|AIDS - 5 years since ICPD: Emerging issues and challenges for women, young people & infants. A UNAIDS discussion document (UNAIDS, 1999, 24 p.)|
The future of the HIV epidemic lies in the hands of young people. The behaviours they adopt now and those they maintain throughout their sexual lives will determine the course of the epidemic for decades to come. Young people will continue to learn from one another, but their behaviour will depend largely on the information, skills and services that the current generation of adults choose to equip their children with.
AIDS Epidemic Update: December 1998, UNAIDS, Geneva
UNAIDS has estimated that every minute of every day, five young women and men become newly infected with HIV. Worldwide, nearly half of all new HIV infections today are in young people aged 10-25 years, and in the worst-affected countries the proportion is even greater, exceeding 60% in some places. This grim statistic reflects the fact that, in advanced epidemics where there is a high prevalence of HIV in the general population, new infections become increasingly concentrated among young people because they run the risk of coming into contact with an HIV-positive partner almost as soon as they become sexually active. A study in Malawi, for example, found that the annual rate of infection in teenage girls was six times higher than in women over 35 years.
In sub-Saharan Africa and Asia the virus is spread predominantly through heterosexual intercourse, whereas in Latin America the main route of transmission is sex between men, and in Eastern Europe it is needle-sharing between drug users. In places where the epidemic is heterosexually driven, young women are often disproportionately affected, for reasons already discussed. Thus studies sponsored by UNAIDS and its partners show that in western Kenya nearly one girl in four between the ages of 15 and 19 years is living with HIV, compared with one in 25 boys in the same age group. In Zambia in this age range, 16 times as many girls as boys are infected. And in rural Uganda among 20-24 year olds, there are six young women who are HIV-positive for every infected young man.
Very high rates of teenage pregnancy and of STIs give an indication of the extent of unprotected sexual activity among young people, and therefore of their vulnerability to HIV/AIDS. Demographic and health surveys conducted in sub-Saharan Africa between 1990 and 1996 show, for example, that nearly 70% of women in Uganda, Burkina Faso and Guinea were pregnant by the age of 19, and over half the women in Benin, Cameroon, Namibia, Tanzania and Zambia also became pregnant as teenagers. As far as STIs are concerned, the under 25 year olds account for around half of the 333 million new cases per year. Fortunately, many of these infections are easy to cure (for those young people with access to affordable youth-friendly health services), but left untreated they increase by as much as ten-fold the risk of acquiring HIV during intercourse.
Among young people, those who live on the margins of mainstream society are the most vulnerable of all to HIV infection. They may be living on the streets, as orphans or fugitives from poverty-stricken or violent homes. They may be refugees or displaced people, young people growing up in urban slums, or young people isolated by prejudice and discrimination because they are homosexual in a society that refuses to accept or acknowledge homosexuality. Young people like these often have limited access to education, services and supplies that might help them protect themselves, and their lifestyles, all too often, are laden with risk. They may sell sex to survive, or use it to bargain for protection, a meal, a place to sleep; or sex may provide one of few opportunities for human warmth and intimacy. Violence, sexual abuse and exploitation are common experiences, and drug-taking is often part of the culture - a response to feelings of loneliness, boredom and despair.
PREVENTION WORKS WITH YOUNG PEOPLE
Where they have been able to access appropriate knowledge, skills and means, young people have shown a remarkable propensity to adopt safer behaviour - even more so than their elders. Countries that have worked with young people to reduce risk in sexual and drug-taking behaviour have often been rewarded by dramatically lowered levels of HIV infection. In northern Thailand, for example, half as many 21-year-old men visited sex workers in 1995 as had done so four years earlier. And of the ones who did visit brothels, far more used condoms than before - 93% in 1995 compared with 61% in 1991. Rates of STIs and HIV among men of this age were dramatically lower than recorded among 21-year-olds in 1991. In Uganda, too, safer behaviour has caught on. For example, young people are increasingly abstaining from sex in the face of HIV. In 1995, over half of men and 46% of women aged 15-19 said they had never had sex, a rise of over 75% since 1989 for both sexes. HIV rates among pregnant teenagers in Uganda have also dropped dramatically in several urban centres - in some cases falling to less than 5% from over 20% at the start of the decade. In Western Europe new infections dropped by nearly 40% between 1995 and 1997, thanks to postponement of first intercourse and consistently high rates of condom use among young people from the beginning of their sex lives.
ZIMBABWES AIDS action programme for schools
Since 1993, weekly lessons in life skills and AIDS have been compulsory for all students from grade 4 (9-10 year olds) upwards in Zimbabwes schools. Teaching material for the lessons, adapted to suit the different age groups, cover four main themes: relationships, growing up, life skills and health, and the topics raised range from gender roles and rape, to coping with emotions, stress and peer pressure. Class teaching includes role-play, and students also carry out AIDS-related projects in their local communities. Teachers are pre-pared for raising these sensitive issues through a special training programme, and all teaching materials are reviewed and approved by a committee which includes representatives from the national AIDS programme, the Ministry of Education and the major religious denominations.
KEY ELEMENTS OF A GLOBAL STRATEGY
Seven sets of actions have been proposed for those concerned with improving the response to HIV/AIDS, and making strategies appropriate to the needs of young people. Priority actions to be considered in the light of situation and response analysis in each country, and feedback from youth organizations include:
1 establishing or reviewing national policies to reduce the vulnerability of young people to HIV/AIDS and ensuring that their rights are respected, protected and fulfilled;
The UNAIDS Cosponsors and Secretariat, governments, nongovernmental organizations and other civil society organizations all have a role to play in these strategic actions.
Taking action to minimize the threat of HIV/AIDS to young people is more than a moral obligation. It is also absolutely necessary for halting the HIV epidemic. Experience to date shows that interventions for, and in partnership with, young people are among the most effective. Besides tapping into the energy and idealism of youth, such interventions profit from the fact that young people are not yet set in their ways, and are generally more willing than older generations to question social norms and change behaviour if necessary.
Towards a safer world with young people
A myriad of programmes have been set up around the world to protect the rights and meet the needs of young people in the AIDS epidemic, and many lessons have been learned about what makes for success. It is very important, for example, that young people be full and active partners, rather than passive recipients of programmes designed and run by adults. They should be involved at all stages of an HIV/AIDS programme, from the conceptualization and planning, to the running and monitoring of activities. This ensures that it is truly relevant to their needs, while profiting at the same time from the energy and enthusiasm of youth, building their confidence and self-esteem, and encouraging communication and mutual respect between the generations.
Building a safer world with young people means focusing on the individual to try to influence behaviour, as well as on the social context in which personal decisions are made and acted upon. It requires that young people be equipped with the knowledge, life skills and services they need to adopt healthy behaviour, resist unhealthy behaviour and protect themselves from diseases, including AIDS. And it requires at the same time that safe and supportive environments be created that are enabling and empowering. Such environments promote and protect human rights.
UNAIDS has always respected the rights and considered the needs of young people as a high priority. In 1998, UNAIDS, the Cosponsors and key partner organizations launched the World AIDS Day Campaign under the title Force for Change: World AIDS Day Campaign with Young People. The intention of the 1998 campaign was to sustain the momentum of the 1997 campaign, whose theme was Children Living in a World with AIDS, and to build on initiatives already taken. The 1999 campaign will build further on this foundation.
For the third consecutive year, the Inter-agency Working Groups on School AIDS Education and on Especially Vulnerable Young People will meet in 1999 to continue the identification of effective policies and programmes. Furthermore, regional consultations will take place with young people, Cosponsors and youth organizations to develop further the elements of a global strategy on young people and HIV/AIDS. The background discussion paper on this topic was recently welcomed by UNAIDS Programme Coordinating Board (PCB) meeting, held in New Delhi in December 1998.
WHAT SHOULD HIV/AIDS EDUCATION COVER?
Young people in many parts of the world are denied sex and health education in schools because parents and others in authority fear that it will give approval, and even encouragement, to early sexual activity. But there is compelling evidence from studies conducted around the world and in many different cultures that sex education has the opposite effect: it encourages responsibility. Knowledgeable young people tend to postpone intercourse or, if they do decide to have sex, use condoms.
In the era of AIDS, denying young people knowledge about their developing bodies, sexuality and prevention of disease, including HIV, is to leave them dangerously exposed to avoidable infection and early death. But experience shows that information is not enough. Young people also need life skills, such as sound decision-making, communication and negotiation. They need to understand the concepts of risk behaviour, such as unprotected sex and the use of alcohol and drugs, the possible consequences of such behaviour and how to avoid them. And they need to know where to go for services and help. AIDS education should cover all these areas. The use of role-play is an effective way of personalizing the issues. And peer education, in which young people are trained to spread messages and promote safe and responsible behaviour amongst their friends and colleagues, is a particularly powerful approach.
The documenting of best practice case studies on school-based sexual health education in Asia, Africa and Latin America is currently in progress.
Source: Technical Update: Learning and Teaching about AIDS in School, UNAIDS, Geneva, 1997