April 1997 Insights Issue #22

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Preventing HIV: behavioural interventions with young people

As the HIV epidemic unfolds and as new areas of the world are touched by the tragedy of AIDS, prevention efforts involving young people must continue to be given the priority they deserve. Working with them has the potential to significantly alter the future course of the epidemic. Lessons learned in this area are likely to be transferable to STI treatment programmes and efforts to reduce unwanted pregnancies.

Young people are at special risk of HIV infection. Estimates from the Joint United Nations Programme on AIDS suggest that up to 60 per cent of new HIV infections are among those aged between 15+24 years. (Similarly, young people experience greater risk of STIs.) But there is much uncertainty about how best to approach HIV and AIDS prevention with this group. Adults are inclined to have some difficulty acknowledging adolescents as sexual and potentially sexual beings. Concerns are often expressed, and reflected in government policies, that providing too much or certain kinds of sex education may propel young people into premature sexual relationships. As a consequence, many programs of sex education in both developed and developing countries have tended to concentrate on abstinence and helping young people to say ‘no’ to sex. Yet evidence clearly suggests that well-designed programs of sex education, which combine messages about safe sex as well as abstinence, may in fact delay sexual debut, decrease sexual activity among those young people who are sexually active and increase contraceptive use.

In order to shed light on these complex issues and concerns, we have carried out a comprehensive international review of effective approaches to HIV prevention among young people in developing countries. Past successes and failures in HIV-related health promotion enable us to identify a series of principles that underpin successful work:

• recognising the diversity of young people and their needs rather than beginning from stereotypes and possibly inaccurate presuppositions;
• beginning work with the expressed needs of young people themselves, and encouraging youth participation in project design and implementation;
• working in a climate of openness which acknowledges the realities that young people face, rather than the preferences and prejudices of adults;
• providing opportunities to address issues relating to gender, social status and sexuality in work to promote young people’s sexual and reproductive health;
• undertaking more work with young men to enable them to think about their role in relation to both their own sexual health and that of their partners, as well as improving programs targeting young women;
• examining the positive aspects of sexual health including eroticism and pleasure as well as the more negative aspects such as unwanted pregnancy and sexually transmitted disease;
• promoting greater awareness of structural issues affecting sexual and reproductive decision making, including rights and protection for young people, as well as improved access to education and health services.

E: tcru.ioe@lon.ac.uk