The Unmapped Journey:
Adolescents, Poverty and Gender
-Adolescence: Opportunities and Risks
-Reproductive Health in the Lives of Adolescents
-Young People and HIV/AIDS
-Young People and Employment
Young People and HIV/AIDS
Almost a quarter of people living with HIV are under the age of 25.(65) Young people now represent half of all new cases. An estimated 6,000 young people are infected every day-one every 14 minutes. The majority are women and girls.(66) In sub-Saharan Africa, 63 per cent of those who were HIV-positive in 2003 were between the ages of 15 and 24.(67) In the Russian Federation and other countries of Eastern Europe and Central Asia, more than 80 per cent of those living with HIV are under the age of 30, a majority of them young men.(68) In these regions, as well as in Southeast Asia and China, HIV is spread primarily by drug injection and commercial sex work. One third of new cases of curable sexually transmitted infections every year are contracted by young people under 25.(69)
YOUNG WOMEN FACE HIGHEST RISK. In the 1980s, HIV/AIDS disproportionately affected men. Now, the face of the epidemic is increasingly that of a young woman. Women between 15 and 24 are 1.6 times more likely than young men to be HIV-positive. In sub- Saharan Africa, young women living with HIV outnumber HIV-positive young men 3.6 to 1.(70) About 70 per cent of all young people living with HIV are women in the Caribbean, the Middle East and in North Africa.(71)
Women are more vulnerable to the infection than men, for biological, sociocultural and economic reasons (see Chapter 4), but adolescent girls and young women face additional risks. The reproductive tracts of girls under 14, for example, are more susceptible to tearing, because they are not yet fully mature. This increases the risks of HIV infection and other sexually transmitted infections. Younger women and girls are especially vulnerable to sexual violence and exploitation, and are at a disadvantage in negotiating the terms of sexual relations, including the right to say "no" and to insist on condom use. Harmful practices, such as child marriage and female genital mutilation/cutting with unsterile instruments, expose them to additional dangers.
THE ROLE OF YOUNG MEN. No discussion of female vulnerability to HIV is complete without mentioning men, whose behaviour drives the epidemic and whose inclusion in prevention efforts is critical to their success. In many countries, having sex with many women is a measure of a young man's virility. Many young men are also exposed to high risks of HIV for a variety of reasons, including through injecting drug use, in prisons, and through their occupations. For instance, most soldiers and many migrants in search of work are young men, in situations that take them away from their families and partners and may lead them to engage in commercial sex. Programmes that allow boys and young men to discuss their concerns in a non-judgemental and supportive environment and that encourage a sense of equality with women are critical, as discussed in Chapter 6.
LACK OF INFORMATION, MEANS AND SKILLS FOR PREVENTION. In many of the worst-affected countries, frank discussion of gender equality, contraception, HIV prevention and related issues remains taboo. Studies from around the globe testify to an alarming degree of misinformation and lack of knowledge about the disease, particularly among young women and girls.(72) Misconceptions can give young people a false sense of security and lead them to underestimate the risk of infection. Empowering young people to abstain as a choice, delay sexual initiation, reject unwanted advances, as well as providing them with access to condoms, knowledge of their proper use and the ability to negotiate safer sex, can, taken together, make the difference between life and death. Even though most people become sexually active during adolescence,(73) adolescent girls and boys have difficulty obtaining condoms and many do not know how to use them properly.(74) The majority of young people lack effective access to prevention programmes.(75) Better quality programmes are also needed, including those that tackle poverty and the harmful gender stereotypes that drive the epidemic.
WORKING WITH YOUNG PEOPLE TO HALT THE EPIDEMIC. The importance of preventing HIV among young people has come into sharper focus since the ICPD. At the 2001 UN General Assembly Special Session on HIV/AIDS, for example, young people were recognized as a priority group for prevention.(76) Working with young people can be as important as working for them. UNFPA and the Joint United Nations Programme on HIV/AIDS (UNAIDS) sponsor the Global Youth Coalition on HIV/AIDS, a network of some 600 youth leaders from 66 countries.(77) In 2003, UNFPA launched its Global Youth Partners initiative to empower young leaders from developing regions to improve HIV prevention through advocacy and dialogue with decision makers.(78)
Examples abound of youth activism and of communities, organizations and governments working to stop the epidemic from harming young people. In the Russian Federation, UNFPA supports Juventa, an innovative municipal programme with 12 clinics in St. Petersburg alone. Offering a confidential telephone hotline, education and medical services, and links with employment programmes for marginalized youth, these youth-friendly clinics, which opened in 1993, now reach 240,000 youth a year. Their "trusted doctors" provide counselling and services to commercial sex workers.
Mass media and entertainment can capture the attention of young people and embed messages in an appealing format. South Africa's Lovelife programme embarked on an innovative multimedia campaign to reach 12-to-17-year olds before they become sexually active.(79) A multimedia initiative in Nicaragua, known as "Sixth Sense", uses radio, a youth-led television soap opera and print materials on young people's rights. It has earned top ratings with young and adult audiences alike in hundreds of media outlets.(80) MTV's "Staying Alive" is the largest global HIV/AIDS campaign, covering 166 countries and territories. Its 2004 campaign, focused on girls and women, was supported by UNFPA, UNAIDS, the World Bank, Family Health International and the Kaiser Family Foundation.(81)
EMPLOYMENT AND INCOME KEY TO PREVENTION. Poverty and gender discrimination are at the root of many HIV infections because they limit young people's options. When people have few alternatives or little hope for the future, their possibilities and motivation for taking action to protect themselves against HIV beyond daily self-preservation and survival are limited. Providing adolescents with the skills and resources they need to make a decent living and improve their prospects can help stem the epidemic.
Some pioneering initiatives are addressing the underlying poverty and gender dimensions of the spread of HIV. In Mali, Save the Children UK introduced microcredit for rural adolescent girls to prevent their migration to cities in search of domestic work. In India, with support from the Population Council and CARE, adolescent girls living in slums acquired marketable skills, began saving money and gained self-esteem.(82) In Benin, a government programme combines job training with HIV and pregnancy prevention.
In Senegal, UNFPA, UNICEF and the World Health Organization have helped educate some 10,000 adolescent girls and young women with emphasis on literacy, gender and human rights, reproductive health services, income-generating opportunities and computer literacy and training.(83) In Mozambique, a large-scale programme known as Geraša?o Biz brought together ministries, UN agencies and donors to give displaced youth greater access to reproductive health, HIV prevention and training and employment opportunities.(84)
UNESCO has been supporting integrated programmes for poor adolescent girls in South Asia that cover literacy, reproductive health and HIV/AIDS, legal education, and training in income-generation and microfinance. A science programme focusing on basic health, safe water, agriculture and renewable energy has trained 4,250 adolescent girls in 176 villages; 10 per cent of them are now employed or have started their own microbusinesses.(85)
24 | 'SUGAR DADDIES' AND SURVIVAL
Poverty drives many young women to survival sex. This exchange of sex for money or school fees or to help support their families sometimes takes the form of "sugar daddy" relationships found in the Caribbean and sub-Saharan Africa. Sugar daddies are typically older men, married and well off, who support younger women financially in exchange for sex. Increasingly, they seek out adolescent girls owing to the belief that they are less likely to be infected with HIV. The greater the age and economic differences, the more unlikely it is that condoms will be used. Older men tend to have had multiple partners and more exposure to HIV.
Studies of pregnant teens in countries of sub-Saharan Africa revealed that 73 per cent of the girls interviewed had sexual partners who were over age 30. In Haiti, one study found that one third of adolescent girls reported entering sexual relationships out of economic necessity. Of these, 95 per cent had children by several fathers, placing both the women and their infants at higher risk of HIV. In Kenya, one study found 47 per cent of sugar daddies' partners were adolescents. In response, some countries such as Gambia, Uganda and Zimbabwe, have launched campaigns to alert young women. See Sources