HIV, teens and young adults

Teenagers and young adults are being especially hard hit by the HIV/Aids pandemic: more than half of people newly infected with HIV are between 15 and 24 years old. In Africa, not only is it striking young people and their friends, brothers and sisters, but also their parents, teachers and other adult role models.

Why are young people so vulnerable to HIV infection?

The following are some of the important factors that combine to put young people at risk for contracting HIV:

Sexual activity usually begins in adolescence. In many countries, unmarried girls and boys are sexually active before age15. (In South Africa, where average age for onset of sexual activity is 13 to15, girls as young as 13 are being diagnosed as HIV-positive.) Adolescence is a time characterised by experimentation and risk-taking, sexual and otherwise, and often a high turnover of sexual partners. This tendency is fuelled by a sense of “it can’t happen to me” as regards sexually transmitted infections (STIs).

The majority of young people lack knowledge about HIV/Aids and sexuality. Although most have heard of Aids, many do not know how HIV is transmitted or how to protect themselves from infection, and do not believe they are at risk. Despite the high infection rates in sub-Saharan Africa, studies show that HIV/Aids is not seen as a personal threat to many young people. Lack of discussion and guidance about sexuality in the home is common. Misinformation is often obtained from peers. Myths and misconceptions about HIV/Aids are also widespread among young people: both on how HIV is spread e.g. by witchcraft, and on how to avoid it e.g. by having sex with a virgin.

Those young people who do possess some knowledge about HIV often do not protect themselves because they lack the skills, support or incentives to adopt safe behaviours. High levels of awareness among youth have not led, in many cases, to significant behavioural change. They may lack the skills to negotiate abstinence or condom use, or be fearful or embarrassed to talk with their partner about sex.

Difficulties obtaining condoms, as well as negative attitudes towards them, are still widespread. For many South African young people, condoms have strong associations of lack of trust and love, disease and “unmanliness”.

Adolescent girls are at very high risk of infection. In sub-Saharan Africa, more than two thirds of newly infected 15- to 19-year-olds are female. The reasons for this include the following:

• Risk of infection during unprotected vaginal intercourse is greater for women than men. The risk is even greater for girls because their vaginal tissues are immature and tear easily.
• Sexuality is seen as a resource that can be used to gain economic benefits. Young girls are often persuaded to have sex with a “sugar daddy”, an older, wealthier man, such as an employer or teacher, in exchange for money or gifts. Some girls enter sex work for similar reasons. Such “age-mixing” may be encouraged by the myth in some places that sex with a virgin can “cure” HIV. Many men also assume that younger girls are not yet infected.
• Cultural norms related to sexuality may contribute to risk. In cultures where virginity is a condition for marriage, some girls protect their virginity by engaging in unprotected anal intercourse. In some cultures, young women are under pressure to prove their fertility by falling pregnant prior to marriage.
• Girls are subject to the unequal power relations between men and women that characterise male-dominated cultures, and which increase their vulnerability to unsafe sex. (See: Women’s vulnerability to HIV infection)

Other STIs increase the risk of HIV/Aids. Over 100 million new STIs, excluding HIV, occur each year in the under-25 age group. STIs that cause genital ulcers increase the risk of HIV infection the most. Adolescents often do not know the difference between normal and abnormal conditions, especially as many STIs have mild symptoms, and do not know when to seek medical care. Even when they suspect they have an infection, many young people do not seek medical care because of embarrassment or fear their privacy will not be respected, or because services are inaccessible.

Both boys and girls are vulnerable to sexual violence, abuse and exploitation, but greater numbers of girls are victimised. Abusers are unlikely to use condoms, and the injuries that result from forced sex increase the likelihood of HIV infection.

Many adolescents experiment with drugs and alcohol, and are more likely to practise unsafe sex while under their influence. Young people who use drugs and alcohol regularly are more likely to have multiple sex partners. Drug dependency may cause young people to turn to crime or prostitution to support their habit. Young people who use injected drugs are at particularly high risk of infection.

Many young people fall into high-risk groups for HIV infection.

• Homeless youths are living on the streets as a result of abuse in the home, poverty or being orphaned – often by Aids. Their daily struggle for survival overrides any concern they might have about contracting HIV. Many resort to highly risky “survival sex”, which involves exchanging sex for money, food or protection. Homeless youths are also very vulnerable to sexual violence.
• Young males who have sex with males. The risk of contracting HIV from unprotected anal sex is especially high. The social stigma and violence often suffered by young homosexuals may cause them to hide their sexuality and not to access information that could help them protect themselves from HIV infection.
• Young people in the sex industry. Clients often favour younger adolescents, believing that they are uninfected. Adolescents also have little or no power to demand safe sex from clients.
• Young people who inject drugs. Intravenous (injected) drug use (IDU) has increased in recent years among young people, especially males. There are rising numbers of “occasional” injectors, young people who experiment with IDU and generally do not consider themselves to be regular users. Sharing needles and syringes carries a very high risk of HIV infection.

The youth: central in the fight against HIV/Aids
Despite young people’s vulnerability to HIV infection, as a group they represent great hope in the fight against Aids. In areas where the pandemic is starting to come under control, it is mainly because continuous efforts are being made to provide young people with the necessary knowledge, skills and incentives to protect themselves against infection.

Young people are often more open to new ways of thinking about sexuality than are adults, and have shown that, with appropriate support, they can make responsible choices. They are also invaluable in educating and motivating their peers to do likewise.