 4] Washington, DC: Population Action International, 1998.
9. UNAIDS. The UNAIDS Report. Geneva: UNAIDS, 1999.

Written by Tawa Jogunosimi
February 2001 © Advocates for Youth

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