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 2008, and 4.9 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.
An in-depth analysis of DHS data from five countries—Cameroon, Swaziland, Uganda, the United Republic of Tanzania and Zimbabwe—found a significant association between a young woman’s HIV status and the number and age of her partners. Young women aged 15-24 were more likely to be infected with HIV when they had multiple partners and when their partners were older.
Risk of HIV infection among young women aged 15-24, by the number of partners in her lifetime, 2003-2006
Note: The odds ratio compares the magnitude of the association of HIV infection between the comparison group and the baseline group. In this chart, the comparison groups are women with two partners and women with three or more partners; the baseline group is women with one partner. An odds ratio of 1.0 indicates the HIV infection rate is equal in the two groups; an odds ratio of greater than 1.0 indicates the HIV infection rate is higher in the comparison group than in the baseline group, and an odds ratio of less than 1.0 means the HIV infection rate is lower in the comparison group than in the baseline group. For example, in Swaziland, women with two partners are 1.6 times more likely to be infected with HIV compared to women with one partner; women with three or more partners are 2.2 times more likely to be infected compared with women with one partner.
Source: UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third Stocktaking Report, 2008
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 2008 UNAIDS Report on the global AIDS epidemic indicates that the percentage of young pregnant women (ages 15–24) who are living with HIV has declined since 2000-2001 in 14 of 17 African countries with adequate survey data on young women attending antenatal clinics in urban and/or rural areas. In 7 countries—Benin, Botswana, Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Zimbabwe—the drop in infections has equalled or exceeded the 25% target decline for 2010 set out in the Declaration of Commitment, suggesting that prevention efforts are having an impact in several of the most-affected countries.
Despite this decline, there is strong consensus based on evidence that girls and young women remain disproportionately vulnerable to HIV infection in sub-Saharan Africa, particularly in the hyper-endemic countries, where prevalence is greater than 15 per cent. In Southern Africa, adolescent women are 2 to 4.5 times more likely to be infected than males of the same age.
HIV prevalence among young people aged 15-24, 2007
On average, about 30 per cent of males and 19 per cent of females aged 15-24 in developing countries have comprehensive and correct knowledge† about HIV and how to avoid transmission. These knowledge levels are far short of the UNGASS target of 95 per cent by 2010. Moreover, only 9 of the countries reporting survey data collected between 2000–2007 have reached at least 50 per cent coverage of comprehensive correct knowledge of HIV among young men or women aged 15–24.
| MDG Indicator |
| Percentage of young people aged 15–24 with comprehensive correct knowledge of HIV |
Many young people in the age group 15–24 engage in unsafe behaviour and a significant number continue to be infected. However, several countries with high HIV prevalence have experienced declines in risky behaviours, including the initiation of sex before age 15, sex with multiple partners and sex without condoms. Moreover, countries are responding to the evidence about girls and HIV. Zimbabwe, for example, has developed a national behaviour change communication strategy with a strong focus on gender issues, which recognizes that sexually active young people need support in avoiding multiple partnerships and in using condoms.
National HIV and AIDS strategic plans need to have a strong focus on prevention, taking into account assessments of young people’s risk and vulnerability. Young people are a component of the national HIV strategic plans of 22 countries in West and Central Africa, a region with general and potentially mixed epidemics.
| MDG Indicator |
| Percentage of young people aged 15–24 using a condom at last higher-risk sexual activity* |
To be effective, HIV prevention programmes must combine information, life skills and behavioural change activities with actions to address the social issues that make adolescents and young people vulnerable to HIV and lead them to engage in risky behaviours. In generalized epidemic settings where children are in school, the education sector is a crucial avenue for reaching adolescents with the gender-sensitive information and skills that are a necessary part of preventing the spread of HIV. There is strong evidence that school-based sex education can be effective in changing the knowledge, attitudes and practices that lead to risky behaviour.
The lack of data, however, continues to be a major constraint on responding appropriately to young people’s need for information on how to prevent HIV. 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.
Notes
† Comprehensive and correct knowledge means that a person 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.
* 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
UNAIDS, Report on the global AIDS epidemic, Geneva, 2008.
UNAIDS and WHO, Aids Epidemic Update, Geneva, 2009.
UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.
UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Fourth stocktaking report, New York, 2009.
UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third Stocktaking Report, New York, 2008.
UNICEF, UNAIDS and the World Health Organization, Children and AIDS: Second Stocktaking Report, New York, 2008.