ADVOCATES FOR YOUTH

The Facts

Youth and the Global HIV/AIDS Pandemic

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Twenty-five years into the HIV/AIDS pandemic, HIV and AIDS continue to be a dire threat to global public health.[1] More than half of all new HIV infections occur among people under the age of 25, and almost 11.8 million youth are living with HIV or AIDS.[1,2] At least 95 percent of all new infections occur in less developed countries - sub-Saharan Africa is the hardest hit region, followed by the Caribbean. Eastern Europe and central Asia experience the fastest growing HIV prevalence rates, while in eastern and southern Asia, the numbers of infected people are staggering – in India alone, 2.5 million[*] are infected with HIV.[1] Throughout the world, almost 6,000 youth ages 15 to 24 are infected with HIV each day.[2] Young women are more vulnerable to the HIV epidemic than men - 62 percent of infected youth are female.[2]

Young People in Every Region are Infected with HIV

• In sub-Saharan Africa, most new HIV infections occur among people ages 15 to 24 and are sexually acquired. Nearly nine million youth are living with HIV/AIDS, and 67 percent of these youth are young women.[2] In sub-Saharan Africa, young women are two to six times more likely then males their same age to be HIV positive.[1]
• In North Africa and the Middle East, rates remain low, but are on the rise. Over 160,000 youth in this region are infected, with a rise in the youth HIV rate in Algeria, Libya, Morocco, and Somalia. Sexual intercourse and injection drug use are the major routes of transmission in the region.[2,4]
• In Latin America and the Caribbean, about 560,000 young people are HIV-infected.[2] In Brazil, survey data show that young people are having sex earlier and with more partners than in previous years. In Haiti, age at first sex declined by one year for both men and women between 1994 and 2000, and condom use was also less frequent among young people.[1]
• Eastern Europe and central Asia have nearly three-quarters of a million HIV-infected youth, mostly as a result of injection drug use. Russia is experiencing the biggest epidemic in the region, with three out of four new HIV infections occurring among people under 30 years of age. Rates are also rapidly rising in Belarus, Kazakhstan, Latvia, and the Ukraine, where one percent of young women and two percent of young men are now HIV infected.[2,3]
• In South Asia, 1.1 million young people are HIV infected, second only in volume to sub-Saharan Africa. Injection drug use and the sex trade have fueled the epidemic, once highest in Cambodia and Thailand but reaching alarming rates in India as well.[2,3]
• In developed nations, nearly a quarter of a million youth are HIV-infected.[2] Higher rates of sexually transmitted infections (STIs) signal a rise in unsafe sex and highlight the need for renewed prevention efforts, especially among youth.[1]
• Leading factors behind the epidemic vary from injection drug use in Spain, France, and Portugal, to heterosexual transmission in the United Kingdom, heterosexual transmission among disadvantaged women in the United States, and sex between males in Japan, Canada, Australia, and the United States.[1,3]

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

• Of the 11.8 million HIV-infected youth worldwide, over seven million are female.[2] The virus is more easily passed to young women because of their immature vaginal tracts and easily torn tissues; meanwhile, gender inequities in many countries prevent young women from negotiating safer sexual practices including condom use.[1]
• 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 their unmarried peers.[5,6] In some developing countries, married women have higher rates of HIV infection than their unmarried peers; in Kenya, for example, married adolescents’ HIV rate is 6.5 percent, vs. a rate of 2.5 percent for their unmarried peers. [5,6]
• In Sub-Saharan Africa, the HIV prevalence rate among young women aged 15-24 years is 4.3 percent, as opposed to 1.5 percent for young men.[1] Female children and young women are especially vulnerable due to cultural practices such as the “sugar daddy” (a relationship where sex is exchanged for material goods and protection from an older man), and to the myth that an infected man can “cure” himself by having sex with a virgin. In Ethiopia, Malawi, Tanzania, Zambia, and Zimbabwe, for every infected male aged 15 to 19, there are five to six infected females the same age.[2]
• In the Caribbean, women are increasingly prone to HIV infection through unprotected sexual intercourse. In Jamaica and Trinidad and Tobago, young women ages 15-19 are two and a half times and six times more likely, respectively, than their male counterparts to be HIV infected.[1]
• HIV infection remains more common among young men than young women in industrialized nations, Latin America, Eastern Europe and central Asia, and the Middle East and North Africa. In industrialized nations and in parts of Latin America and Asia, cases occur mostly among young men who have sex with men; in the other regions, cases occur mostly among young men who use injection drugs.[1]
  

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

• Around the world, the vast majority of youth have little understanding of HIV transmission or how to protect themselves against HIV. Globally, 33 percent of young men and 20 percent of young women aged 15-24 can correctly identify prevention methods of HIV transmission. According to surveys, in no country were more than half of youth fully educated about HIV transmission and prevention.[1]
• The frequency of condom use in most countries is under 50 percent, with more males than females reporting condom use during intercourse with a non-regular partner.[1] In Somalia, 19 out of 20 young women aged 15-24 years and 17 out of 20 young men had never used a condom.[1]
• Young people face serious obstacles to accessing medical care, including fear their privacy will not be respected; embarrassment; distance to services, and health providers who are reluctant to serve adolescents.[2] In Dakar, Senegal, for example, young people visiting family planning clinics were told they were “too young” to receive contraception.[7]

Programs and Policies Can Help Protect Young People

• In sub-Saharan Africa, the percentage of young people engaging in sex prior to age 15 declined and condom use increased in 9 of the 13 sub-Saharan countries studied between 2000 and 2005.[1]
• In Brazil, concentrated campaigns led to increased condom use among men having sex for the first time (up from less than ten percent in 1986 to more than 60 percent in 2003).[8] Mass media campaigns promoting condom use for both at-risk groups and the general population have helped keep the HIV rate stable at 0.6 percent among Brazilians 15-49 years of age since 2000.[1,8]
• In Burkina Faso, young pregnant women 15-24 years old attending antenatal clinics showed an HIV prevalence decrease from 4 percent to almost 2 percent in 2003. The decrease is attributed to increased efforts in HIV prevention, an increase in condom use and a decrease in sex with non-regular partners.[1]
• In India, the HIV rate fell by a third from 2000 to 2004 among young adults.[9] The decline is attributed to an early response to the AIDS pandemic and a trend of sustained efforts thus far.[1]
• Evaluations of more than 150 programs around the world have shown that no increase in sexual risk-taking is associated with providing complete information about sexuality (including abstinence, contraception and condoms) to young people.[10,11]
  

References

* New estimates released in 2007 showed a significant change in the estimated number of HIV infections in India. Read the UNAIDS Q and A on India’s Revised Estimates.

1. Joint United Nations Programme on HIV AIDS (UNAIDS). 2006 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2006.
2. UNAIDS et al. Young People and HIV/AIDS: Opportunity in Crisis. Geneva: UNAIDS, 2002.
3. Lamptey P et al. Facing the HIV/AIDS pandemic. Population Bulletin 2002; 57(3):1-39.
4. UNAIDS/WHO. AIDS epidemic update December 2005
5. 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.
6. 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.
7. Family Health International. “Better Services can reduce abortion risks.” Network 2000; 20 (3):1-7.
8. Okie, S. “Fighting HIV – lessons from Brazil.” New England Journal of Medicine 354 (19): 1977-1981.
9. Kumar, R. et al. “Trends in HIV-1 in young adults in south India from 2000-2004: a prevalence study.” Lancet 367 (9517): 1164-1172.
10. Smoak ND et al. Sexual risk reductions do not inadvertently increase the overall frequency of sexual risk behavior: a meta-analysis of 174 studies with 116,735 participants. Journal of Acquired Immune Deficiency Syndrome 2006; 31: 374-384.
11. Speizer I et al. “The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence.” Journal of Adolescent Health 2003 22: 324-348.
    

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


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