HIV/AIDS and Young People

Increasingly, youth in the Asia-Pacific region are at high risk of contracting HIV/AIDS. We spoke with Dr. Wiwat Rojanapithayakorn, Team Leader, Asia-Pacific Intercountry Team, UNAIDS, about youth and HIV/AIDS in the region.

What is the situation of youth and HIV/AIDS in the Asia-Pacific region?

The situation here in the Asia-Pacific region is similar to other regions in that we have a high proportion of youth infected with HIV/AIDS. It is of course difficult to get exact figures, but we can take Thailand as a good example since there is a high number of AIDS cases. At the end of June 1999 this year, there were an accumulated 117,108 AIDS cases in Thailand, with 18 percent of them in people under 24 years. If we look at women directly, then we can see that one-third of all female cases are youth under 24 years. Or, if we specify youth from 15 to 24 years, then 23 percent of female cases fall into this category. This may not seem high when compared to the overall age group, but it you look at the peak of HIV/AIDS cases in Thailand, it is at 24-29 years. This mean that they have contracted the disease around six to seven years earlier, as youth. This indicates the high risk of HIV/AIDS infection among young people. It is not different from other regions, as the modes of transmission that place youth at-risk are very similar.

What changes have you seen in the past ten years with regards to HIV/AIDS vulnerability and youth? How is this effecting HIV/AIDS prevention programmes?

The changes have not been very abrupt, but have rather been a gradual evolution. The biggest change in the Asia-Pacific region is that we now have a higher proportion of women infected with HIV/AIDS when compared to ten years ago. Formally, for Thailand, the proportion of male to female with HIV/AIDS was approximately seven or eight to one; it is now four to one. This is the big change. In addition, the disease has spread more among the younger population, especially those having unsafe sex and using drugs -- these youth are at very high risk. With the changes in society, and the information technology era, a lot of information is being spread which advertise the sex industry or promote drug use. This is definitely increasing the risk of the younger generation when compared to ten years ago.

We have thus changed our responses, and are now implementing more programmes aimed at the younger generation. In the past, we aimed only at the high-risk groups which were different ten years ago, as they were sex workers or drug users. Now most countries try to aim their programmes at the younger generation, in both schools and the workplace.

What programmes are needed to assist youth living with HIV/AIDS? What challenges do these programmes face?

Most importantly, young people need support and care. There are two groups of children/youth who need this care. First, those infected with HIV/AIDS. Secondly, there are many orphaned children whose parents have died due to HIV/AIDS that need support. The services for these groups must be child/youth-friendly, so that they can receive services easily as well as voluntarily. In addition, programmes are needed to reduce the stigma and discrimination against people living with HIV/AIDS, so that they can receive the same care as the general population.

A big challenge facing programmes is the lack of understanding of the service providers. It is very difficult to get service providers to change their attitudes toward young people living with HIV/AIDS. There are many instances of bad practices by service providers, such as using results of HIV/AIDS tests as a criteria to select students to enroll in a programme. Service providers must change their attitudes and stop discriminatory practices.

What are the biggest challenges facing UNAIDS' work in the area of youth and HIV/AIDS in the Asia-Pacific region?

One of the biggest challenges HIV/AIDS prevention faces is the lack of access by young people to education and information. Young people must be provided with information about HIV/AIDS in order for prevention to work. In addition, a very big challenge is the lack of effective interventions in preventing HIV/AIDS among young people. Related to this is a lack of resources in the region (both human as well as financial). UNAIDS is thus promoting three types of interventions to prevent HIV/AIDS among youth. First, life skills education and information. This is necessary to increase awareness among young people about HIV/AIDS as well as to change their behavior into what we call "healthy behavior". Secondly, promotion of condom use. This can be a very effective way of preventing HIV/AIDS transmission. The third type of intervention is the provision of medical services to prevent sexually transmitted diseases (STDs). Young people must be provided with these types of services, as having an STD increases the risk of contracting or transmitting HIV/AIDS.

Some countries, such as Thailand, have reduced their rate of HIV/AIDS infection. What were the key factors to their success?

There are many factors leading to the success of HIV/AIDS programmes in Thailand. The most important one is the political commitment. Thailand is the only country in the region where the highest political person (the Prime Minister) is the chairman of the National AIDS Committee. This national committee is comprised of the heads of all concerned sectors in the government, the private sector, NGOs as well as people living with HIV/AIDS. This multisectoral mechanism helps ensure that there is an appropriate budget accorded to implement prevention and care programmes and that there is involvement from all sectors of society. Secondly, the Sentinel Surveillance programme has been very successful in tracking the epidemic in Thailand. There is a well-established reporting system so we know where the problem is and to what extent. This system has been working very effectively in the last ten years.

The third key factor is the implementation of effective intervention programmes. There have been very good programmes in Thailand, especially the integration of HIV/AIDS programmes into the education system. There is a lot of peer education, HIV/AIDS information has been written into the school curriculum, and there is a high coverage of HIV/AIDS issues in both the formal and non-formal education systems. In addition, there are many NGO programmes working with young people in the workplace. One key programme has been condom promotion. The percentage of condom use among sexual high-risk groups is now very high, at over 90 percent. Condom promotion has thus been a very effective intervention to prevent this main transmission mode. Indeed, one study in 1996 noted that the Government of Thailand's programmes had already prevented 2 million HIV infections through sexual transmission. In other countries, condom promotion programmes are still unsuccessful. This can help explain the difference with Thailand.

This year's theme is "Listen, Learn, Live: World AIDS Campaign with Children and Young People". What sort of activities is UNAIDS undertaking to promote this theme?

Since 1988, December 1 has been noted as World AIDS Day. Every year, a theme is selected. The theme "Listen, Learn, Live: World AIDS Campaign with Children and Young People" was selected this year to make people aware that HIV/AIDS is still a very important problem for young people. In most countries new infection can be found mainly in young people. Why is this? It is because young people are more vulnerable to infection: they have limited access to information, and social norms place young people at a higher risk as they are more likely to change sexual partners often and engage in unsafe sex.

Young women are especially vulnerable to HIV/AIDS, as there is also the biological vulnerability (the nature of the sex organ). This increases young women's risk compared to young men. In addition, the phenomenon of the sex industry and the use of young girls as sex workers places them at an even higher risk. So UNAIDS is trying to advocate the importance of programmes for youth to help prevent HIV/AIDS. An important way we are doing this is through the facilitation of programme to strengthen national capacity to prevent HIV/AIDS among young people, especially through the implementation and monitoring of programmes. In addition, we are identifying best practices which demonstrate policies, strategies and actions that are working effectively. Furthermore, we are continuing to track the epidemics, evolutions and responses. We have gathered a lot of information on the risks for young people and are providing information about these risks to the general public, as well as policy makers and those most directly in touch with young people. Finally, UNAIDS will continue to support and help strengthen the work of the United Nations system agencies and organizations within their own areas of responsibility and expertise in the field of HIV prevention and care.

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