Danny Glover

At the margins of society
Targeting HIV prevalence among urban children

Positive behaviour change works: Global collaboration has proved fruitful in slowing down the rate of infection with the human immunodeficiency virus (HIV), reducing the number of people dying from AIDS-related causes and making it possible virtually to eliminate mother-to-child transmission by 2015. Yet, in 2010, about 1,000 babies were infected every day, as were nearly 2,600 young people aged 15–24. Studies in numerous countries show that HIV prevalence is higher in urban areas than in rural settings.

What’s behind these disturbing numbers? Major factors include stigma and discrimination, poverty, lack of access to appropriate services and the absence of effective legal protection for children most at risk.

My visit to Tanzania in July 2009 was a real wake-up call. Commercial sexual exploitation of children in the country’s urban areas had been on the rise for a decade or so, mostly due to poverty, tourism and the growing number of children living on the street. Cultural taboos, among other walls surrounding the situation, made it hard to stop the trafficking of children into cities like Dar es Salaam for sexual exploitation. I saw first-hand the need to reduce stigma, expand testing and invest in youth-friendly support clinics. Stigma is a particularly damaging factor, because it prevents many from getting the information they need to prevent infection and the treatment they need if they become infected – and because it further prevents them from taking part in efforts to design programmes that could better meet the needs of at-risk and infected people.

Shame and fear are at the heart of the problem, and result in deadly ignorance. By some estimates, around 5 million young people worldwide are HIV-positive, and many of them don’t even know it. In particular, children living in slums, poor households or on the street are unlikely to get tested or seek services.

Children living in urban slums find that their economic disadvantage makes them the object of societal prejudice, leaving them more susceptible to exploitation and drug use. Economic disadvantage also hardens hearts. Many see children who live in the street not as vulnerable or endangered, but as outcasts or problems that need to be ‘cleaned up’. The stigma, judgment and social exclusion these exposed children face are compounded if they are identified as being HIV positive. On top of this prejudice, the law fails them, too: Once entangled in drug use and sexual exploitation, they become targets for law enforcement to round up.

What can we do to confront this escalating problem? We need to recognize that the needs of teenagers, particularly those living with HIV, differ from the needs of adults and young children. We must train care providers to address stigma and discrimination and offer youth-friendly services. In order to break social barriers, encourage treatment and overcome the fear of disclosure, we must assure adolescents that health services will respect their confidentiality and will not discriminate against them. We must also assure them that the community will not judge them. This will require greater efforts to debunk harmful stereotypes and raise social awareness of the obstacles young people face.

Beyond access to free, age-appropriate services, we need creative approaches that will attract adolescents, build their trust and keep their interest. In Ukraine, for example, one non-governmental programme uses mobile phones to remind adolescents about appointments with health and social workers, facilitate emergency calls and provide phone-based counseling.

In order to achieve urban health equity, we must turn our attention to those places where HIV has continued to spread underground, affecting the most at-risk and least visible members of society. Especially in a world shaken by economic volatility and natural disasters, we have to prioritize marginalized children, who often bear the brunt of these tough times, and not let them fall to the bottom of our agenda or end up in the streets. Just look around your city.

Danny Glover has been a UNICEF Goodwill Ambassador since 2004. An internationally acclaimed actor, producer and director, he has won several awards for humanitarian work and chairs the board of TransAfrica Forum.

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