Adolescents
and young adults are especially vulnerable to HIV infection
.........................................................................................................................
Mahmudul Hasan
Assistant Professor
Department of Population Science and Human Resource
Development
University of Rajshahi
Rajshahi-6205, Bangladesh
E-mail: mahmud_ru@hotmail.com
.........................................................................................................................
|
ABSTRACT
This paper
investigates the vulnerability of adolescents
and young adults, to HIV infection. The paper
also looks at how the incidence of HIV AIDS has
increased, and why adolescents are vulnerable
to it. It emphatically attempts to identify the
patterns of such infection according to the nature
of these groups and the people who usually contract
HIV AIDS. The secondary sources data in this paper
indicates that this is the age when the mentioned
groups try to involve themselves with some curious
works. The present research indicates they are
having sex heedlessly and contracting such infection.
The paper is primarily based on the secondary
sources of data gathered through searching different
reports, articles, and other research documents
are also consulted in this research. Finally,
the paper provides a number of suggested policy
measures that planners and implementers may consider
as measures they can implement to prevent this
socially and culturally humiliating disease.
|
Key
words: Adolescents, Young Adults, Vulnerable, and
HIV
..........................................................................................................................
Today
adolescents of both sexes face a serious risk
of HIV infection, which is the cause of AIDS.
AIDS is a chronic and most often fatal disease.
Despite growing understanding and awareness,
HIV infection is a serious threat to both heterosexual
and homosexual teens. When adolescents take
certain risks, they are more likely to become
infected with HIV and develop AIDS.
The
scale of the AIDS epidemic is enormous. UNAIDS
estimates that by the end of 2001, over 40 million
people were living with HIV/AIDS, 17.6 million
of them adult women, and 2.7 million children
under 15 years of age. About 5 million people
were newly infected in 2001 alone, and roughly
the same as in 199931.
Membership
in a particular population group does not confer
automatic risk for HIV infection. Risk depends
on behavior, and millions of the world's youth
are engaging in sexual and drug-using behaviors
that put them at risk for HIV. In fact, experimentation
and risk-taking are considered fundamental to
the period of adolescence, and as long as the
epidemic exists each generation of the world's
youth will need access to the information and
skills necessary to make good decisions and
to stay healthy.
It
should be mentioned here that special attention
has been given to adolescents to find their
particular vulnerability to HIV infection.
Adolescent
and Young Adults
Adolescence,
designated by the World Health Organization
(WHO) as age-range of 10-19 years1 and young
adults of aged 15-24 are the groups considered
in this paper. 33UNFPA report shows that the
terms "adolescents", "youth"
and "young people" are used differently
in various societies. These categories are associated,
where they are recognized at all, with different
roles, responsibilities and ages that depend
on the local context.
This report uses definitions
that are commonly used in different demographic,
policy and social contexts:
- Adolescents: 10-19
years of age (early adolescence, 10-14; late
adolescence, 15-19).
-
Youth: 15-24 years of age.
- Young
people: 10-24 years of age.
Vulnerable
Vulnerable means capable of being physically
or emotionally wounded.
|
iii) Risk of AIDS is increased by: |
- an increased number
of sexual partners
- IV drug use
- anal intercourse
- any sex (oral, anal
or vaginal) without condoms
- alcohol and other
drug use (sex is more impulsive and use of
condoms less
likely if under the influence of alcohol or
other drugs)
- tattoos and body
piercing with contaminated (unsterile) needles
or instruments
Particularly vulnerable
to becoming HIV-infected are certain subgroups
within the adolescent population. These include:
regular intravenous drug users; those from homes
in which family members are substance abusers;
those in detention and residential facilities;
dropouts; the homeless; migrant children; adolescents
who have had STDs; hemophiliacs; and those who
adopt high-risk behaviors, such as unprotected
sexual intercourse and drug and alcohol use2.
|
iv) Why Adolescents Are at Risk for HIV Infection: |
Although
less than 1 percent of persons known to have
AIDS are teenagers, this segment of the population
presents characteristics that increase the
risk of becoming HIV infected3.
1.
Perceived Invulnerability
Adolescents characteristically believe that
they are impervious to disease, accidents,
and death4. Ninety-one percent of 16-19 year
olds surveyed by telephone did not think they
would get AIDS5, 73 percent of adolescents
in another study were not worried about becoming
HIV-infected6. Even when 79 percent of San
Francisco teenagers reported being afraid
of getting AIDS, more than half believed they
were not the kind of person who gets AIDS7.
2.
Developing Personal Identity
Sexual orientation becomes clarified during
adolescence. One study found 1-2 percent of
16-19 year old boys had had homosexual relationships8;
0.5 percent reported bisexual relationship5.
These boys could serve as agents of transmission
to subsequent female or male partners.
3.
Unprotected Sexual Intercourse
Adolescents are already at high risk for sexually
transmitted diseases (STD). Recent data suggest
that 70 percent of teenagers are sexually
active by age 20, over half have had sexual
intercourse by age 17, and fewer than half
use condoms9.
It
is not surprising that slightly under half
of all patients treated for STD are under
age 25 years10. The Centers for Disease Control
(CDC) reports that 15-19 year olds have the
highest rate of gonorrhea of any age group
and that the number of reported cases of STD,
an indicator of unprotected sexual intercourse,
is increasing among 15-19 year olds.
4.
Drug Experimentation
An individual's first experience with drugs
typically occurs during the first three years
of high school11. Over half of adolescents
have experimented with psychoactive drugs
by high school graduation9. Most drug use
among 12-17 year olds involves alcohol, although
a small proportion, 0.1 percent in a recent
study8 uses heroin and other injectable drugs.
Experimentation with non-injectable drugs
may impair judgment and lead to behaviors
that increase the risk of HIV infection.
During
the process of maturation and emancipation,
adolescents are at increased risk for contracting
HIV for several reasons identified by 'The
American Psychiatric Association' which are
given below:
-
Adolescence
is a time of experimentation. Sexual and
drug-using behaviors can place them at risk
for contracting HIV. Most intercourse between
teenagers occurs without the use of condoms
or consistent condom use. Few teenage pregnancies
are planned. Drug and alcohol abuse further
impairs judgment and decreases the likelihood
that safer sex and needle exchange or cleaning
will occur. Teenagers who inject drugs often
share or do not clean their needles.
-
Adolescents
are particularly prone to peer influences
to take risks and often have false beliefs
about what peers are doing.
-
Adolescents
often believe they are omnipotent and invincible,
and they may be unconcerned about future
consequences.
-
Adolescents may be the victims of sexual
abuse, incest, and rape or trade sex in
exchange for drugs, money, shelter, or other
needs. These problems are particularly acute
for homeless youth and those presenting
with a conduct disorder. All of these youth
should be evaluated for screening for HIV
and other sexually transmitted diseases/infections
(STD/STIs).
-
Psychiatrically
ill or developmentally disabled youth may
have problems with impulse control, self-destructive
urges, suicidality, poor insight and judgment,
and hypersexuality and thus place themselves
in encounters where they are at risk for
contracting HIV. Co-morbid substance abuse
often further exacerbates risk behaviors.
-
Youth who seroconvert are at risk for suicide
attempts, running away or being thrown out
of their homes, and not accessing appropriate
medical services. This is especially true
for gay, bisexual, and trans-gendered teen
boys.
-
Many
parents are unaware of the extent of adolescent
HIV risk behaviors or may not have the skills
to help their teenagers. Some family dynamics
may actually exacerbate risk-taking behaviors.
Adolescence
is a vulnerable period when young adults are
exposed to new experiences relating to sexuality
and reproduction12. For many reasons, female
adolescents are more vulnerable than any others
and are biologically more susceptible to some
STIs, such as Chlamydia and gonorrhea that
could facilitate the transmission of HIV13.
In addition, early age-at-marriage and ignorance
about sexuality and reproduction stimulate
the risk of early pregnancy among female adolescents
in Bangladesh. The source of information and
advice on contraception are rarely available
or accessible to the adolescents14. Susceptibility
of female adolescents to HIV infections is
rooted in the traditional gender discrimination
that denies them the power to protect their
health. The traditional gender roles render
women less able to control the nature and
timing of their sexual activity as men are
more able to determine how, when, and with
whom sex will take place. This unequal gender
role enhances the vulnerability of women to
HIV infection, especially when women are economically
dependent on men and have under-representation
in the decision-making process. In such a
situation, when men are the traditional authority
of their families, women, particularly young
women, are not likely to make independent
decisions relating to their health and are
often unable to seek crucial reproductive
health information and services on their own15.
The female adolescents in Bangladesh are not
sufficiently aware of AIDS. Of great concern
is that a sizeable proportion of the adolescents
had misconceptions about the fatality and
avoidance of AIDS. In addition, the prevalence
of STIs among them is relatively high. One
recent study, conducted in late 1996 with
2,100 married and unmarried adolescents, reported
that 39% of husbands of adolescents had symptoms
of syphilis, and 7% reported using condom,
indicating that most of them were exposed
to unsafe sex16.
Several
factors make youth particularly vulnerable
to HIV/AIDS, including their age, biological
and emotional development and their financial
dependence. From the 'Henry J. Kaiser Family
Foundation's' HIV/AIDS Policy Fact Sheet (May
2002), we observe the following factors:
- Surveys indicate
that although many more young people across
the world have now heard about the HIV/AIDS
epidemic, awareness is not universal and
many are still unaware of how to protect
themselves or harbor misconceptions about
HIV transmission.
- Many sexually
active young people at risk for HIV do not
perceive themselves to be at risk, even
those in countries with very high prevalence.
Moreover, most young people living with
HIV do not know they are infected.
- Being infected
with another sexually transmitted disease
(STD) increases the likelihood of both acquiring
and transmitting HIV. Studies indicate that
the prevalence STDs other than HIV among
youth is high.
- Most young
people at risk for HIV infection or already
living with HIV/AIDS reside in the world's
poorest regions; their vulnerability to
HIV operates within a broader context of
poverty, which may include lack of access
to education, economic opportunities, and
health-related services.
32A recent situation of HIV/AIDS cases has
been shown by a following table released
by 'Global Statistics' last updated on November
2006:
|
Table 1. HIV and
AIDS around the World
|
|
People
living with HIV and AIDS
|
39.5 million*
|
|
Adults
|
37.0 million
|
|
Women
|
17.7 million
|
|
Children
under 15
|
15 2.3 million
|
|
New HIV
cases in 2005
|
4.3 million
|
|
Adults
|
3.8 million
|
|
Children
under 15
|
530,000
|
|
AIDS deaths
in 2005
|
2.9 million
|
|
Adults
|
2.6 million
|
|
Children
under 15
|
380,000
|
|
Total HIV cases to date
|
64.3 million
|
|
Total AIDS deaths to date
|
23.1 million
|
|
*All figures from UNAIDS AIDS Epidemic Update 2006
|
The
above table indicates a highly significant percent
of adolescents and young people are living with HIV/AIDS.
So it is our intention to explore the vulnerability
of these groups.
17Certain
subpopulations of youth have been identified as bearing
a disproportionate share of HIV's proliferation and/or
being at increasing risk18:
Young
women and girls:
· Women comprise an increasing proportion of
those living with HIV/AIDS, rising from 41% in 1997
to 47% in 2001. The rate of new infections among girls
is as much as 5 to 6 times higher than those of boys
in some hard hit countries and young women represent
the majority of young people living with HIV/AIDS
in sub-Saharan Africa and Asia18. Biologically, the
risk of becoming infected with HIV during unprotected
vaginal intercourse is greater for women than men
and on average; women are infected at younger ages
than men.
Young
men who have sex with men (MSM):
· Stigma, social exclusion, and lack of information
can result in increased risk-taking among men who
have sex with men. Male-to-male sexual transmission
is a predominant risk factor for HIV in several countries,
including the U.S., Brazil, Costa Rica, and Mexico,
and may be playing an increasing role in Eastern Europe.
Risky behaviors and HIV infection rates among young
MSMs may again be on the rise in the developed world.
Injection
drug users (IDU):
· Injection drug use continues to be a risk
factor for many young people, particularly in Eastern
Europe, Central Asia, and the Russian Federation.
About
3 million teenagers acquire an STD every year in the
United States19. This represents roughly one in eight
young people between the ages of 13 and 19, and about
one in four of those who have ever had sexual intercourse.
In addition, about 25% of all young people are infected
by any STD by age 2120. Approximately a quarter of
all reported cases of STDs occur among teenagers21.
Globally, over 100 million STDs occur each year in
people who are younger than 25 years old22.
Sexually
transmitted infections (STIs) including HIV are most
common among young people aged 15-24 and it has been
estimated that half of all HIV infections worldwide
have occurred among people aged under 25 years23.
In some developing countries, up to 60% of all new
HIV infections occur among 15-24 year-olds. Yet, vulnerability
to STIs including HIV is systematically patterned
so as to render some young people more likely to become
infected than others24.
Young
people may also face the increased risks of HIV infection
by virtue of their social position, unequal life chances,
rigid and stereotypical gender roles, and poor access
to education and health services.
One
of the most important reasons why young people are
denied adequate access to information, sexual health
services and protective resources such as condoms,
derives from the stereotypical and often contradictory
ways in which they are viewed. It is popularly believed
that all young people are risk-taking pleasure seekers
who live only for the present. Such views tend to
be reinforced by the uncritical use of the term adolescent
(with its connotations of "storm and stress")
in the specialist psychological and public health
literatures. This term tends not only to homogenise
and pathologise our understanding of young people
and their needs, it encourages us to view young people
as possessing a series of "deficits" (in
knowledge, attitudes and skills) which need to be
remedied by adults and the interventions they make25.
In
Nicaragua where virginity is highly valued among young
women, having multiple sexual partners is taken as
a sign of virility in young men26. Here, teenage boys
face social pressures from older men (including fathers,
older brothers and uncles) to have sex as early as
possible and, in the recent past, it was not uncommon
for fathers to arrange for their son's sexual initiation
with a sex worker26. So while for girls, public disclosure
of sexual activity leads to dishonour, bragging about
sex is common for boys. 27Berglund et al (1997) note
that for young Nicaraguan men the pressure to be sexually
active and multi-partnered may be so great that those
who do not fulfill this expectation are open to ridicule
by their peers for not being a real man.
|
vi) Across the World's Regions, Youth Face Significant
Rates of HIV Infection |
-
In
sub-Saharan Africa, most new HIV infections
occur among people ages 15 to 24 and are
sexually acquired. Nearly nine million
youth are infected with HIV, and 67 percent
of infections occur in young women28.
Prevalence rates exceed 20 percent in
several countries in southern Africa,
experts fear rates will rise in West Africa(29,30).
- In Latin America
and the Caribbean, about 560,000 young people
are HIV-infected28. In Latin America (especially
in Mexico, Brazil, and Peru), marginalized
populations-such as young men who have sex
with men-are most affected28. In the Caribbean,
infection rates are the second highest in
the world, and most new infections occur among
women ages 15 to 2428.
-
In
southern and southern Asia, over one million
youth are HIV-infected28. Initially fueled
in Thailand and Cambodia by the sex trade
and injection drug use, the epidemic has
been successfully slowed in both countries.
Now, India shows alarming increases in
HIV/AIDS throughout its diverse population(28,29).
-
In
eastern Asia and the South Pacific, nearly
three-quarters of a million youth are
HIV-infected. Most new cases are in China,
home to one-fifth of humanity, where UNAIDS
warns of an "unfolding epidemic of
proportions beyond belief"29.
-
Eastern
Europe and central Asia have nearly half
a million HIV-infected youth, mostly as
a result of injection drug use. Rates
are rising rapidly in Belarus, Kazakhstan,
Latvia, and Russia, as well as in the
Ukraine, where one percent of young women
and two percent of young men are now HIV-infected
(28, 29).
- Rates remain
low, though increasing, in North Africa and
the Middle East. Over 160,000 youth in this
region are infected28. Sexual intercourse
and injection drug use are the major routes
of transmission; and Djibouti and Sudan have
large, widespread epidemics (29, 30).
- In developed
nations, nearly a quarter of a million youth
are HIV-infected28. Higher rates of sexually
transmitted infections (STIs) signal a rise
in unsafe sex and highlight the need for renewed
prevention efforts, especially among youth30.
Leading factors behind the epidemic vary from
injection drug use in Spain, France, and Portugal,
to heterosexual transmission in the United
Kingdom, heterosexual transmission among disadvantaged
women in the United States, and sex between
males in Japan, Canada, Australia, and the
United States (29,30). Nevertheless, each
of these factors, heterosexual transmission,
injection drug use, and sex between males,
plays a part in the HIV epidemic in every
industrialized nation.
|
vii) Conclusion and Recommendation |
Adolescents are
not a homogeneous group; they have significant
social, economic and gender differences. They
are not only the individual but global concern
of the present world. In spite of a lot of
anti-AIDS campaigns in the world, the vulnerability
among adolescents is still increasing. To
protect adolescents and young adults from
HIV infection, societies will have to change
cultural and sexual norms, values, and practices
by adopting a lot of logical programmes.
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