Young people, sexual and reproductive health and HIV

One quarter of the world's population is made up of 1.7 billion young people aged 10-24, 1.5 billion of whom live in developing countries where HIV/AIDS has reduced their chances of living to the age of 60 by 20%. (1) Despite their vulnerability to HIV infection, young people's needs are often overlooked when national AIDS strategies are designed and implemented. (1) Half of all new HIV infections occur among young people, aged 15-24. (2) In 2007, an estimated 33.2 million people were living with HIV, 5.4 million of whom were aged 15-24 years. In sub-Saharan Africa, there are 3.2 million young people living with HIV, with a ratio of three young women infected for every young man. (3) In 2001, governments committed that 90% of young people would be able to correctly identify modes of HIV transmission and prevention by 2005. (4) Yet, by 2007 only 40% of young males and 36% of young females had accurate HIV knowledge. (4) Until recently, these statistics were only used to address youth as a target group for prevention messages, rather than allowing each new generation to work through the issues themselves. We are slowly recognizing youth as a resource and actively involving them in finding solutions. Is it too little, too late? One of the great challenges in HIV prevention is that today's young people have never known a world without AIDS; they did not experience the shocking early days of the "new disease". Improved (access to) treatment has changed HIV and the image of AIDS from a fatal disease to "just a sexually transmitted infection". Many young people are fatigued by prevention campaigns that are out-dated or unrealistic. Not all youth experience the same HIV vulnerabilities. An impoverished young girl in a rural village in Malawi has different needs in terms of effective HIV prevention than emerging gay youth in the favelas of Rio. The key lies in providing young people with the information and tools they need to make safe and healthy choices. But they must be true choices, not based on other people's ideologies. Girls and boys Young women and girls are disproportionately vulnerable to contracting HIV/AIDS due to biological factors and structural elements of culture, economic and social inequalities. Marriage and long-term relationships do not protect them from contracting HIV and insisting on abstinence is simply not realistic. To address the global feminization of the epidemic, policies, programmes, legislative frameworks and social norms must guarantee women's rights, ensure protection from gender-based violence and discrimination. Despite the numerous references in national and international documents to the rights of women and girls, few countries have actually implemented and enforced policies and laws that protect such rights. While the focus on young women and girls remains necessary, particularly in areas such as sub-Saharan Africa where more than 75% of those living with HIV are female, it risks excluding the very group whose involvement is essential if we are to successfully turn the tide on HIV; namely, young men, particularly those living with HIV. (5) The engagement of young men is also essential to improve their own health outcomes. The importance of directly engaging young men and boys in shaping the response to HIV and AIDS is clearly reflected within the 1994 International Conference on Population and Development Programme of Action. Commitments to ensure special efforts around this have been reiterated in several key international declarations since then. (6) Traditional sex education and HIV prevention often focus (intentionally or otherwise) on young women and do not adequately address the needs of young men. (7) Sexual and reproductive health clinics are often perceived, and indeed sometimes promote themselves, as "feminine spaces". Young men often feel uncomfortable visiting these clinics, which frequently lack services catering for their specific needs. …