Also available in PDF format. Click here to order publication. 

Reaching Key Affected Populations and Empowering a Generation

More than thirty years into the HIV/AIDS pandemic, it remains one of the most serious challenges to global public health. Around the world, 5 million young people ages 15-24 are living with HIV. ^[1] Young people ages 15-24 represent 41 percent of all new HIV infections, and 890,000 acquire HIV each year – meaning that around the world, nearly 2500 young people acquire HIV every day. ^[2] At least 95 percent of all new infections occur in less developed countries, with sub-Saharan Africa by far the hardest hit region. ^[1] Young women are more vulnerable to the HIV epidemic than are men – young women comprise 60 percent of all young people with HIV. ^[1] In some regions, the populations most at risk include young injecting drug users, young commercial sex workers, and young men who have sex with men. Millions of young people are at risk for HIV. Yet young people have shown they are committed to prevention: in 16 of the 21 countries most affected by HIV, prevalence among young people is falling, largely due to reductions in risk behavior. ^[3] Young people around the world must be provided with the tools they need to protect themselves from HIV – including comprehensive sex education and youth-friendly, affordable health care.

Young People In Every Region Are Living With HIV

• In sub-Saharan Africa, nearly 3.8 million youth are living with HIV/AIDS – comprising 76 percent of the world’s HIV positive youth. ^[1] However, between 1994 and 2010, 13 countries in sub-Saharan Africa saw declines in HIV prevalence of more than 25 percent. ^[3]
  
  
• In North Africa and the Middle East over 94,000 young people are living with HIV. ^[1] The number of all new HIV infections in 2009 (75,000) was nearly double that in 2001 (36,000). ^[4]
  
  
• In Latin America and the Caribbean, about 250,000 young people are living with HIV. ^[1] The Caribbean has a higher HIV prevalence rate (the percentage of the population living with HIV) than any besides sub-Saharan Africa. The Caribbean is also the only region outside of sub-Saharan Africa where women and girls outnumber men and boys living with HIV, while in Latin America, the epidemic is concentrated among men who have sex with men. ^[4] In Central and Eastern Europe and Central Asia, 81,000 young people are living with HIV, with HIV prevalence rising. ^[1] One-third of new HIV infections in this region are among young people ages 15-24. ^[1] The Russian Federation and Ukraine account for almost 90 percent of new infections in the region. ^[4] The major mode of transmission in the region is sharing infected needles. ^[4]
  
  
• In South Asia and East Asia/Pacific, 500,000 young people are living with HIV. These regions account for ten percent of all new HIV infections among young people. ^[1] In India, Nepal, and Thailand, HIV prevalence has fallen by more than 25 percent since 2001, while in Bangladesh and the Philipines, new infections rose by more than 25 percent. ^[4] Here the epidemic is concentrated among sex workers and injecting drug users. ^[4]
  
• In industrialized countries, over 150,000 young people are living with HIV or AIDS. ^[1] Young people in these countries comprise a lower percentage of the total number people living with HIV than do young people in low income countries (8 percent compared to 20 percent). ^[1] But marginalized populations are more vulnerable; rates of transmission among men who have sex with men have risen in the U.S. and several European countries, while African Americans in the U.S., and aboriginal people in Canada, experience disproportionate rates of infection. ^[4]
  
• Millions of infants have acquired HIV through mother-to-child transmission (“perinatally infected”). While limited data is available, with anti-retroviral therapy, many in the first generation of HIV-positive infants have lived to adolescence and even young adulthood. ^[4]

Among Young People, Women, Men Who Have Sex With Men, Commercial Sex Workers, And Injecting Drug Users Are At Higher Risk

• An estimated 3.2 million young women are living with HIV or AIDS, compared to 1.7 million young men. ^[1]
  
  
• In sub-Saharan Africa, 72 percent of young people living with HIV (2.7 million) are young women. ^[1]
  
  
• The common practice of child and adolescent marriage is an 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. ^[5,6] Further, married girls can be at particular risk of HIV. For example, a study in Uganda showed that HIV prevalence was 28 percent for married and 15 percent for single girls. This study noted that the age difference between the men and their wives was a significant HIV risk factor for the wives. ^[7]
  
  
• Young men who have sex with men experience an unmet need for prevention in many countries. Around the world, MSM are more likely than young men overall to experience HIV. ^[4] In North America, Central Europe, and Western Europe, MSM experience the majority of new HIV infections.
  
  
• Young people who inject drugs can also be at increased risk of HIV; injection drug use accounts for the majority of new infections in some regions. Most injecting drug users begin use at a young age. In a multi-country study of injecting drug users aged 15–24, up to 30 percent reported their age at first injection as less than 15 years. ^[1] In a study conducted in Vietnam, 48 percent of injecting drug users were less than 25 years old, 24 percent of them had started injecting within the previous 12 months, and of these, 28 percent were infected with HIV. ^[1]
  
  
• Many HIV infections are linked to sex work (they occur among sex workers or their clients), and young sex workers are vulnerable to HIV infection. In a study conducted in St. Petersburg, Russia, 33 percent of sex workers under 18 years of age were found to be HIV-positive. In Guyana, 27 percent of sex workers were found to be HIV positive. ^[4]

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

• Poverty is a major driver of the HIV epidemic, creating major barriers in treatment and prevention. Sub-Saharan Africa and South Asia, the two hardest-hit regions, are also the poorest regions in the world. ^[8]
  
  
• Young people around the world lack complete knowledge of how to protect themselves from HIV. ^[4]
  
  
  • Globally, 66 percent of young people do not have comprehensive knowledge of HIV. ^[4]
    
    
  • Young women have lower levels of HIV knowledge than do males. ^[4]
    
    
• In 2007, most countries around the world (120 out of 137 reporting) included HIV education at the secondary school level. However, program quality varies, and in the poorest countries, many young people, especially young women, are out of school. ^[1]
  
  
• Many 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. ^[1]
  
  
• Given young women’s vulnerability to HIV and reduced access to services, young women who are HIV positive and become pregnant may also have reduced access to drugs that can prevent HIV from being transmitted to a fetus. Yet experts believe that with treatment for all HIV positive mothers, MCT can be virtually eliminated. ^[4]

HIV prevention programs, which include information about abstinence, condoms, as well as monogamy/partner reduction, help reduce HIV rates and improve risk behaviors among young people. ^[9,10]

What About Early Treatment?
In 2011, a National Institute of Health-funded study found that treating HIV- positive people immediately after they were found to be HIV positive, vs. waiting until their viral load dropped to a certain point, reduced transmission by 96 percent. ^[18]

What Impact Does Male Circumcision Have On HIV Transmission
Research has shown that men who are circumcised are up to 73 percent less likely to acquire HIV through heterosexual transmission than men who are not; circumcision maintained its effectiveness five years after the initial study. ^{[15, 16, 17]}

Why Do More Young Women Around the World Have HIV Than Young Men? ^[1]

• They are biologically more susceptible to HIV.
  
  
• Gender inequalities in many countries prevent young women from negotiating safer sexual practices including condom use.
  
  
• Young women may have older male partners who are more likely to have HIV.

Young Men Who Have Sex With Men Have A Heightened Risk of HIV: ^[1]

• A study in sub-Saharan African found that HIV prevalence among young MSM was two to four times that of young men overall.
  
  
• In the Bahamas, 25 percent of MSM are HIV-positive.
  
  
• In the United States in 2009, MSM accounted for 69 percent of new infections among young people ages 13-29. In France, MSM account for half of men newly infected with HIV.

Innovative Programs Can Reach Young People With HIV Prevention Information and Services

• In Gabon, the Sylvia Bongo Ondimba Foundation, an organization run by the country’s First Lady, launched a campaign to stop the spread of AIDS. The campaign, called “CAN without AIDS,” uses sports as a platform to reach millions of people with messages on HIV prevention across Africa. The launch of the campaign coincided with the 2012 Coupe D’Afrique des Nations (or “CAN”) - a football championship co-hosted by Gabon and Equatorial Guinea. Support has been shown for the campaign by Brazilian soccer player, Pele, Cameroonian soccer player Samuel Eto’o and Didier Ovono, captain of Gabon’s national team. ^{[11, 12]}
  
  
• In Jamaica, two “Bashy Busses,” run by a Jamaican community-based organization called Children First, hit the streets to provide children and youth access to key HIV prevention services. The “Bashy Bus” travels throughout Jamaica’s most vulnerable neighborhoods. The Bashy Bus team consists of a group of talented young people who are trained as peer educators and peer counselors. Some of their services include: individual, group and peer-to-peer counseling and testing for HIV, medical services, adolescent reproductive health and life skills information, risk reduction conversations, and health education through community drama and music. In 2009, the Bashy Bus saw over 37,332 adolescents and children and provided access to “free” Voluntary Counseling and Testing for 3,965 people, including adolescents. ^[13]
  
  
• In Vietnam, the Ministry of Health supports the HIV/AIDS Prevention among Youth Project. The majority of new HIV infections in Vietnam are among young people. The project works to decrease the number of young people becoming infected with HIV. To do this, the project works with a youth advisory group to ensure that sexual and reproductive health services that are provided are youth-friendly. Some accomplishments of the program include: producing a wide-spread TV drama exploring the lives of youth in Vietnam covering a variety of sexual and reproductive health issues; airing several radio and TV spots with messages about HIV prevention as well as counseling and testing; and creating and distributing numerous materials on HIV prevention to young people in Vietnam. ^[14]

Empowering A Generation to Prevent HIV

Young people around the world are at risk for HIV, and millions face serious barriers to prevention. Yet rates have fallen by over 25 percent among young people in 16 of the world’s 21 worst affected countries. In most of these, young people have reduced numbers of partners, increased condom use, and are waiting longer to have sex. ^[3] Young people have shown that given the tools, including youth friendly services, complete information about HIV, and access to contraception, and condoms, they can protect themselves. A combination of approaches, and the removal of societal barriers to prevention, can give this generation the power to prevent HIV.

Advocates for Youth © July 2012
Written by Nicole Cheetham, Director, International Division; Emily Bridges, Director, Public Information Services; and Lauren Kalina, Intern, International Division.

References

1. United Nation’s Children’s Fund (UNICEF). Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood. New York: Unicef; 2011. Accessed November 1, 2011 from http://www.unicef.org/publications/files/ Opportunity_in_Crisis-Report_EN_052711.pdf
   
   
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). “Global Report 2010, Core Slides, Slide 11.” Accessed on No- vember 1, 2011 from
   
   
3. UNAIDS Outlook Report. “Young People Are Leading the Prevention Revolution.” Accessed from http://www.unaids.org/outlook/YoungPeople.aspx on June 27, 2012.
   
   
4. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global Report. Geneva: UNAIDS, 2010. Accessed April 12, 2012 from http://www.unaids.org/globalreport/Global_ report.htm
   
   
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. Nour NM. Health Consequences of Child Marriage in Africa. Emerging Infectious Diseases, 2006: Vol. 12, Number 11.
   
   
8. Oxford Poverty and Human Development Initiative. “Multidimensional Poverty Index.” Accessed July 5 from http:// www.ophi.org.uk/policy/multidimensional-poverty-index/.
   
   
9. Kirby D. “Sex and HIV Programs: Their Impact on Sexual Behaviors of Young People Throughout the World.” Journal of Adolescent Health 40 (2007) : 206-217.
   
   
10. Alford S, Cheetham N. Hauser D. Science and Success in Developing Countries: Holistic Programs that Work to Pre- vent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2005.
    
    
11. UNAIDS. Feature Story: “CAN without AIDS”: reach- ing youth with HIV prevention messages at the Africa Cup of Nations football tournament.” https://www.un- aids.org/en/resources/presscentre/featurestories/2012/ january/20120125gabon/ Accessed June 27, 2012.
    
    
12. UNAIDS. Feature Story: “Brazilian football legend Pelé joined Gabon’s “CAN without AIDS” Campaign.” http://www. unaids.org/en/resources/presscentre/featurestories/2012/ february/20120215acanpele/ Accessed June 27, 2012.
    
    
13. Children First. “Mobile Health Clinic in a Bashy Bus.” http://www.childrenfirst.org.jm/html/?page_id=40 Accessed June 27, 2012.
    
    
14. Asian Development Bank. “HIV/AIDS Prevention Among Youth.” Accessed from www.kswann.com/Proj_2.pdf on June 27, 2012.
    
    
15. Auvert B et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Medicine 2005; 2:e298; doi:10.1371/ journal.pmed.0020298.
    
    
16. Bailey RC et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet2007; 369: 643-56.
    
    
17. Gray RH et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007; 369: 657-66.
    
    
18. National Institutes of Health. “Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.’ http://aidsinfo.nih.gov/guidelines/html/1/adult-and- adolescent-treatment-guidelines/0/ Accessed June 27, 2012.

MISSION
Established in 1980 as the Center for Population Options, Advocates for Youth champions efforts to help young people make informed and responsible decisions about their reproductive and sexual health. Advocates believes it can best serve the field by boldly advocating for a more positive and realistic approach to adolescent sexual health.

OUR VISION: THE 3RS
Advocates for Youth envisions a society that views sexuality as normal and healthy and treats young people as a valuable resource.
The core values of Rights. Respect. Responsibility.® (3Rs) animate this vision:

RIGHTS: Youth have the right to accurate and complete sexual health information, confidential reproductive and sexual health services, and a secure stake in the future.

RESPECT: Youth deserve respect. Valuing young people means involving them in the design, implementation and evaluation of programs and policies that affect their health and well-being.

RESPONSIBILITY: Society has the responsibility to provide young people with the tools they need to safeguard their sexual health, and young people have the responsibility to protect themselves from too-early childbearing and sexually transmitted infections (STIs), including HIV.

SOME RELATED PUBLICATIONS FROM ADVOCATES FOR YOUTH

The Facts: Young People and HIV in the United States

The Facts: Young People Living with HIV Around the World

The Facts: Youth and Unsafe Abortion: A Global Snapshot

See the complete library of publications at www.advocatesforyouth.org/publications