It is estimated that approximately one-third of the world's population is between 10-24 years of age, and four out of five young people live in developing countries, a figure which is expected to increase to 87% by the year 2020 (Friedman, 1993; Ainsworth and Over, 1997). In many countries the majority of young people are sexually experienced by the age of 20 and premarital sex is common among 15-19 year-olds. For example in recent surveys it was found that 73% of young men and 28% of young women in this age group in Rio de Janeiro reported having had premarital sex, compared with 59% and 12% respectively in Quito, and 31% and 47% respectively in Ghana (Population Council, 1996)
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 less than 25 years (World Health Organization, 1995). 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 others. Gender, socio-economic status, sexuality and age are important factors structuring such vulnerability. Unequal power relations between women and men, for example, may render young women especially vulnerable to coerced or unwanted sex, and can also influence the capacity of young women to influence when, where and how sexual relations occur (Rivers & Aggleton, 1998).
The consequences of HIV/AIDS can be far-reaching for young people. Not only does HIV have terrible consequences for the individual, causing serious illness and eventual death, it has the potential to trigger negative social reactions. Across the world, people with HIV/AIDS routinely experience discrimination, stigmatization and ostracization.
Evidence from a variety of countries suggests that the age at which young people become sexually active may be falling (Fee & Yousef, 1993). Certainly young people become sexually active at an early age in many countries. In Uganda, for example, almost 50 per cent of young men and nearly 40 per cent of young women recently surveyed reported having had sex by the age of fifteen years (Konde-Lule et al, 1997). In Dar es Salaam, Tanzania 60 per cent of 14 year-old boys and 35 per cent of girls have reported that they are sexually active (Fuglesang, 1997). In a recent Brazilian school-based study, 36% of females reported having had intercourse by the age of 13 (Weiss, Whelan & Gupta, 1996). In parts of the world such as India where there is sparse evidence about sexual activity among young people and it is widely assumed that sexual initiation takes place within the context of marriage, recent studies show that approximately one in four unmarried adolescent boys report that they are sexually experienced (Jejeebhoy, 1998).
In both developed and developing countries, there are a number of obstacles which makes it difficult for young people to protect their sexual and reproductive health.
Young people often have less access to information, services and resources than those who are older (Friedman, 1993; Aggleton and Rivers, 1999). Health services are rarely designed specifically to meet their needs, and health workers only occasionally receive specialist training in issues pertinent to adolescent sexual health (Friedman, 1993; Zelaya et al, 1997, World Health Organization, 1998). It is perhaps not surprising therefore that there are particularly low levels of health seeking behavior among young people. For example, even where they are able to recognize signs and symptoms of STDs, young people recently interviewed in Tanzania indicated that they were hesitant to go to public clinics or hospitals, but were more likely to treat themselves with over-the counter medicines (Fuglesang, 1997). Similarly, young people in a variety of contexts have reported that access to contraception and condoms is difficult (e.g. Zelaya et al, 1997). Most importantly, legislation and policies which prevent sex education taking place, or which restrict its contents, prevent many young women and men from maximizing their sexual and reproductive health.
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 make (Aggleton & Warwick, 1997).
These powerful images and assumptions influence policy and practice in relation to young people and their sexual health. Some adults believe that young people are of their nature sexually promiscuous and that giving them information about sex will make young people more sexually active (Friedman, 1993). As a result, sex education in schools either does not take place or promotes only certain risk reduction measures (most usually abstinence). Yet there is now clear evidence that well-designed programs of sex education, which include messages about safer sex as well as those about abstinence, may delay the onset of sexual activity, and reduce the number of sexual partners, and increase contraceptive use among those who are already sexually active (Grunseit et al, 1997; Grunseit 1997).
However, evidence suggests that young people who openly communicate about sexual matters with their parents, especially mothers, are less likely to be sexually active or (if girls) become pregnant before marriage (Gupta, Weiss and Mane, 1996). While young people have been commonly stereotyped as uniformly hedonistic and irresponsible, they are in fact a remarkably heterogeneous group. Their experiences vary widely according to cultural background, gender, sexuality and socio-economic status among other variables. While some young people may take risks, the majority are at least as responsible as their parents, and some may be even more so. Moreover, it is important to recognise that in many developing countries, the onset of puberty signals greater economic and family responsibility rather than increased pleasure-seeking and
risk taking (Aggleton & Rivers, 1998). That said, there are a number of structural as well
as individual factors which may heighten young people's vulnerability to HIV and AIDS.
While developing countries in Asia, Africa and Southern and Central America vary in terms of culture, religion and socio-economic factors, young people living in them share a number of experiences which render them particularly vulnerable to HIV infection. Access to education and information is often limited, levels of literacy lower, and poverty is more prevalent. Young people living in poverty, or facing the threat of poverty, may be particularly vulnerable to sexual exploitation through the need to trade or sell sex in order to survive (World Health Organization, 1998). Estimates suggest that as many as 100 million young people under the age of 18 live or work on the streets of urban areas throughout the world (Connolly & Franchet, 1993). Many are at heightened risk of acquiring STIs including HIV. More than half of 141 street children recently interviewed in South Africa, for example, reported having exchanged sex for money, goods or protection, and several indicated that they had been raped (Swart-Kruger & Richter, 1997). Street children in Jakarta, Indonesia, have reported that being forced to have sex is one of the greatest problems that they faced living on the streets (Black and Farrington, 1997). In Brazil, where it is estimated that 7 million young people live on the streets, between 1.5 to 7.5% of those tested for HIV are infected (Filgueiras, 1993). In addition to risk from unprotected sexual activity, rape and coercion, the high prevalence of injecting drug use on the streets in Brazil and some other countries may heighten young people's vulnerability to HIV (Filgueiras, 1993). It is important to recognise, however, that children and young people who live and work on the streets of urban areas, do not commonly list HIV/AIDS as an over-riding concern. Instead, the day-to-day need for shelter, food and clothes take higher priority (Swart- Kruger & Richter, 1997). For young people struggling for daily survival, a disease like AIDS, which may or may not kill them in years to come, can seem unimportant (Finger,1993). It is not only the most socio-economically deprived children and young people in developing countries who are vulnerable to sexual exploitation. Other young people living in precarious economic circumstances report having been forced to exchange sex for material benefit. Two thirds of 168 sexually active young women recently interviewed in Malawi, for example, reported having exchanged sex for money or gifts (Helitzer-Allen, 1994), and eighteen per cent of 274 sexually active female Nigerian University students reported that they have exchanged sex for favours, money or gifts (Uwakwe et al, 1994).
References:
Adolescent Sexuality, Gender and the HIVEpidemic
By
Kim Rivers and Peter Aggleton
Thomas Coram Research Unit
Institute of Education, University of London.
World Health Organisation (1995). Women and AIDS: an agenda for action.
World Health Organisation (1998). Coming of Age: from facts to action for adolescent
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