• 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

---

Use the world's largest
collection of HIV/AIDS
prevention materials...

www.jhuccp.org/mmc

Over 30,000 posters, pamphlets, videos,
audiotapes, photographs, training
materials, novelty items, and more on
HIV/AIDS prevention around the world.

Also...you can request What's New on
youth and AIDS, a newsletter issue high-
lighting new communication materials, from

JHU/PIP Media/Materials Clearinghouse
111 Market Place, Suite 310
Baltimore, MD 21202 USA
Email: mmc@jhuccp.org

---

• POPLINE
• Other reports
• To Order
• CCP Home Page

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.

For millions of young people living with HIV/AIDS, little treatment and care are available. Indeed, for most young people in the countries hardest hit by the HIV/AIDS epidemic, no treatment is available at all. Although treatment for related conditions such as STIs and opportunistic infections is more available, many young people cannot afford it. They cannot ask their parents or others for financial help if they do not want to reveal their infection (82).

Nor can the governments of most developing countries severely affected by AIDS afford the huge sums needed to provide treatment for AIDS patients. Brazil has halved its AIDS deaths by providing generic AIDS drugs at US$4,500 per patient per year, while in the US similar drugs would cost $12,000 to $15,000. This amount is still far beyond the means of most African countries, however.

Recent promises by global pharmaceutical companies to make AIDS drugs available at deeply discounted prices still leave the neediest people unable to afford the medicines (16). Nevertheless, efforts to allow the importation of less costly generic drugs without fear of lawsuits from pharmaceutical manufacturers raise hope for the future. In 2001 the largest producers of AIDS drugs agreed to drop their lawsuit that would prohibit the South African government from importing cheaper AIDS drugs (61). Several other countries are preparing to develop their own AIDS drugs or purchase generic versions.

Management of HIV/AIDS among young people requires a variety of assistance and referral networks for their range of problems (132). As with other chronic diseases, compliance with a strict regimen of complex care and medications for HIV is difficult and often is not a high priority for youth. To keep young people in the health care system, a balanced approach is essential—both working with young people to address personal issues and developing a realistic prevention and care plan (405). Providers need to be sensitive to young people's lack of maturity and difficulty following treatment plans (311). Many health care providers have had no training in the management of HIV, however, or in how to be sensitive to young clients (132, 324).

The advent of antiretroviral therapy has prompted an important debate about the relative merits of prevention versus treatment and care. Many industrialized countries and several developing countries, including Brazil and South Korea, can afford treatment as well as prevention efforts. Most other countries, however, must make difficult decisions about whether to emphasize prevention or treatment, because the funds for either effort must come from the same source. Some are trying to find a middle ground (62). Prevention is still the hallmark of HIV/AIDS programs for young people, to ensure that no more young people become infected. At the same time, treatment for HIV/AIDS and for opportunistic infections and antiretrovirals should be offered wherever possible.

Helping young people avoid HIV/AIDS requires also helping them improve the social conditions that place them at risk. Recent initiatives seek to avoid the conditions that promote the spread of HIV, building on earlier poverty reduction models (290, 307). These include:

• Helping youth find employment and other opportunities;
• Providing credit and other financial help for job training and learning business development skills;
• Developing institutions, alliances, and networks that improve the economic skills of youth; and
• Promoting policy and social changes that improve young people's lives.

While a wide range of youth livelihood programs exist, most are small (307). They have only recently begun to link HIV/AIDS prevention to their other activities. Many focus on children orphaned by HIV/AIDS (see side-bar Children Orphaned by AIDS: A New Challenge). Others provide education and job training—for example, in Thailand scholarship projects rescue girls being sold into prostitution and help them to attend school (176).

Ketan Joshi for JHU/CCP

At the International AIDS Conference in 2000, a South African woman protests the high cost of AIDS treatment. Most AIDS programs emphasize prevention. Most people and governments cannot afford to pay the huge sums needed to treat AIDS patients.

Some livelihood projects offer loans to help young people begin businesses, pay school fees, or buy food (67, 290). In Bangladesh Action AIDS, an NGO, helps young women become entrepreneurs. In 1998, some 547 women received loans to start small businesses (76). In India the Deepak Charitable Trust operates clinics, where young men and women can receive information on reproductive health including HIV/AIDS (429).

Such programs can run into trouble, however, if they are not carefully designed. In Kenya, for example, a group of HIV-positive women received a loan to grow crops for sale, but no one would buy their produce (67). Also, loans to young people can raise ethical and legal questions—for instance, is it appropriate to allow a young person to take on debt? What can young people use as collateral? And how can credit for young people be protected from some unscrupulous adults (25)?

The impact of youth livelihood approaches is bound to vary. Impact depends on the factors motivating adolescent sexual risk-taking and the likelihood of exposure to HIV/AIDS. Still, the approach constitutes a promising addition to such other efforts as sex education, mass media communication, and counseling. In particular, to the extent that young people's sexual relations are linked to their economic needs, livelihood approaches may be crucial.