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.
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.
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.
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.