HIV and AIDS: Young People versus HIV and AIDS: A Comprehensive Approach

In June 2005, the G8 leaders committed to developing a comprehensive package of HIV prevention, treatment and care aimed at achieving universal access by 2010. Special Adviser to the UN Secretary-General and Special Envoy for HIV and AIDS in Asia, Dr. Nafis Sadik reflects on what future interventions are needed from governments, NGOs and civil society to ensure women and young women have universal access.

Young people are especially at risk from HIV and AIDS. Around half of the people who acquire HIV become infected before they turn 25, and AIDS is the second most common cause of death among 20-24 year olds.
Two-thirds of HIV infections are passed on by sexual contact between men and women. Lifestyles are changing – young women are delaying marriage, and a growing number of young people are sexually active outside marriage. Traditional culture is no protection – younger women often marry older men, who may or may not respect their marriage vows. Violence, in the home, in conflict situations, and through trafficking increases young women’s exposure to infection.

With no cure or vaccine on the horizon, all these factors highlight the urgent need for specific steps to prevent HIV infection among young people. The key groups for prevention awareness include not only children and young people, but also their parents, teachers, employers and others in contact with them. Successful programmes for young people involve them directly, and include their perspectives based on age, lifestyle, and needs.

Health policies must address the whole spectrum of young people’s sexual and reproductive health and take their special needs into account. There are three key areas of focus.

Education has been a development goal for many years, but few countries have given it priority. This must change. Countries must move urgently towards educating every girl, and every boy, within the next decade, at least to primary level. They must ensure education systems carry age-appropriate information on reproductive health, including the risks of infection. They must reach out to young people out of school with education, information, and services.

Health, including reproductive health, is another basic development goal. There has been more lip service than real action, especially where the poor are concerned. Reproductive health care is an essential part of our defence against HIV infection. Despite many years of family planning programmes, comprehensive reproductive health care is still in the future and the poor have little access. There is a great deal of ignorance and misinformation.

Reproductive health programmes, including HIV prevention, must reach out to young people, especially the most vulnerable: young women on the street, injecting drug users and migrants. They must reach young women whose husbands are violent or unfaithful. They must reach the newly married and the unmarried.

There is no time or place for discussion about whether we approve of some behaviour or other. My analogy is to a hospital emergency room. If someone comes in with a bullet wound, we do not stop to ask questions: we remove the bullet. It is the same with HIV prevention. It is a matter of health care, not morality.

Finally, gender inequality is still a fact of life in almost all societies. For the sake of every young woman – and every young man – in the world, we must challenge this. As well as giving women and girls equal access to education and health care, we must pay special attention to enforcing the protection our laws provide young women, within and outside marriage. We must not allow obstacles to stand in our way.

A comprehensive approach to HIV and AIDS calls for resources beyond national capacity. All countries are faced with difficult policy choices. Prioritising young people requires a generous response from more affluent countries. HIV and AIDS know no borders: we are all affected, and we must all respond.