Young people, HIV and AIDS

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Around 2,100 young people and adolescents are infected with HIV every day. In 2013, four million young people aged 15-24 were living with HIV, with 29% aged under 19.2 AIDS remains the number-one killer of adolescents in Africa and the second-leading cause of death among adolescents worldwide.

The majority of young people living with HIV are in low- and middle-income countries.

The number of AIDS-related deaths among adolescents rose by 50% between 2005 and 2012. This is in comparison to a 30% fall among people of all ages living with HIV.

Why are young people vulnerable to HIV?

Young people are vulnerable to HIV at two stages of their lives; the first decade of life when HIV can be transmitted from mother-to-child, and the second decade of life when adolescence brings new vulnerability to HIV.

There is a lack of data showing the proportion of young people infected at each stage, making it difficult to roll out HIV services specific to each group.

HIV transmission in the first decade of life

In 2013, an estimated 240,000 children were infected with HIV from their mother during pregnancy, childbirth or breastfeeding.9 Many of these children were linked to care as infants, and they need to be supported to adhere to their HIV treatment in adolescence and into adulthood.

This becomes difficult with pressures such as puberty, increased risky behaviours, changes to their HIV treatment needs and new responsibility for their own health. These explain why some young people stop adhering to antiretroviral treatment (ART) correctly during their adolescent years.

HIV transmission in the second decade of life

Unprotected sex is the most common cause of HIV among young people, with sharing infected needles second. Adolescence is often associated with experimentation of risky sexual and drug-related behaviours, increasing a young person’s vulnerability to HIV.

For some, this is a result of not having the correct knowledge about HIV and how to prevent it, highlighting the need for HIV and sexual and reproductive health education. For others, it is the result of being forced to have unprotected sex, or to inject drugs.

Whilst programmes to prevent mother-to-child transmission of HIV (PMTCT) have been hugely successful in recent years, reducing new infections among adolescents is more difficult. There are many factors that put young people at an elevated risk of HIV.

Excluded from national plans

Young people are often forgotten in national HIV and AIDS plans which typically focus on adults and children. Consequently, there are a lack of youth-friendly health services.

Data issues

HIV-related data for young people is often divided between adolescents (aged 10-19) and young people (aged 15-24), with less data available for adolescents. However, these age groups are not well defined internationally and even vary within countries, making data collection and its reliability very complex.

Ethical and legal issues make it difficult to conduct studies and research on people under 18, limiting what data is available about how HIV affects young people.

Vulnerability via unprotected sex

    Early sexual debut

The age of sexual debut is rising, showing a positive change in attitudes among young people with regards to sexual behaviour.

    Not using condoms

Condom use among young people and adolescents is usually low, with only 34% of young women and 45% of young men using them.

    Multiple partners

The number of sexual partners young people have is falling, although it remains high in countries most affected by the HIV epidemic. More than a quarter of young men in kenya are thought to be in multiple relationships.

    Older partners

Inter-generational sex (when young people have relationships with older people) is thought to be a driver of the HIV epidemic in Kenya.

Older partners are more likely to be living with HIV, therefore risking exposure to young people. Young women also find it harder to negotiate condom use with older partners who have greater power in the relationship and may use gifts or money to encourage girls to have unprotected sex.

Young people who are part of key populations

Young people may also belong to other key affected populations – such as sex workers, men who have sex with men, people who inject drugs or transgender people. In Asia, 95% of young people diagnosed with HIV fall under at least one of these groups.

These young people are often subjected to strict laws and discrimination relating to their behaviours, preventing them from accessing specific HIV information and services. In some countries, being homosexual, injecting drugs or having sex under the age of consent is criminalised.

Young women

60% of new HIV infections among young people occur in young women, equating to 380,000 every year. More than 5,000 young women and girls, the vast majority of them in southern Africa, acquire HIV every week.26 27 In sub-Saharan Africa, women are likely to become HIV-positive five to seven years earlier than men, and girls account for seven in 10 new infections among those aged 15−19. Young women aged between 15 and 24 years old in sub-Saharan Africa are twice as likely as young men to be living with HIV.

A number of reasons for this are reported, including gender-based violence and a lack of access to education and healthcare services. In some places, up to 45% of women report that their first sexual experience was forced or against their will.

In many places, intergenerational relationships – between older men and younger women – are also seen to be driving a cycle of infections. Young women and adolescent girls need the means to protect themselves in order to break this cycle. While the rate of new HIV infections among young women in 26 countries is declining, these gains are fragile and by no means universal.

Young sex workers

40% of female sex workers (FSW) in North America, East and South Asia begin selling sex before the age of 18.

The low age of sex work initiation puts young women at an elevated risk of HIV, both biologically, and because of being powerless to negotiate condom use.

Young people who inject drugs

HIV prevalence among young people who inject drugs worldwide is 5.2%.38 However, it is much higher in countries such as Pakistan, where 23% of young people aged 15-24 who inject drugs are living with HIV.

Many drug users who start injecting young are more likely to become HIV-positive because they are:

less likely to access harm reduction and treatment services
more likely to share needles and syringes
more likely to rely on older drug users for equipment
less likely to understand the risks of injecting
likely to require parental consent to access HIV testing, needles from pharmacies and harm reduction programmes.

There are often age restrictions on accessing harm reduction services, forcing young people away from services and being denied help to overcome their addiction. If someone starts injecting drugs in their youth, they should be prioritised for harm reduction services, not denied them.

HIV prevention programmes for young people

Age-appropriate services

Young people respond much better to HIV and sexual health services that are specific to their age group. This includes sexual and reproductive health education, contraception and condoms, mental health services, peer support, and support transferring from paediatric to adult health services.

Greater emphasis should be placed on counselling to encourage behaviour change among young people, rather than just handing out commodities such as condoms.

Voluntary medical male circumcision (VMMC)

The effect of male circumcision on reducing transmission of HIV from women to men via vaginal sex has shown to be most successful among men under the age of 25. This is likely due to the fact that it is easier to encourage safer sexual behaviour among younger people than older people who have already established behavioural norms.

Younger males also face less pressure from female partners when abstaining from sex during the healing process, due to greater cultural acceptance of circumcision among younger people.

Engaging schools in the response

Schools have the potential to provide detailed education on HIV and AIDS and other sexual health issues. More progress needs to be made to ensure there is equality in access to schools by both girls and boys, and to prevent them from dropping out.45
Engaging young people in the response

Young people have the potential to be great peer educators, and to help in the design of HIV-related services and programmes. Technology and social media are consistently being proved as effective ways to engage young people in sharing HIV knowledge.

These peer educator and social media ideas have been combined by the Y+ Programme, a platform for young people living with HIV to talk, find a mentor, become a mentor and advocate for the needs of young people.

Cash transfers plus care

Small cash transfers to households on a very low income have been shown to have a positive effect on reducing risk-taking behaviour among adolescent girls . The study also found that HIV incidence halved among both girls and boys who received cash, coupled with other forms of care, known as ‘cash plus care’.

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