• Editors' Summary
• Credits

1. The Invisible Epidemic
2. How Young People Become Infected
3. Why So Vulnerable?
4. Addressing the Epidemic
• Towards an Enabling Environment
• AIDS Education
• Mass Media Communication
• Condom Use
• Voluntary Counseling, Testing, and Referral
• HIV Treatment and Care
• Youth Livelihood Approaches
5. Reaching Out
6. Consequences of Inaction
7. HIV/AIDS: What Young People Want to Know
8. Profiles
9. Youth at the Center

• Figures
• Tables
• Side-bars
• Bibliography

• 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.

Addressing the Epidemic

In several developing countries recent declines in the prevalence of HIV/AIDS among young people, accompanied by clear signs of individual behavior change, give hope of eventually curbing the epidemic:

• In Thailand HIV incidence among young army recruits declined by 90% between 1991 and 1995 after the government adopted its comprehensive AIDS-prevention campaign (151).
• In Lusaka, Zambia, HIV prevalence among 15-to-19 year old women dropped from 28% in 1993 to 15% in 1998, and similar declines occurred in some rural areas (93, 424).
• In Uganda several studies have documented declines in HIV prevalence among young men and women in the 1990s (14, 181, 254).
• Tanzania, too, has seen recent declines in HIV prevalence among young people (199).

While few countries have made a determined effort to deal with the HIV/AIDS epidemic, 20 years' experience has demonstrated that national strategic approaches, not just more projects, are essential to contain the epidemic effectively (162). In Australia, Brazil, Senegal, Thailand, and Uganda, AIDS-prevention programs owe their relative success in part to collaboration among government, the private sector, and nongovernmental organizations (NGOs) (150, 151, 243, 288, 406). An AIDS strategy is likely to be more sustained when included in national government budgets and development goals (62).

Within an AIDS-prevention strategy, a combination of approaches is essential, including:

• Advocacy. Advocacy efforts inform and motivate policy-makers and communities—at international, regional, national, and local levels.
• Education and communication. Education and communication alert young people to the risks of HIV/AIDS and promote healthier behavior—through, for example, curriculum-based programs in schools, mass-media campaigns, peer education, and community outreach.
• Access to condoms. Condoms are the only contraceptive method that also prevents transmission of HIV. Making condoms widely accessible to young people can and does help control the spread of HIV/AIDS.
• Voluntary counseling, testing, and referral. Knowing one's HIV status can lead to healthy behavior. Also, as treatments become more widely available, early voluntary counseling and testing can lead to timely care (156).
• Improving young people's lives. AIDS-prevention efforts that focus on protecting young people's health will have more impact if they are joined by other efforts to improve young people's economic and social conditions (7).

As program efforts to change people's behavior continue, other efforts to influence social norms and empower communities to address the epidemic are becoming more important. Researchers and policy-makers now recognize that individual behavior is more likely to change in the context of a supportive community (7, 155, 156, 184, 223, 264, 329).

Patrick Coleman for JHU/CCP	South Africa Department of Health
A South African school drama troupe performs a play about HIV/AIDS for young people. Some wear t-shirts with the poster from the "Action for AIDS—Youth: A Force for Change" campaign (see inset). Addressing the AIDS epidemic requires a variety of approaches, including advocacy, sex education, and communication.