|Adolescent Sexuality and the HIV Epidemic (UNDP, 1999, 24 p.)|
|4. HIV-RELATED WORK WITH YOUNG PEOPLE|
Some young people are at heightened risk of becoming infected with HIV. They include young people who live in abject poverty, those who are denied regular or appropriate adult support, and those who are stigmatised and discriminated against. Young people who are marginalised in these ways are more vulnerable to rape and coercive sex, may be forced to exchange sex in order to meet their needs for food and shelter and are routinely denied access to education, accurate information and health services. Young people living in particularly precarious circumstances are often difficult to reach with programs about HIV/AIDS since they are more concerned with their daily survival.
A number of innovative programs have attempted to reach young people considered to be at particular risk of HIV/AIDS across the developing world. Civil unrest and war mean that some young people in developing countries are living in refugee camps where conditions increase the risk of HIV infection. Rwandan refugees, for example, may be at particular risk of HIV infection because of the destruction of families, deterioration of social structures, loss of income and inadequate health services. One project attempted to reach adolescent refugees living in camps in Tanzania (Benjamin, 1996). In addition to 'Adolescent Health Days', sporting events, which attracted large numbers of young men, were among the vehicles used to disseminate messages about HIV infection. Girls in refugee camps are at particular risk of becoming infected with HIV because they are forced to exchange sex for economic advantages or protection. This same project is now developing income-generating activities to enable young Women to earn some money without endangering themselves.
Children and young people who live on the streets are especially vulnerable to HIV infection. These young people have a myriad of other pressing concerns, including the need for shelter, food, money, protection and love and affection. Young people living on the streets of Rio de Janeiro, for example, have reported that hunger and violence will kill them before AIDS (cited in Mann, Tarantola & Netter, 1992). Additionally, young people who live on the streets do not usually have access to adequate health services. In order to achieve good results, HIV-related programs must therefore address issues which are of perceived relevance to young people living on the streets and to help them to address their basic needs. Projects providing food, access to health services, shelter and schooling have been established for street children in Brazil for example (Vasconceles et al, 1993). An emphasis on helping young people to develop feelings of self-worth and taking full account of self-perceived needs has been given precedence over work specifically on sexual health. The project workers believe that meeting immediate needs and developing self-confidence will help street children to protect themselves from the risks of HIV infection (Vasconceles et al, 1993).
Same-sex relationships are highly stigmatised in many developing and developed countries, and homosexually active young men and women may experience marginalisation and social sanctions. Where such behaviours remain stigmatised, accurate information about the risks of HIV infection is rare. Although male-to-male sex exists in every culture, widespread official denial often renders homosexually active men socially invisible. This may place them at enhanced risk of HIV and other sexually transmitted diseases since the expression of their sexuality must be covert. Relatively few programs have targeted homosexually active men in developing countries, and even fewer have concentrated specifically on the needs of younger men (Parker, Khan and Aggleton, 1998).