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The Facts

Overcoming Challenges in HIV Prevention among Youth

Revisiting the United Nations General Assembly Special Session on HIV and AIDS

Also available in [PDF] format and in Spanish [HTML] [PDF].

Introduction

Today's generation of young people is the largest in history. Almost three billion people—nearly half of the world's population—are under the age of 25.[1] They are the first generation that has never known a world without AIDS. When the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS met in New York City in 2001, representatives from all 189 member states signed the Declaration of Commitment on HIV and AIDS, an international pledge to fight the pandemic.[2,3]

This fact sheet summarizes the commitments that were made by member states regarding youth; summarizes data that highlight the current status of the HIV and AIDS pandemic; and addresses the social, cultural, and political barriers to effective HIV prevention for youth. Finally, it issues a call to action to fulfill the commitments made in 2001 to achieve a world without HIV and AIDS.

Commitments Made by the Nations of the World

By signing the Declaration of Commitment, governments made several promises in regard to youth. Governments pledged to:

• Acknowledge the particular role and significant contributions of young people in addressing all aspects of HIV and AIDS.[3]
• Recognize that youth’s full involvement and participation in designing, planning, implementing, and evaluating programs is crucial to developing effective responses to the epidemic.[3]
• By 2005, reduce HIV prevalence by 25 percent among young men and women ages 15 through 24 in the most affected countries; by 2010, reduce HIV prevalence by 25 percent among youth worldwide.[3]
• Ensure that by 2005, at least 90 percent of young men and women ages 15 through 24 have access to information and services they need to reduce their vulnerability to HIV infection. By 2010, assure access to HIV prevent information and services for 95 percent of the world’s youth, ages 15 through 24.[3]
• By 2003, ensure access to primary and secondary education for both girls and boys, including HIV prevention curricula and safe and secure environments, especially for young girls.[3]
• Expand good-quality, youth-friendly, sexual health education and counseling services and strengthen reproductive and sexual health programs.[3]
• Involve families and youth as much as possible in planning, implementing, and evaluating HIV prevention and care programs.[3]

Have We Made Progress?

• The HIV and AIDS epidemic has plagued humanity for more than 20 years; and infection rates continue to grow.[4] Today, experts estimate that as many as 40 million people may live with HIV or AIDS.[4]
• By the end of 2001, one-third of those living with HIV or AIDS were under age 25.[5] Today, young people represent half of all new HIV infections.[6] Every day, more than 6,000 young people ages 14 through 24 become infected with HIV.[7]
• Young women are especially vulnerable to HIV infection.[3] In sub-Saharan Africa, young women are at least three times more likely to be HIV-positive than are young men; and in the Caribbean, young women are 2.4 times more likely to be infected.[8]
• Despite a flood of information on growing rates of infection among young people, the global community still lags in its prevention efforts. For example, UNAIDS reports that, in 24 sub-Saharan countries, two-thirds or more of young women lack adequate knowledge of HIV transmission.[4] At the same time, fewer then one in five people at risk for infection globally has access to basic prevention services.[8]
• Some adolescents become sexually active at young ages—often involuntarily. Very young teens often lack HIV prevention information, skills, and services. Programs targeting young people often fail to acknowledge such early sexual activity.[9]

What Challenges Complicate HIV Prevention for Youth?

• Policies and programs in several countries have been hampered by adults’ beliefs about what young people should know. Many adults, including political leaders, hold to baseless fears that sex education might lead to promiscuity.[6]
• Many factors discourage young people from using health services: lack of privacy and confidentiality; insensitive or disapproving staff; threatening environments; cost; and requirements that minors be accompanied by an adult or be married.[9]
• While male latex condoms are the most effective technology available to prevent HIV among sexually active people,[10] the U.S. government’s promotion of abstinence-only creates barriers to condom education and access for the roughly 11 million sexually active youth in PEPFAR countries. In fact, the U.S. government believes that condoms are only appropriate for “high risk” groups, such as commercial sex workers and injection drug users.[11,12]
• A new study by the U.S. Government Accountability Office (GAO) found that the abstinence-only requirement in the President’s Emergency Plan for AIDS Relief (PEPFAR) has caused major confusion and challenges, created a culture of fear around condoms amongst PEPFAR implementing partners, and thwarted the ability of country teams to respond to local needs.[13]
• A new study of abstinence-only by the Society for Adolescent Medicine found that, “although theoretically completely effective … in actual practice, the efficacy of abstinence-only education may approach zero.”[14] Moreover, abstinence-only policies contradict decades of scientific research about what is effective in HIV prevention. [14,15,16,17,18,19,20]

Call to Action

In order to achieve a world without AIDS, the international community should stand up for young people and ensure that they do not fall victim to policies based in ideology or wishful thinking.

Governments Should:

• Include young people as members of official delegations to the UNGASS Review.
• Include the voices of youth in official statements at the UNGASS Review.
• Commit to reducing HIV infection in young people by supporting comprehensive HIV prevention programs and integrating them with sexual and reproductive health services and speak out against abstinence-only prevention policies.

Civil Society Should:

• Demand comprehensive HIV prevention and speak out against abstinence-only prevention policies.
• Sponsor young people as members of NGO delegations to the UNGASS Review.
• Involve young people in developing and implementing HIV prevention programs for youth.

Young People Should:

• Speak out for comprehensive HIV prevention.
• Lobby governments to include young people on official delegations to the UNGASS Review.
  Monitor governments’ implementation of the UNGASS Declaration of Commitment and U.S. government-funded abstinence-only programs in PEPFAR countries, reporting harmful programs to Advocates for Youth. E-mail: policy@advocatesforyouth.org.

References

1. UNFPA. Adolescents Fact Sheet, 2006; http://www.unfpa.org/swp/2005/presskit/factsheets/facts_adolescents.htm; accessed 3/24/06.
2. Kannabus A, Fredriksson-Bass J. The History of AIDS: 1998-2002. United Kingdom: Avert; http://www.avert.org/historyi.htm; accessed 4/7/2006.
3. UNGASS. Declaration of Commitment on HIV/AIDS. New York: United Nations, 2001; paragraphs 33, 47, 53, and 63.
4. UNAIDS. AIDS Epidemic Update. Geneva: UNAIDS, 2005.
5. UNAIDS. AIDS Epidemic Update. Geneva: UNAIDS, 2001.
6. UNAIDS. 2004 Report on the Global AIDS Epidemic. Geneva: UNAIDS, 2004.
7. UNICEF. A Call to Action: Children—the Missing Face of AIDS. Geneva: UNICEF, 2005.
8. UNAIDS. At the Crossroads: Accelerating Youth Access to HIV/AIDS Interventions. Geneva: UNAIDS, 2004.
9. UNAIDS. Children and Young People in a World of AIDS. Geneva: UNAIDS, 2001.
10. UNAIDS, UNFPA, World Health Organization. Position Statement on Condoms and HIV Prevention. Geneva, Authors, 2004.
11. U.S. Agency for International Development. Annual Program Statement: HIV/AIDS Prevention through Abstinence and Healthy Choices for Youth: President's Emergency Plan for AIDS Relief. [APS No. M/OP-04-812] Washington, DC: USAID, March 11, 2004.
12. United Nations. World Population Prospects: The 2002 Revision, Volume II: Sex and Age. New York, NY: UN, 2003; [used with USAID-acknowledged data in citation #11, above].
13. U.S. G.A.O. Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding under the President’s Emergency Plan for AIDS Relief [GAO-06-395] Washington, DC: The Office, 2006.
14. Santelli J et al. Abstinence and abstinence-only education: a review of U.S. policies and programs. Journal of Adolescent Health 2006; 38:72-81.
15. Baldo M et al. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presented at the Ninth International Conference on AIDS, Berlin, 6-10 June 1993. Geneva: WHO, 1993.
16. UNAIDS. Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: A Review Update. Geneva: UNAIDS, 1997.
17. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.
18. Alford S et al. Science & Success: Sex Education & Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003; http://www.advocatesforyouth.org/programsthatwork/index.htm
19. Alford S et al. Science & Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2004; http://www.advocatesforyouth.org/programsthatwork/index.htm
20. Hauser D. Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact. [Title V State Evaluations] Washington, DC: Advocates for Youth, 2004; http://www.advocatesforyouth.org/publications/stateevaluations.pdf

Written by Sarah Audelo
2006 © Advocates for Youth