| Last update: April 2008 |
Prevention of Infection Among Adolescents and Young People
| UNGASS Target |
| By 2005, ensure that at least 90 per cent, and by 2010, at least 95 per cent of young men and women aged 15–24 have access to the information, education, including peer education and youth-specific HIV education, and services necessary to develop the life skills required to reduce their vulnerability to HIV infection |
The Challenge
During the 2001 United Nations General Assembly Special Session (UNGASS) on HIV/AIDS, leaders from around the world drew up a comprehensive set of goals that included: 1) Reducing HIV prevalence among young people aged 15–24 by 25 per cent in the most affected countries by 2005, and by 25 per cent globally by 2010; and 2) Ensuring that 90 per cent of young people aged 15–24 have the knowledge, education, life skills and services to protect themselves from HIV by 2005, and 95 per cent of them by 2010.
Young people aged 15–24 accounted for about 40 per cent of new HIV infections in 2007, and 5.4 million young men and women are currently living with HIV. With the millions of new HIV infections predicted among young people in future years, AIDS will not be halted until young people have the knowledge and capacity to avoid behaviours that put them at risk.
In response to these goals, adolescents and young people need accurate and relevant information about HIV transmission and an enabling and protective environment in their communities where they can talk openly about risk behaviours. They also need preventive interventions, which include voluntary counselling and testing, HIV education in schools, and prevention of sexually-transmitted infections. People who engage in high-risk behaviour—sex workers, injecting drug users and men having sex with men—also need to be factored into the equation. In many developing countries, the majority of these people are young people.
The great challenge is reaching the many young people who are not aware of their vulnerability to HIV or who do not understand the best ways to prevent becoming infected. HIV prevention where prevalence is low or the epidemic is concentrated in specific populations is challenging because the spread of HIV is fuelled by high-risk and typically stigmatized behaviour. Much is known about how to prevent HIV infection among adolescents and young people most at risk, but programmes generally have not been taken to scale.
Progress
| MDG Indicator |
| HIV prevalence among young people aged 15–24 |
The 2007 UNAIDS/WHO AIDS epidemic update indicates that HIV prevalence among young pregnant women aged 15–24 attending antenatal clinics has declined since 2000/2001 in 11 of 15 countries with sufficient data. Eight of these 11 countries are in Eastern and Southern Africa, the region with the highest HIV prevalence levels among adults and young people. Further, significant declines in HIV prevalence among young pregnant women in urban and/or rural areas of Botswana, Côte d’Ivoire, Kenya, Malawi and Zimbabwe suggest that prevention efforts are having an impact in several of the most-affected countries.
In Kenya, HIV prevalence among young pregnant women declined significantly by more than 25 per cent in both urban and rural areas, while similar declines were observed in urban areas of Côte d’Ivoire, Malawi and Zimbabwe, and in rural parts of Botswana. Other declines, though not as significant, have occurred in both rural and urban areas of Burkina Faso, Namibia and Swaziland, urban parts of the Bahamas, Botswana, Burundi and Rwanda and rural parts of Tanzania.
In some areas of Kenya, Uganda, the United Republic of Tanzania and Zimbabwe where adult HIV infection rates have decreased, there have also been steep declines in multiple sexual partnerships in all age groups.
HIV prevalence in men and women aged 15–24 in sub-Saharan Africa (2000–2006)
Source: UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.
| MDG Indicator |
| Percentage of young people aged 15–24 with comprehensive correct knowledge of HIV |
Among 15- to 24-year olds living in low- and middle-income countries, only 24 per cent have comprehensive correct knowledge of HIV, which means they can correctly identify the two major ways of preventing the sexual transmission of HIV (using condoms and limiting sex to one faithful, uninfected partner), reject the two most common local misconceptions about HIV transmission and know that a healthy-looking person can have HIV. This figure is far short of the UNGASS target of 95 per cent by 2010. Moreover, only 9 of the countries reporting survey data collected between 2000–2006 have reached at least 50 per cent coverage of comprehensive correct knowledge of HIV among young men or women aged 15–24.
Despite this, some progress is being made to provide a combination of interventions that are required to prevent HIV transmission among adolescents and young people, including opportunities to build risk-reduction skills. More than 70 developing countries and territories now mandate life skills based education with an HIV prevention component in national school curricula.
Note: In countries marked with an asterisk (*), data for 2000–2002 refer to years earlier than those specified in the key.
Source: UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.
| MDG Indicator |
| Percentage of young people aged 15–24 using a condom at last higher-risk sexual activity* |
Many young people in the age group 15–24 engage in unsafe behaviour. Condom use during higher-risk sex is increasing but still very low, ranging from 31 per cent among young women in sub-Saharan Africa, for example, to 59 per cent among young men in South Asia. Condom promotion and use has been less successful in high prevalence countries of sub-Saharan Africa, where most HIV transmission occurs during long-term relationships in which condoms are seldom used.
Availability of nationally representative data collected between 1999 and 2006 in some countries has provided an opportunity to assess sexual behaviour trends among young people aged 15–24 relative to declines in HIV prevalence among young pregnant women. In some countries the decline in HIV prevalence seems to be consistent with significant reductions in some forms of sexual behaviour that place people at risk of exposure to HIV. The proportion of young people who reported having had sex with nonregular partners in the previous year decreased for both men and women in Cameroon, Kenya and Zimbabwe, for women only in Haiti and Zambia and for men only in Chad and Malawi. However, the proportion of young men and women having sex with non-regular partners increased in both Rwanda and the United Republic of Tanzania.
Similarly, there have been striking shifts in condom use during sex with non-regular partners in some countries. The proportion of young people who said they used condoms the last time they had sex with a non-regular partner increased for both men and women in Cameroon, Haiti, Kenya, Malawi and Zimbabwe, for women only in Chad, Rwanda, Togo and Uganda, and for men only in Botswana. On the other hand, that proportion decreased in for both young men and women in the United Republic of Tanzania, and for men only in Chad, Rwanda and Uganda.
Most countries have insufficient or no data on HIV prevalence and/or sexual behaviour trends among young people, including several countries with exceptionally high HIV prevalence in southern Africa. This limits a more comprehensive global analysis of trends.
The key message is that the combined evidence of significant declines in HIV prevalence among young pregnant women in urban and/or rural areas of some high prevalence countries suggest that prevention efforts are having an impact in several of the most affected countries. Thus, it is imperative that HIV prevention interventions both decrease risk factors, such as non-regular and multiple concurrent partnerships, and increase protective factors linked to social, economic and cultural drivers of the epidemic in order to ensure the reduction of HIV prevalence among young people in the years to follow.
Note: In countries marked with an asterisk (*), data for 2000–2002 refer to years earlier than those specified in the key.
Source: UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.
Notes
* Higher-risk sex is defined as sex with a non-marital, non-cohabitating partner or sex with multiple sexual partners. Condom use during higher-risk sex is a proxy for safe sexual practices.
References
Expanded Inter-Agency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, A Report Card on Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment in Low- and Middle-Income Countries: Scaling up Progress from 2004–2005, 2007.UNAIDS/WHO, Aids Epidemic Update, Geneva, 2007.
UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.
UNICEF, UNAIDS and the World Health Organization. Children and AIDS: Second Stocktaking Report, New York, 2008.
UNICEF, UNAIDS and World Health Organization. Children and AIDS: A Stocktaking Report, New York, 2006.