Children and HIV and AIDS

Preventing Infection among Adolescents and Young People

© UNICEF/ HQ06-1500/Pirozzi

Youth leaders stand in a circle, holding hands, to symbolize the slogan ‘We can do it together’, at a child care centre that supports AIDS-affected children in Manila, Philippines.

The facts

In 2007, it was estimated that more than 5.4 million young people between ages 15 and 24 were infected with HIV. Prevalence rates are highest in sub-Saharan Africa and higher among young women than young men in the region. A high-level of HIV prevalence in a country suggests a greater probability that an individual will acquire HIV if he or she engages in risk behaviours than in a country with low prevalence. Regardless of how many people are living with HIV in a country, there are specific sub-populations, due to a number of factors, who will be ‘most-at-risk’ to HIV infection.  HIV prevention programmes, therefore, should focus on identifying these sub-populations, understanding the issues that make them ‘most-at-risk’ or ‘vulnerable’, and design interventions accordingly.

The probability that adolescents and young people will acquire HIV depends on many factors, including whether they engage in HIV risk behaviors such as unprotected sex with an infected partner or using non-sterile injecting equipment. Forced or violent sex without a condom also increases the probability of HIV transmission, as does the frequency of unprotected sex, the number of partners, especially concurrent partners, and any co-infection with a sexually transmitted infection. It is important not to confuse behavior with risk behavior. For example, adolescents, who inject drugs but do not use non-sterile injecting equipment, are not at risk of HIV infection through injecting. If, however, they share equipment it is this risk behavior that substantially increases their chances of acquiring HIV.

The issues

Many adolescents engage in multiple risk behaviors. Adolescents injecting drugs, for example, may sell or buy sex in exchange for drugs. This interplay between injecting drug use and unprotected sex, much of which is transactional, is at the centre of many HIV epidemics. Yet, prevention strategies often focus on just one risk group or behavior, and rarely address combinations of risk-taking.

Evidence shows that young people around the world are more likely to reduce risk behaviours when they are offered relevant information, skills, and services in an enabling and protective environment. Young people everywhere need life skills education that imparts accurate information about HIV transmission and promotes compassionate attitudes to those affected and at risk. 

Comprehensive programs are also required for adolescents involved in sex work, injecting drug use, and high risk sex between men. One study in Guatemala and El Salvador, for example, showed HIV infection rates among street-based female sex workers to be four times higher compared to female sex workers, in the same community, who were working out of fixed settings.

Prevention efforts need to understand the subtleties which create these variations, including the link between risk-taking behaviors and context, to ensure that the ‘most-at-risk’ adolescents are reached. Adolescents may be vulnerable to HIV infection, but not necessarily 'at-risk' of infection.

UNICEF’s role

UNICEF works with lead agencies United Nations Population Fund (UNFPA), United Nations Educational, Scientific and Cultural Organization (UNESCO) and United Nations Office on Drugs and Crime (UNODC) and theWorld Health Organization (WHO) for preventing HIV infection among adolescents and young people, focusing attention on adolescents up to age 18, especially most-at-risk adolescents. 

To ensure an effective primary prevention response UNICEF and UN partners support national school-and community-based life skills interventions, peer education, adolescent-friendly services, counselling and testing, and mass media and interpersonal communication interventions. Moreover, teaching adolescents and young people risk reduction skills – to make informed decisions, solve problems, think critically, cope with emotions and stress, and negotiate – can endow them with the ability to manage challenging situations, to adopt healthy behaviors, and the power to act on their own decisions. 

Such risk reduction skills programmes aim to promote: abstinence; faithfulness; partner reduction; consistent condom use; comprehensive and relevant information on sexuality, reproductive health, and substance use; the development of age-relevant skills to reduce risk and vulnerability to HIV infection; and links to youth-friendly health services through which they may seek advice and obtain treatment for sexually transmitted infections. For the most marginalized young people, such as those who inject drugs, specialized prevention services are also essential.

A combination of interventions is required to prevent HIV among adolescents and young people, including opportunities to build risk-reduction skills. Over 70 developing countries now mandate life skills-based education with an HIV component in national school curricula, of which 19 have been newly developed or revised since 2005. 

UNICEF and UNESCO are working with national governments to provide life-skills based education (LSBE), which includes HIV prevention, in the classroom. LSBE is an important approach to opening up discussions about sexuality, relationships and substance use. Almost all countries in West and Central Africa have some form of life skills-based education in the school curriculum, including HIV and gender equality components. Mandatory national provision through the formal curricula is reported in Cameroon, Central African Republic, Chad, Côte d’Ivoire, the Gambia, Ghana, Mauritania, Nigeria, Senegal, and Togo. Countries in this region have also adopted whole school approaches, such as in Nigeria through a National School Health Policy, and education sector plans for HIV and AIDS, such as in Benin, the Democratic Republic of the Congo, Gabon, Ghana, and Senegal. However, as this region has the lowest school participation rates at the primary level, and the lowest rates after Eastern and Southern Africa at the secondary level, it is clear that more is required to strengthen efforts to reach adolescents and young people who are not attending school.