HIV/AIDS and Adolescents
HIV/AIDS has become a disease of young people, with young adults aged 15-24 accounting for half of the some 5 million new cases of HIV infection worldwide each year. Yet young people often lack the information, skills and services they need to protect themselves from HIV infection. Providing these is crucial to turning back the epidemic.
An estimated 6,000 youth a day become infected with HIV/AIDS—one every 14 seconds—the majority of them young women. At the end of 2001, an estimated 11.8 million young people aged 15-24 were living with HIV/AIDS, one third of the global total of people living with HIV/AIDS. Only a small percentage of these young people know they are HIV-positive.(1) (See Table 4).
Table 4: Young People 15-24 Living with HIV/AIDS, by Sex, December 2001 (2)
|North Africa and the Middle
|East Asia and the Pacific
|Central Asia and Eastern Europe
|Latin America and the Caribbean
In addition, more than 13 million children under age 15 have lost one or both parents to AIDS. The overwhelming majority of these AIDS orphans live in Africa. By 2010, their number is projected to reach 25 million.(3 )
A combination of social, biological and economic factors help fuel the AIDS pandemic:
POVERTY HIV/AIDS is a disease highly associated with poverty. A World Bank study of 72 countries showed that both low per capita income and high-income inequality were linked to high national HIV infection rates, and a $2,000 increase in per capita income was associated with a 4 per cent reduction in infections.(4) The 2001 United Nations General Assembly Special Session on HIV/AIDS recognized that “poverty, underdevelopment and illiteracy are among the principal contributing factors to the spread of HIV/AIDS”.
GIRLS AND WOMEN ARE MORE VULNERABLE For reasons of biology, gender and cultural norms, females are more susceptible than males to HIV infection. Thus an estimated 7.3 million young women are living with HIV/AIDS compared to 4.5 million young men. Two thirds of newly infected youth aged 15-19 in sub-Saharan Africa are female. Among women, the peak age for HIV prevalence tends to be around age 25, 10 to 15 years younger than the peak age for men.(5)
Biologically, the risk of infection during unprotected sex is two to four times higher for women than men;(6) young women are even more vulnerable because their reproductive tracts are still maturing and tears in the tissue allow easy access to infection.(7)
Socially, young women also face higher risks. When they have sexual relations, it tends to be with older men, increasing the likelihood that their partners are already infected. Some adolescent girls are attached to “sugar daddies”, much older, relatively well-off (usually married) men who support them in exchange for sex. More commonly, sexually active adolescent girls, in Africa at least, have partners 2-10 years their senior who provide them with gifts, such as soap, perfume, meals out and jewellery. Some poor girls exchange sex for money for school fees or to help their families. Once in these relationships with teachers, drivers, shopkeepers or even policemen, girls have little power to negotiate the use of condoms.(8)
Men often seek younger sexual partners who are unlikely to be infected with HIV.(9)
The common myth in some places that sex with a virgin can cure AIDS or STIs further endangers young girls who fall prey to forced or coerced sexual relations.
MARRIED YOUTH AT RISK Marriage does not always protect young women against HIV infection. Since a much higher percentage of young men than young women become sexually active early, young women are likely to marry an already sexually experienced man. In Pune, India, a study in an STI clinic found that 25 per cent of the 4,000 women attending the clinic were infected with an STI and 14 per cent were HIV positive. Among the 93 per cent who were married, 91 per cent had only one partner, their husbands.
A study in Kisumu, Kenya, found that as many as half of the married women whose husbands were 10 or more years older were infected with HIV, compared to none of the women whose husbands were only up to three years older.(10)
Within marriage it is particularly difficult for women to negotiate condom use, especially if they are much younger than their husbands.
LACK OF INFORMATION AND SKILLS FOR PROTECTION Because sex is a taboo topic in many countries, large numbers of young people do not get sufficient information—or the skills—to refuse sex or negotiate safer sex practices. While most young people have heard about HIV/AIDS, few know enough to protect themselves against infection.
Surveys from 40 countries indicate that more than half of the young people have misconceptions about how HIV is transmitted.(11) In Ukraine, while 100 per cent of adolescent females know about AIDS, only 21 per cent know of three methods of prevention. In Somalia, only 26 per cent of adolescent females have heard of AIDS and only 1 per cent know how to protect themselves. In Botswana, where one in three people is living with HIV/AIDS, virtually all young people have heard of AIDS and more than 75 per cent know the three primary means of protection. Still, 62 per cent of girls had at least one major misconception about how HIV is spread. Far too many young people think they can tell if someone is HIV positive simply by looking at them.
FEELINGS OF INVINCIBILITY Adolescents tend to underestimate, downplay or deny their risks of HIV infection. Case studies by the World Health Organization (WHO) indicate that only between one fifth and one third consider themselves at risk.(12) Many young people do not recognize that their partner’s behaviour also puts them at risk. Still others may perceive HIV as something that occurs only among sex workers, drug users or men who share intimate relations. Feelings of invincibility, combined with the lack of awareness of the consequences of risky behaviour, may make them less likely to take precautions to protect their health—and lives.
SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections increase the likelihood of HIV transmission considerably,(13) as well as having other reproductive health consequences such as chronic pain, infertility or life-threatening ectopic pregnancies. While data on STIs in developing countries are scarce, particularly for young people, WHO estimates that at least a third of the more than 333 million new cases of curable STIs each year occur among people under age 25.(14) Young people are also substantially more likely than adults to become re-infected after having been treated.
A study in South Africa showed that adolescent girls were 30 per cent more likely to get STIs than were boys, in large part because they were involved with older males who were more likely to have STIs themselves.(15)
Studies on gonorrhoea in selected Middle Eastern and African countries found infection levels were highest among the 15-19 age group.(16) A substantial minority of young people, more men than women, have experienced symptoms of STIs, according to studies from Argentina, Botswana, Peru, the Philippines, the Republic of Korea and Thailand.(17)
Knowledge about STIs is generally poor among young people. A study among young sex workers in Cambodia found that their limited knowledge was based on a mixture of facts, myths and rumours and was not always correct.(18) An unfortunate misconception among many young people, including in Kampala, Uganda, and Ho Chi Minh City, Viet Nam, is that STI symptoms will go away over time or that good personal hygiene will prevent STIs (and HIV). One in five female university students in Ilorin, Nigeria, 30 per cent of youth in parts of Chile and half of young men and women in sites in Guatemala also hold this belief.(19)
Young people are more likely to seek traditional remedies for STIs, or to ignore the symptoms. This pattern is attributed to feelings of guilt over having an STI and to the stigmatizing treatment they tend to receive in health care centres, including STI clinics.
ALCOHOL AND DRUG USE Sharing needles for drug use is a highly efficient means of spreading HIV because the virus is injected directly into the blood stream. Mixing drug use with sex for money provides a bridge for HIV from injecting drug users to the wider community.
Drug use often starts in adolescence. In Nepal, where half of the country’s 50,000 injecting drug users are 16 to 25 years old, the incidence of HIV among people who inject drugs climbed from 2 per cent in 1995 to nearly 50 per cent in 1998.(20) The Russian Federation’s HIV epidemic is the fastest growing in the world, fuelled by the rising number of young drug users. In China, HIV rates are highest among injecting drug users, typically young men.
The number of drug addicts is rising, particularly
in Eastern and Central Europe, as is the number of
occasional users. According to 2000 figures from UNAIDS, injecting drug use accounts for more than half of all HIV cases in Argentina, Bahrain, China, Georgia, Iran, Italy, Kazakhstan, Latvia, Moldova, Portugal, the Russian Federation, Spain and Ukraine.(21)
Alcohol use can also fuel the HIV epidemic by increasing risky sexual behaviour. A study in Rwanda found that young people aged 15-24 who consumed alcohol were less likely to abstain from sex.(22) In a study of young adolescents in Jamaica, those who had experimented with alcohol were 2.4 times more likely than others to say they had sexual activity, other factors being equal.(23)
INTERACTION WITH TUBERCULOSIS Tuberculosis is the leading cause of death among AIDS patients worldwide. One third of all AIDS patients are infected with tuberculosis. Those infected with HIV are much more likely than others—800 times, by some estimates—of developing active tuberculosis.(24) In Kenya, the prevalence of both HIV and tuberculosis doubled between 1990 and 1996.(25)
Young people should receive vaccinations to prevent tuberculosis.(26) Most tuberculosis is treatable using directly observed therapy. Leaving it half-treated or mistreated can result in drug-resistant tuberculosis, which is harder and much more expensive to treat. Thus, tuberculosis control programmes, including for young people, must be an integral part of AIDS prevention and care strategies.