As Covid-19 has dug its paws deep into our lives, disrupting the plans and ambitions of many young individuals; another epidemic lurks in the shadows too, HIV. Often missing from the conversation is the role and impact of HIV on young lives. Lack of agency has relegated the young to a passive receiver status.
The youth is constituting an increasing share of people living with HIV worldwide. According to UNAIDS, in 2019 alone, 460,000 individuals between the ages of 10 to 24 were newly infected with HIV, of whom 170,000 were adolescents between the ages of 10 and 19. Countries like India and continents like Africa are heavily relying on a favourable demographic dividend window which can bolster the economy.
India’s median age is at 27 presently, and nearly two-thirds of Africa’s population is under 25 years. This mandates that the future of global HIV response be very different from today’s efforts. It must be youth-focused and youth-led. In the absence of this, the successes achieved might be reversed by the rapid growth of vulnerable youth populations in the highest-burden countries.
The testing rates in West and Central Africa and South Asia, when compared to the global average, reflect poorly. A significant population of HIV-positive children over the last decade are transitioning into adolescence. Meanwhile, the HIV epidemic is propelled by a lack of honest conversations, access to resources and services, particularly around sex, sexuality, and the needs of the people most heavily impacted.
Denial, stigma, taboo and a lack of empowerment are some of the key factors that continue to fuel this epidemic, especially among the youth. Reproductive health services are seldom customized towards the needs of young people, who therefore tend to avoid them—putting themselves and their sexual partners at risk of HIV infection.
The primary risk of contraction of HIV for the young comes from high-risk sexual behavior and drug use. Typical behaviors such as sexual and drug experimentation initiated during adolescence increase risk, but more research and insights are required about the causal mechanisms associated with these behaviors among young people. Youth with mental health problems are at even greater risk of exposure because they engage in the same behaviors as their peers but at higher rates.
A social-personal framework of HIV risk behavior among youth includes maturational constructs implicated in adolescent risk-taking (e.g., pubertal development, perceptions of immortality, identity exploration, limitations in abstract thinking) and key psychosocial and contextual risk factors. The framework underscores the interplay of four factors described below: personal attributes, family context, peer and partner relationships, and environmental circumstances.
An open inter-generational dialogue about the social, political and structural realities facing a diverse range of young people must be amplified. Taking cognizance of this, in 2015, UNICEF and UNAIDS, in partnership with other international health and development partners, launched ALL IN! to End Adolescent AIDS. This global initiative established 2020 as a target towards ending the AIDS epidemic among adolescents by 2030. We will be on track only if the young join the fight.
Another one of the spearheading initiatives in this direction is the National Youth HIV & AIDS Awareness Day (NYHAAD), which is observed every year on April 10th. The 2020 theme announced by Advocates for Youth is “Young People to the Front: Ending the HIV Epidemic in America”. NYHAAD serves as a day to educate the public about the impact of HIV-AIDS on young people, slash the stigma around HIV and AIDS, and to lend support to young people who are living with HIV.
Most healthy young people don’t think of HIV as a significant risk. As a result, they skip on regular medical care. Innovative new approaches like after-school HIV prevention interventions, widespread peer-to-peer support networks and sustainable support for youth-led community-based organizations are needed.
There is a need to engage in transformative, multi-sectoral change that takes HIV prevention out of isolation and incorporates youth into every layer of global and domestic decision-making. Training and hiring a generation of young adults to support the health and well-being of their communities is essential. This solves two problems.
First, the challenge of effectively reaching youth with crucial HIV prevention and safe-sex promotion messages. For example, usage of PrEP (Pre-Exposure Prophylaxis) as an HIV prevention medication can be propagated via youth warriors. This might lend relative ease of acceptability towards PrEP, at least among other young people who have HIV. And, second, the unemployment crisis that threatens not just health outcomes, but holistic development and potentially life-security.
Most global studies and interactions have shown that the immediate concerns of the young often do not relate directly to HIV. They are often most concerned about being able to stay in school, preventing unwanted early pregnancies, finding a job, and creating a future for themselves. The need for well-coordinated community health worker programs is one of the most important areas that have gathered consensus in public health. Yet, few countries have achieved this, and including youth to the scheme of things can multiply benefits.
Young people should not just be passive recipients of HIV services; they should be in the driver’s seat, helping to design and implement HIV prevention, care and treatment programmes that respond to the lived realities of their lives. This will help cement a safe space and access to information and resources for the next generation of young leaders openly living with HIV.
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