Youth crucial to stopping AIDS

Posted: 24 April 2002

To stop the AIDS epidemic from becoming a catastrophe, prevention strategies must do much more to reach young people right away, according to a new report from the Johns Hopkins University. The report follows grim new United Nations statistics that show almost 12 million young people are now living with the disease.

Furthermore, roughly half of the more than 60 million people infected with HIV over the past 20 years became infected between the ages of 15and 24, according to the latest issue of Population Reports, Youth andHIV/AIDS: Can We Avoid Catastrophe?

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 11.8 million young people are now living with HIV/AIDS, compared with 10.3 at the end of last year.

But the worst is yet to come, according to Hopkins researchers. Public health officials estimate that current illness and deaths from HIV/AIDS represent just 10 per cent of the eventual impact. In 1998, UNAIDS reported, 2.5 million youth became infected with HIV - 7,000 each day, or about five per minute.

Life expectancy

The epidemic has hit hardest in sub-Saharan Africa, where over eight million youth are living with AIDS - two-thirds of them young women, according to the Hopkins report. In Africa and elsewhere, as older men seek increasingly younger partners to avoid becoming infected, female adolescents are particularly vulnerable. Women become infected on average ten years earlier than men. In certain regions young women are two to six times more likely than young men to be infected.

In some African countries - Botswana, Mozambique, Namibia, Swaziland, and Zimbabwe - "it may already be too late to avoid catastrophic numbers of AIDS deaths," writes Hopkins researcher Karungari Kiragu. As infected youth eventually die, life expectancy will drop to around 30 years by 2010. Even now "in some communities many adolescents head their own households, raise children, and care for their parents who are dying of AIDS. Without immediate action, what is true of these communities today could become true of towns, cities, and even entire nations in the future."

"Youth are the future, if they survive," said Dr. E. Anne Peterson, Assistant Administrator for Global Health at the United States Agency for International Development (USAID), which funded the report. "And I believe they are ready to lead the way in changed and fewer risk behaviours to give themselves, their country and their culture hope of surviving this pandemic."

Worst affected

In countries worst affected by the epidemic little can be done to reduce the number of deaths to young people in the near term, according to the Hopkins report. Statistics from UNAIDS show, for example, that in Botswana some 88 per cent of 15-year-old boys will eventually die of the disease if the risk remains at present levels. Even if the risk of infection could be cut by half by 2015 - before the young boys turn 30 - the percentage of deaths due to AIDS would drop only to 78 per cent because so many people already are infected and likely to spread HIV to others.

In other countries, such as Thailand, where the disease is not so prevalent, further prevention efforts would have more effect. Reducing the risk by half by 2015 would lower the percentage of 15-year-old boys who will eventually die of AIDS by half from 22 to 11 per cent.

Twenty years' experience has demonstrated that national strategic approaches, not just more projects, are essential to contain the epidemic effectively, according to Population Reports. Comprehensive strategies in Australia, Brazil, Senegal, Thailand, and Uganda which combine the efforts of government, private sector, and non-governmental organizations, have had the most success at reducing the prevalence of HIV.

Limited information

Infected adolescents - because they are likely to have been recently infected - are at their most infectious stage. Sexually active young people are more likely to have a series of sex partners, too, so they can spread HIV more rapidly. If these adolescents changed their behaviour, the spread of the epidemic could be slowed. In countries where the epidemic is already generalised, a combined focus on youth and on high-risk groups - such as drug injectors, street children, and sex workers - would be the most effective. Models suggest that such a campaign could have the same impact at only 20 per cent of the cost of a broad national campaign. Despite over 15 years of international attention to the need, young people today still have only limited opportunities to learn about HIV/AIDS. In Bangladesh, for example, surveys reveal that 96 per cen of girls ages 15 -19 and 88 per cent of boys did not know any way to protect themselves against HIV/AIDS. In Bolivia the percentages were 33 and 26.

The report calls for comprehensive strategies to include:

  • Increased political and financial support for AIDS prevention among youth in developing countries. While 95 per cent of people with HIV infection live in developing countries, 95 per cent of all AIDS prevention funding is spent in industrialized countries. Moreover, a larger share of that spending should focus on youth.

  • Increased education and communication. Some adults still think that sex education encourages sexual experimentation. In fact, some school-based programmes have delayed the onset of sexual activity and increased condom use without increasing sexual activity.

  • More youth-friendly services. Social policies and health care providers' behaviour often reflect intolerance and discrimination against youth, limiting access to health information and care and making young people reluctant to seek information, guidance, and care.

  • More attention to the root causes of youth's vulnerability. Programmes must address cultural practices and the economic dependence that put young people - especially young women - at high risk of HIV infection.

Population Reports is published by the Population Information Program at the Johns Hopkins University, Bloomberg School of Public Health.Related link:Population Reports, Youth andHIV/AIDS: Can We Avoid Catastrophe?