YOUNG PEOPLE: WHO CAN CHANGE THE COURSE OF AIDS EPIDEMIC?
Dr. Subhasish Bhattacharyya (Asst. Prof. ) *, Dr. Kaberi Basu (Assoc. Prof.) **, Dr. D. P. Banerjee (Prof.) ***
Department of Pediatric, Medical College Kolkata *, Department of Pediatric, Medical College Kolkata **, Department of Pediatric, Medical College Kolkata ***
Introduction
According to UNFPA 2003, today's youth generation is the largest in history. Nearly half of the global population is less than 25 yrs old (UNFPA 2003).(1) Young people between the ages of 15-24 are both the most threatened - globally accounting for half of all new cases of HIV (Fig. 1). Young people in India today number more than 280 million and from more than quarter of our entire population. More than 35% of all reported AIDS cases in India occur among young people in the age group of 15 to 24 yrs, which indicates that young people are at a risk of contracting HIV infection.(2)

High Vulnerability: Young people are exposed to HIV in different ways. The majority is infected through unprotected sex. Mobile, unemployed, underemployed migrant youth and street children are also particularly vulnerable to HIV as they are also likely to have information about HIV or access to prevention services. They may be exposed to repeated risk of HIV infection through unprotected sexual exposure due to coercion or while selling sex in order to survive.

A variety of factors place young people at the center of HIV vulnerability. These are lack of HIV information, education and experimentation, curiosity regarding sex. Most young people become sexually active in their teenage years along with increasing urbanization, poverty and limited ability to exercise control over their sexual lives poses high risk of getting infected with HIV virus.

Early Sexual debut
Most adolescent become sexually active in their early teenage and may before 15th birthday.(1)

Factor responsible are:
  1. Increasing urbanization. Conflicting ideas regarding sexual behavior and values. External influence which encourages premarital sexual activity and promiscuity. Multi-partner Sex. Lack of knowledge regarding HIV, STI (Sexually Transmitted Infections) and Condom.
  2. Violent or forced sex in this group can increase the risk of transmitting HIV because forced vaginal penetration associated with abrasions and cuts.

Injecting drug use and young people:
In Central Asia and Eastern Europe, there is evidence that the age of initiation of injecting drug use is decreasing.(3) Due to wide spread political turmoil, sharp declines in living standards and widespread availability of drug due to international smuggling chain, overall drug use is increasing. All this things are associated with rapid spread of HIV/AIDS and hepatitis-B in North Eastern India, especially in Manipur, Nagaland & Mizoram. Young injecting drug users are particularly at risk, since they may not have the knowledge to protect themselves from infection via contaminated syringes.

Creating supportive environments:
Many adults including political leaders, still find it difficult to acknowledge the sexuality of young people and they fear that sexual education will lead to promiscuity. But different studies all over the world found very little evidence that sex education among adolescent encourages sexual promiscuity (4), young people are especially vulnerable to HIV, but they are also our greatest hope for change in the course of the AIDS epidemic.

School AIDS Education Program:
This program is conducted by the State AIDS Control Societies either through NGOs, the Department of Education or a combination of the two, which focuses on:
  1. Raising awareness levels about HIV/AIDS. Helping young people resist peer pressure to participate in risky behavior. Helping develop a safe and responsible lifestyles like abstinence.
  2. Life skill approach towards prevention of HIV/AIDS infection.

Teachers and peer educators are trained to conduct the program among the students. A training tool in the form of a special module "Learning for Life" has been developed by NACO and distributed to all the states for utilization in the program.(2)

Almost 42-100 million young people (10-25 yrs) are out of school in India. They represent the most vulnerable population to HIV infection. They are heterogeneous group in relation to age, marital states and social background NACO is attempting new approaches which are both effective and can be replicated across the states with the help of education, rural and Heal Department along with NGOs & CBOs.(2)

Mass media, HIV prevention and young people:
Several studies have shown that mass media campaigns along educational effect regarding HIV/AIDS are most effective. One such effort, a mass media campaign in Jamaica uses a targeted, age-based approach to encourage young people. For 10-12 yrs old, abstinence messages are the focus. Children between 13 and 15 yrs of age are targeted with self-awareness and abstinence messages; older youth are targeted with information on protection from pregnancy, HIV & STIs.(1)

Agenda for Action:
AIDS agenda for young people needs to translate the 2001 UN Declaration of commitment on HIV/AIDS into concrete action.(1) These includes:
  1. Creating a supportive environment. Reaching those who influence young people. Placing young people at the center of the response. Mobilizing the educational system. Mainstreaming HIV prevention and AIDS care for young people into other sectors. Addressing gender inequalities.
  2. Opening dialogue on sensitive issues.
Conclusion
NACO realizes the need of young people for accurate education on sexual health and HIV/AIDS and access to youth friendly health services such as counseling and prompt treatment of STIs. The time has come for much more openness, transparency and clarity in messages about safer sex, sexuality and dissemination of prevention information at schools, colleges and at homes. Elders in the family need to be educated that they need to equip the younger generation with adequate skills to combat HIV/AIDS.

Fig. 1 Young people (15-24 yrs old living with HIV, by region), end 2003

1 = 6% Eastern Europe & Central Asia
2 = 1% North Africa & Middle East
3 = 2% High income countries
4 = 7% Latin American & Caribbean
5 = 22% Asia
6 = 62% Sub-Saharan Africa
(Source: UNAIDS / UNICEF / WHO, 2004)
References :
  1. Woods S. 2004 Report on Global AIDS epidemic, 4th Global Report, UNAIDS, Geneva pp 93-98, 2004. National AIDS control organization report 2004, www.naco.nic.in Rhodes T. Behavioural risk factors in HIV transmission in Eastern Europe and Central Asia. Geneva, UNAIDS, 2002.
  2. Cowan F. Adolescent Reproductive Health Interventions, Sexually Transmitted Infections, 78:315-318:2002.
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