Contents
Chapters
- The Invisible Epidemic
- How Young People Become Infected
- Why So Vulnerable?
- Addressing the Epidemic
- Reaching Out
- Consequences of Inaction
- HIV/AIDS: What Young People Want to Know
- Profiles
- Youth at the Center
Highlights
- Why young women face more risk
- Culture can hurt
- Profile: Going public
- Education should start early
- Condoms for dual protection
- Orphans: A new challenge
- What can parents do?
- Reaching street children
- Putting youth at the center
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Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXIX, Number 3
Fall 2001
Series L, Number 12
Issues in World Health
Strategic Focus on Youth
No one strategy against AIDS can apply everywhere; the approach in each country should reflect the epidemiological patterns of the infection (7). Nevertheless, because most HIV infections occur during adolescence, focusing on young people appears to be a crucial strategy.
Based on simulation models, in a hypothetical African country with HIV prevalence of 10% in the general population, focusing on preventing HIV among adolescents would be more effective than focusing on high-risk populations—defined in this case as people having sex with more than one partner in the past six months. A combined focus on young people and on high-risk groups would be most effective, the models suggest—at only 20% of the cost of a full-scale national campaign against AIDS (345).
Another reason to focus prevention efforts on youth is that HIV-positive youth, because they were recently infected, are highly infectious. HIV is most infectious when viral loads in the blood are high, resulting in HIV shedding in many body fluids. Normally, there are two such periods: The first period, the primary infection, occurs immediately after HIV infection and lasts only a few months. The second period is at the end, when HIV infection progresses to AIDS (11, 46, 312). Because adolescents are likely to have been recently infected, many are at the primary, most infectious stage, where behavior change could be especially effective at reducing further HIV transmission (46, 312).
Preventing HIV infection among youth also would help reduce the mounting cost of treatment, providing resources that could help meet other needs of young people. For instance, in India the cost of treating one AIDS patient for one year, even without expensive therapies, equals the annual cost of providing primary school education for 10 students (266).
Early action against HIV/AIDS is far more effective than delayed action. One estimate is that an AIDS-prevention program begun 10 years ago would have had 60% more impact on HIV prevalence than the same program begun today (345). In particular, addressing HIV/AIDS among youth earlier rather than later could do much to stem the spread of the epidemic.
Delegates at the 2001 United Nations General Assembly Special Session on HIV/AIDS resolved to "reduce by 2005 HIV prevalence among young men and women aged 15 to 24 in the most affected countries by 25% and by 25% globally by 2010" (166). Reaching this ambitious goal will require much greater efforts.
The health sector alone cannot hope to contain the HIV/AIDS epidemic, nor can individual AIDS-prevention programs, working alone—although any and all efforts help. Only a large-scale, coordinated strategic approach, involving national governments, local communities, and the private sector, with international support, holds real hope.
 Reproductive Health Association of Cambodia (RHAC) |
Young people excitedly crowd the stage following an entertaining educational event organized by the Cambodian Reproductive Health Association. While no single strategy against HIV/AIDS can apply everywhere, focusing on youth is crucial, especially if efforts begin right away, because most HIV infections occur during adolescence. |
