New strategies needed for HIV prevention in youth

Prevention of HIV infection that targets the youth is seen as key to the fight against AIDS. But, analysts say, there is no clear consensus on the content of the message, how it should be transmitted, and the profile of the audience it intends to reach. "Strategies that are developed to address youth as a homogeneous group are inefficient. They do not take into account differences in gender, culture, norms, values and sexuality," youth leader Raoul Fransen said at the International AIDS Conference in Thailand this week. "The AIDS vulnerability of an impoverished young woman living in a rural village in Africa is different to the AIDS vulnerability of an emerging gay youth in the favelas of Rio." Sophie Dilmitis of Zimbabwe's Choose Life Trust said orthodox AIDS messages portrayed HIV as a consequence of promiscuity. But she didn't feel she was "sleeping around", and therefore not at risk when she contracted HIV. "Sex education is currently not youth-friendly, or realistic, or addressing our needs," she told the conference. The "fear of promiscuity" meant that some schools prevented her AIDS education NGO - which involves youths talking to their peers - from showing condoms or demonstrating their use. "I'm not against abstinence, but strongly believe in giving youth all the facts to take responsibility for their lives," said Dilmitis. "The problem with the ABC campaign [Abstinence, Be faithful, Condomise] is that it is relentlessly boring," said Mary Crewe of the Centre for the Study of AIDS at the University of Pretoria, South Africa. AIDS education risked being taken over by "dogmas" and "nostalgia", which do not acknowledge that "if you educate about desire, to really understand desire and sexuality, it can have an enormous impact". Poverty helps drive the epidemic, requiring policies that "recognise vulnerability to HIV goes far beyond individual choices and behaviours", said Dennis Altman, president of the AIDS Society for Asia and the Pacific. "There is a double vulnerability involved in HIV: both economic and social factors are crucial. Someone who sells their body to survive is likely to be more vulnerable to HIV, and this is a result both of the specific behaviour, and the poverty and despair that underlies that behaviour." Poverty and disempowerment allowed transactional sex to flourish, typically the phenomenon of "sugar daddies". "What kind of community is it that sits back and watches the sugar daddy phenomenon? Why is it left to young girls [to shoulder the burden]?" asked Crewe. AIDS education can provide an opportunity for education that is transformative; that addresses issues about gender, power and accountability. What was needed was to give children a vision of a world "that was worth not being infected to live in", said Crewe. "We have to give them a vision that they are valuable, rather than vulnerable." More than a third of all people living globally with HIV/AIDS are young people between the ages of 15 and 24, and almost two-thirds of them are girls.