EDITORIAL: Youth and HIV/AIDS in Africa: A Call for Effective Policies and Programs

Abstract

Recent demographic data indicate that Africa consists largely of a youthful population as compared to other regions of the World.  United Nations data indicate that in 2010, there were 364 million Africans aged 15-34 years, and 209 million aged 15-24 years, accounting for 35.6% and 20.2% respectively of Africa’s total population¹. It is widely believed that Africa has a unique opportunity to invest in youth development as part of an overall strategy to secure its growth and economic prosperity.  However, for many African youth, the transition through adolescence continues to be fraught with several challenges and difficulties.  These include pervading high rates of poverty, illiteracy, unemployment and underemployment, violence, sexual coercion and exploitation, substance abuse and other deviant social behaviors. Coupled with high rates of judgmental values by adults and negative societal/cultural attitudes which deny young people access to appropriate information and services including on sexual and reproductive health, it is not surprising that African youths currently have some of the highest rates of HIV/AIDS in the world.

Data from the UNAIDS²indicate that the prevalence of HIV/AIDS in young people aged 1524 years in sub-Saharan Africa is 2.3%, compared to a global average of 0.4% and 0.1% in South Asia.  HIV/AIDS is currently the leading cause of death among young people in Africa, with up to 40% of new HIV/AIDS infections occurring in young people aged 15-24 years.  Available data indicate that young women are at greater risk of acquiring HIV/AIDS when com-pared to young men.  For every young man infected with HIV in

Africa, three young women are equally infected. 

This greater predilection of females to higher rates of infect-ion is not only due to anatomical factors (such as increased susceptibility of the vaginal mucosa, etc.), but is also fuelled by women’s unequal socioeconomic position, the role of power in sexual relations and socio-cultural and patriarchal norms that promote gender inequality.

Since the HIV/AIDS pandemic began to unfold beginning from the early 1980s, two concurrent events and patterns have acted to ensure a heavy concentration of the disease among African youth.  The first is the large cohort of children who acquired the virus through mother to child transmission at the early phase of the pandemic.  Many such children have survived, thanks  to  anti-retroviral drugs and other high level treatments and are now young adults and are living with the virus.  The number of such “congenitally acquired” HIV infected young adults are growing daily in the African continent, but very little is currently documented about their life course experiences.  This cohort also includes orphans and vulnerable children whose parents have died as a result of the disease. To date, subSaharan Africa accounts for 80% of the 12 million globally estimated numbers of AIDS orphans. While some of these orphans may not have acquired the disease in earlier life, they are at greater risk of being infected as they transit through the teenage and adolescent years due to their greater socio-economic vulnerabilities during this stage of life.

The second patterns of youth vulnerability to HIV/AIDS in Africa are youths who acquired the virus during their adolescence years.  Although only small proportions of youth are intravenous drug users, and may therefore have acquired HIV/AIDS through intravenous drug use, it is evident that a large proportion of cases are due to sexual intercourse.  While same-sex relationships are reportedly becoming more prevalent among African youth, heterosexual intercourse remains the principal route of infection of HIV..  Available data indicate that African youth are increasingly sexually active, with declining rates of sexual debut, and high rates of risky sexual practices and transactional sex^3.Coupled with low rates of comprehensive knowledge of HIV in young persons aged 15-24 years⁴, and low condom use⁵that are characteristics of the region, it is evident that multiple factors converge to increase the risk of HIV acquisition for the African youth.

Despite the growing documentation of evidence that indicates increased vulnerability of Africa’s youth and the higher prevalence of HIV/AIDS among them, there are limited policy and programmatic efforts concentrated or targeted at reducing the burden of the disease and other reproductive health related pathologies in young Africans.  The state of the African Youth

Report⁶developed as a background paper to the African Union Conference in November 2011 quite aptly recommends that: “HIV prevention interventions for young people should be comprehensive and synergistic, by incorporating a complex set of biomedical, behavioral and community approaches.”  This implies that interventions must go beyond simplistic approaches and begin to address the complex mix of social, economic and cultural vulnerabilities that predispose African youth to higher risks of acquisition of HIV/AIDS and poor reproductive health.  This also means that programs need to address the basic developmental, educational, informational, health and psychological needs of young people.  They must also be deeply rooted and connected to the growth and developmental agendas and plans of Africa’s leaders.  Indeed, the specific adoption of policies and policy actions to prevent and manage HIV/AIDS in young person’s is currently one of the most important unmet needs for social change in sexual and reproductive health programming in the African region.  To date, only a handful of African countries have instituted specific policies that address the prevention and care of HIV/AIDS in young people as part of their comprehensive plan of action for tackling the disease. 

 While specific funding for HIV/AIDS is often limited in the budget of many African countries, the budget component that deals with youth issues in general is even more restricted.  Although many governments, including those in sub-Saharan Africa reaffirmed their commitment to combat the epidemic by signing the Declaration of Commitment made at the UN General Assembly

Special Section on HIV/AIDS (UNGASS) in 2001⁷, where they agree among other things, to ensure that “by 2010 at least 95% of young men and women aged 15 to 24 have access to the information, education, including peer education and youth-specific HIV education”, very little progress is being made in this direction in Africa.  

Fortunately, instituting policies and programs is possible because more is apparently known about African youth’s sexual and reproductive health behaviours than in other developing regions of the world, ironically because of the high rates of fertility and HIV prevalence in some parts of the region⁸.  Lessons indicated the need to scale up school-based and out-school HIV and family life education programs that will provide appropriate information to young people about their bodies, preventing HIV/AIDs and pregnancy and gender equity.  At the same time adolescent-friendly reproductive health services, including HIV counseling, testing and treatment should become widely available. Including community and faith leaders and targeting men has also proven to yield encouraging outcomes.  In addition, it is evident that scaling up efforts at reducing mother to child transmission of HIV would also slow down the rate of HIV infection amongst African adolescents.  

While these lessons, many of which are widely recommended, would appear to hold the key to the prevention and curtailment of HIV/AIDS in young persons, there has been limited use and scale up of specific youth-focused sexuality and reproductive health programming in the region. In addition, the provision of funding for HIV/AIDs prevention and treatment amongst youth is often limited in the same way that overall funding of programs to tackle youth issues on the continent are restricted.  Clearly, commitments toward achieving the scale, acceptability and sustainability of concerted indigenous HIV reduction efforts and collaboration requires deep commitment of political and community actors, working in tandem with a new resolve.  In this regards 

African governments need to evolve youth policies that promote all sectors of youth development, and that strongly engages youth in life-promoting and life-building opportunities. With the publication of the document titled “the Young Face of NEPAD: children and young people in the New Partnership for Africa’s Development⁹”by the African Union, and the adoption of the African Youth Charter in 2006 by all African Heads of State¹⁰, the commitment of Africa’s political leadership to addressing HIV/AIDS and its related problems in not in doubt.  However, youth development must be seen as part of an integral component of the development experience of African nations because experiences have shown that a well educated and highly skilled youthful population is easily the most effective pathway to development.  Within this broad-based approach, HIV/AIDS programming can then be more effectively scaled up to help youths prevent trans-mission, and to implement initiatives that mitigate harmful norms and attitudes and that lead youths to life-promoting and life-building opportunities, with increased access to evidence-based information and services on sexual and reproductive health as well as HIV/AIDS. Development partners must continue to support such efforts through strategic interventions.  The ongoing effort to aggregate knowledge about how practitioners at all levels are mitigating young people in Egypt, Senegal, Nigeria, Kenya, Uganda, South Africa and Zimbabwe’s vulnerabilities to HIV and related stigma and discrimination will go a long way in informing new interventions.  So too, this collection of essays and similar research, documentation efforts, play an important role in building a shared understanding of the evolving sexual and reproductive health landscape in Africa and tailoring programs, policies and strategies that will improve the sexual and reproductive health of young Africans at scale.