Working with young people to stop AIDS in Bangladesh

Globally, roughly 40 million people are living with HIV/AIDS. In 2005, there were 4.9 million new HIV infections: of which half were between the ages of 15-24. Today's young people have never seen a world without HIV. Every day 6,000 young people are getting infected. Young people are adventurous and they like to experiment, which makes them more vulnerable to HIV. Women and girls comprise the fastest growing population of those infected as they are biologically, socially, and economically more vulnerable. Gender inequality, poverty, and gender-based violence are some of the driving forces behind this pandemic.

Young people in many countries lack information that they require to protect themselves from STIs including HIV. In many societies due to cultural barriers, parents and teachers do not discuss sexuality with the children. Ignorance and embarrassment go hand in hand and young people end up having little or inaccurate information, which leads to a sense of false invulnerability. In sub-Saharan Africa, young women between 15 and 24 years old are at least three times more likely to be HIV-positive than young men. Poverty, low social status, and less access to education limits the channels of information for young women. Women's own fidelity is not necessarily enough to protect against HIV infection. In India, the epidemic continues to shift towards women and young people. It has been estimated that 38 percent of adults living with HIV/AIDS in India as of the end of 2003 were women. In 2004, it was estimated that 22 percent of HIV cases in India were housewives with a single partner.

This disease threatens to wipe out the gains of development of many decades. In African countries, where HIV prevalence exceeds 35 percent, the life expectancy has gone down tremendously. In Swaziland the life expectancy is 38 years and in Botswana it is 39 years only, as against 72 in 1981.

As of December 2004 Asia is the home for an estimated 8 million HIV positive people. An estimated one million are HIV positive in China and five million in India. India has a large number of people living with HIV/AIDS, second only to South Africa. By the end of May 2005, 37 percent of all reported AIDS cases were diagnosed among people under 30. In the region, the epidemic is spreading among young people almost exclusively in two ways: unsafe sex and also sharing injecting paraphernalia.

Bangladesh is a low HIV prevalence country. The 6th Sero surveillance (2005) shows HIV prevalence among the high-risk groups is less than 1 percent except among Injecting Drug Users (IDUs) it has reached 4.9 percent. This indicates that HIV epidemic is evolving in Bangladesh and also indicates the urgency and importance of a concerted and multi-sectoral effort to counter the epidemic.

In Bangladesh 23 percent of the total population are young people. Most young people have limited knowledge about HIV/AIDS because societies make it difficult for them to obtain information. In a recent study among youth, it was found that by the age 21, one third of unmarried Bangladeshi youth become sexually active and among them less than 30 percent had used condom for most recent sexual encounter.

What the young people need
No single strategy can protect young people from HIV infection, as they are not a homogenous group. Interventions must be tailored to meet their individual characteristics. They are in and out of school youth, married and unmarried, employed and unemployed. They need information, education, access to services and protective measures (both male and female condoms), access and knowledge of VCT, life skills and openness to protect them from getting infected with HIV.

Working with young people
Substantial evidence exist that prevention interventions targeting young people could significantly help curtail the AIDS epidemic. Young people must not only be the beneficiaries of interventions; they should also be the key resource in the design and implementation of program. Involving young people from the very beginning and in all stages of prevention program will be effective for greater ownership. Young people can be powerful instruments for change. They can be the role models for their peers as such peer education is of great importance. They understand each other's realities, trust each other's judgments, and respect each other's opinion. Curricula should reflect the realities young people face and equip them with relevant skills. Giving life skill training and providing commodities (condoms and clean injecting equipments) is of paramount importance. Prevention of Violence against Women and creating a safe and enabling environment is also crucial to stop the pandemic.

Conclusion
Young people are most vulnerable to HIV infection; they are also the source of greatest hope for changing the course of the epidemic. They love life and can take the charge of their lives. Studies have shown that giving information to young people on sex and sexuality does not increase promiscuity rather help them in shaping responsible behavior by understanding the process of growing up and the emotional and hormonal changes taking place. This is a human right. Young people say: "If we are too young to know, are we not too young to die?"

Let us keep our promise. Government, NGOs, civil society and development partners should work together and provide information and services through the young people to keep Bangladesh a low prevalence country.

Suneeta Mukherjee is UNFPA Bangladesh country representative.