In East Asia and the Pacific, more than half of all HIV infections in the region have been among young people – adolescents and adults under 25. Young people are a global priority for UNICEF HIV/AIDS programming, both because of their special vulnerability and because they are tomorrow's - and even today's - parents. In East Asia and the Pacific, UNICEF supports a range of HIV/AIDS prevention and care activities aimed specifically at this crucial population group.

Why are Young People So Vulnerable?

In the last decade or so, substance abuse, including alcohol, and pre-marital sexual activity have spiralled among adolescents and young people in East Asia and the Pacific. New social trends like population mobility, postponement of marriage and high availability of illicit substances and commercial sex are radically altering young people's outlook and behaviour, while increasing their vulnerability to HIV/AIDS.

Young people in Nyauk U, Myanmar

The main routes of HIV transmission in the region continue to be needle-sharing among injecting drug users (IDUs) and unprotected sex. Sexual transmission puts girls and young women at greater risk, both biologically and socially. Girls and young women often have little control over the timing of sex or the use of condoms. They also have fewer opportunities to learn about reproductive health. The vast majority of sex workers and victims of sexual violence are young women.

Another significant factor in the spread of HIV/AIDS among young people is population mobility. Across the region, growing numbers of young people are leaving home to earn money in factories, on construction sites, in mines, in the fishing industry, and in sex work - often in distant cities or neighbouring countries. Newfound freedom from family controls, and the distance from family and community support, are leaving them vulnerable to exploitation, to temptation and to peer pressure.

Factory jobs are luring thousands of rural youth to a new life in the city

Young people need guidance tempered with understanding and with respect for their evolving capacities and independence. Responses at national, local and family level have often failed to deliver this and have even exacerbated problems, by resisting open discussion of sex, sexuality and substance abuse and so leaving adolescents and young people themselves without the knowledge or means to protect themselves.

Promoting Healthy Living

With the right guidance, young people have proven capable of mature decision-making and attitudes regarding HIV and AIDS, and are even willing participants in HIV/AIDS/STI prevention and care.

Under the Mekong HIV/AIDS/STI Project (1996-2000), UNICEF supported national assessments of HIV/AIDS/STI prevention education in all of the countries of the Mekong subregion: Cambodia, China, Lao PDR, Myanmar, Thailand and Viet Nam. UNICEF has subsequently supported development of new Lifeskills-based HIV/AIDS/STI prevention and healthy living education programs in primary and lower secondary schools in each of the countries, and gives ongoing technical assistance in teacher training, curriculum development and implementation.

This comic strip drawn by a Lao youth peer educator shows how well young people understand the complexities of relationships

However, many of the most vulnerable young people are not in school. Starting Lifeskills education in primary school means some benefits reach the great number of children who drop out before secondary school. Meanwhile, UNICEF supports Lifeskills-based prevention activities outside the school setting, through outreach teams, national youth unions and community volunteers. Some activities specially target highly vulnerable groups like sex workers, seafarers, street children, factory workers and children affected by HIV/AIDS.

Peer to Peer

Young people tend to look to their peers for information and opinion – especially when they live away from the family. To maximize the impact of its HIV/AIDS communication and education activities, UNICEF supports a range of peer education programs on HIV/AIDS across the region, among a variety of target groups: young people in schools, young women, street children, young people with HIV/AIDS, young drug/substance users, young factory workers and others.

More information on these programs can be found under Promoting Healthy Lifestyles and in the individual country pages.

Youth-friendly Services

Access to reproductive health and services is more important than ever for young people, yet these services continue to cater mainly to older adults in established heterosexual relationships. UNICEF is involved in advocacy and action on developing youth-friendly services across the region. It is also involved in building prevention of parent-to-child transmission services in Cambodia, Myanmar and Papua New Guinea.

Accompanying behaviour change campaigns encourage young people to use the services and try to resistance to women's access.

Substance Abuse

Cross-infection between injecting drug users through needle sharing still dominates the HIV/AIDS epidemics in China and Viet Nam. Significant numbers of IDUs also have HIV/AIDS in Myanmar, Thailand and Malaysia.

Prevention materials, like this image from Myanmar's SHAPE curriculum, are more effective when they confront the real impacts of substance abuse, rather than simply condemning it

Use of alcohol and other substances is also rising. Methamphetamine use as a work or study aid and for recreation has reached alarming levels in Thailand, and is spreading in other countries. While most of these substances are not usually injected, they can reduce users' perception of risk. UNICEF is one of the UN agencies working to more closely link HIV and substance abuse prevention efforts.

Young People Who Are Especially Vulnerable

Sex workers: Inexperienced in negotiating for safe sex with clients, young sex workers tend to become infected more often than their older colleagues. Successful campaigns for 100% condom use in commercial sex establishments in Thailand and Cambodia have contributed to the remarkable slowdowns in new HIV infections, including among young sex workers. Lifeskills-based prevention education can help younger sex workers develop skills to protect themselves.

Children affected by HIV/AIDS: Children of parents with HIV/AIDS are easily caught in a vicious cycle of HIV/AIDS vulnerability. Without adequate support from the family and community, they suffer social stigmatization, poverty and missed educational opportunities, at a time of great emotional distress. They may end up living on the street, engaging in substance abuse, or in the most hazardous, exploitative work.

Living on the street, children grow up fast and take risks

Seafarers: Recent studies have found up to 22% HIV prevalence among young men in seafaring industries. UNICEF has been a lead player in a joint initiative that directly addresses this mobile population in the Mekong subregion.

Street children: Street children are often pressured by their circumstances to engage in substance abuse, criminal activity and commercial sex. Many factors, such as lack of access to quality education and vocational training, discrimination against populations and national groups, HIV/AIDS epidemics, rising incidence of child abuse and growing economic disparities in many countries, are swelling the ranks of disadvantaged young people who spend much of their time living on the streets. Beyond the reach of traditional education and social services, street children can be particularly difficult to reach with effective prevention and care activities.

Men who have sex with men: Studies have shown that sexual experimentation between young men is common in East Asia and the Pacific. However, very little information or education on HIV risks in the context of homosexual sex is available to these young men, and sexual health services rarely cater to men who have sex with men. Regionally, UNICEF advocates for research and appropriate programming and services for men having sex with men.

UNICEF coordinates the UN Regional Taskforce on Youth and HIV/AIDS Vulnerability, with participation from a range of UN, government and non-governmental bodies in South and Southeast Asia.

For more information on country-level activities, see the individual country reports.