Saturday December 1 2012

Let us focus on strategies for young people to reverse the HIV epidemic

By Susan B Kayongo

Today, Uganda joins the rest of the world to mark World Aids Day. This year’s World Aids Day comes at a time when Uganda is grappling with the increasing HIV prevalence despite the earlier registered gains in the HIV battle.

The 2011 Uganda Aids indicator Survey showed an increase in the HIV/AIDS prevalence from 6.4 per cent in 2005 to 7.3 per cent in 2011, which is an indicator that HIV/AIDS is still a major challenge to the country. This upwards trend in HIV prevalence, however, affords the country an opportunity to rethink the current strategies aimed at taming the epidemic. As we celebrate World Aids Day, I would like to call more attention to young people aged 15 to 24 years and the need for more specialised interventions for this age group.

Research shows that young people constitute a significant proportion of the most at risk populations like men who have sex with men, drug abusers, sex workers, fishermen, uniformed men, Boda boda cyclists and truck drivers.
Studies have also shown that worldwide, half of HIV transmission takes place among the 15 to 24 year olds, and every day, about 6,000 young people become infected with HIV.

In Uganda, young people constitute the biggest proportion (56 percent) of the population and according to the 2011 Uganda Aids indicator survey, 3.7 per cent of young people aged 15 to 24 are HIV positive. Girls are particularly at a greater risk of acquiring HIV due to a number of factors including multiple concurrent partnerships, intergenerational sex, transactional sex and gender-based violence. Lack of knowledge about HIV/AIDS and life skills, poor access to health services and commodities, early sexual debut, early marriage, sexual coercion and violence, and growing up without protection from sexual exploitation and abuse continue to expose young people to HIV/AIDS.

In addition, thousands of babies who contracted the virus at birth are now young people and they are exercising their right to sexual relationships, which among other things includes the sexual adventurism and exploration typical of youths.

Those facts demonstrate a big problem and explain why young people remain at the center of the HIV epidemic. Despite the growing attention that has been given to HIV programming for young people, little explicit focus has been given to the needs of the different sub groups of young people especially those within the most-at-risk populations.

Efforts to prevent HIV among young people have mainly focused on the general population of young people or the general population of most-at-risk populations, instead of focusing on specific groups of young people.
Different groups of young people have individual uniqueness and different exposure factors. Therefore for HIV prevention approaches to be effective, they have to adapt to the realities of young people’s lives by recognising the needs of the different subgroups and the factors that increase their vulnerability to HIV.

From the foregoing, it is clear that one of the areas that need to be revisited is the structuring of interventions meant for young people. All interventions; whether behavioral, biomedical or structural, must be designed with particular youth target audiences (subgroup) in mind. Unless we take urgent steps to intensify and structure HIV prevention interventions for young people, reversing the epidemic may be a mystery.

Beating the HIV epidemic will largely depend on how well we protect young people from HIV/AIDS and the effectiveness of the HIV prevention interventions for young people will determine the course of the epidemic and the fate of our nation.

The writer is a MakSPH-CDC fellow at FHI 360