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The Facts
The HIV/AIDS Pandemic among Youth in Sub-Saharan
Africa
HIV/AIDS seriously affects adolescents throughout
the world. One-third of all currently infected individuals are youth,
ages 15 to 24, and half of all new infections occur in youth
the same age.1 More than five young people
acquire HIV infection every minute; over 7,000, each day; and more
than 2.6 million each year.1
About 1.7 million new adolescent
HIV infections—over half of the world's total—occur in
sub-Saharan Africa.1 In fact, nearly
70 percent of people living with HIV/AIDS live in sub-Saharan
Africa, and over 80 percent of AIDS deaths have occurred there.2,3 Although
HIV/AIDS rates vary considerably throughout sub-Saharan Africa—generally
lower in western Africa and higher in southern Africa—the
epidemic has had a devastating effect on most African youth
who often lack access to sexual health information and services.
In particular, unmarried youth have great difficulty getting
needed sexual health services. At the same time, cultural,
social, and economic norms and pressures often put young African
women at excess risk for HIV infection.
Leaders of some African nations, once unable to acknowledge the presence of
HIV/AIDS, now publicly address HIV prevention and appoint task forces to mobilize
and coordinate efforts against the epidemic.3 In
addition, business coalitions and non-governmental organizations (NGOs) often
lead in utilizing peer education, advocacy, youth-friendly service delivery,
and social marketing to battle HIV infection in sub-Saharan African nations.4 Some
NGOs encourage youth to get involved in finding and implementing ways to stop
the spread of HIV.
African Youth
Face Fast Growing Rates of Infection with HIV and Other STDs.
- Experts estimate that
half a million African youth, ages 15 to 24, will die
from AIDS by the year 2005.5 In
African countries with long, severe epidemics, half
of all infected people acquire HIV before their 25th
birthday and die by the time they turn 35.6
- The epidemic means that
African youth face a bleak future. In 1997 in Zimbabwe,
half of all 15-year-old males could expect to die before
age 50 compared to 15 percent in 1983. Between 1983
and 1997, 15-year-old females' risk of death prior
to age 40 quadrupled from 11 to over 40 percent.6
- Infection with a sexually
transmitted disease (STD), especially one that causes
genital ulcers, such as herpes or syphilis, puts one
at increased risk for HIV infection, and sexually active
youth in sub-Saharan Africa are at high risk for STD
infection.7 For example,
10 to 20 percent of the sexually active population
of sub-Saharan Africa is infected with gonorrhea.5
Young Women Are Disproportionately
Affected by HIV/AIDS.
- Half of all HIV infections
worldwide occur in women in Africa.2
- In seven of 11 studies
in Africa, at least one woman in five, ages 20 to 25,
was HIV infected; most HIV-infected young women will
not live to age 30.6 In
one city in South Africa, six out of 10 women, ages
20 to 25, were HIV infected; among youth in their early
20's, women's rates were three times higher than men's.6 In
Malawi, HIV incidence in teenage women is six percent
compared to less than one percent in women over age
35.1
- Throughout sub-Saharan
Africa, HIV infection rates among teenage women are
over five times higher than rates for teenage males.
In Kenya, nearly one teenage woman in four is living
with HIV, compared to one teenage male in 25.1
- The physical immaturity
of younger women and women's lower status in society
may contribute to disproportionate HIV infection rates.
Women's lower status may prevent them from having control
of their sexual relationships. For example, studies
on women's first sexual experience show that over half
of young women in Malawi and over 20 percent of young
women in Nigeria experienced
forced sexual intercourse.6,7
Inadequate Sexual Health Information
and Limited Access to Health Care Are Obstacles to Lowering Adolescent
HIV/STD Infection Rates.
- African adolescents cite
lack of knowledge, inaccessibility, and safety concerns
as primary reasons for not using contraception. For
example, one study showed that less than 50 percent
of youth in Madagascar and Nigeria know
about contraception. Limited resources also make contraceptive
use lower in Africa than in other world regions.5
- Many African health services
workers feel it is inappropriate to provide contraceptives
to adolescents, often making it difficult or impossible
for youth to obtain condoms and other contraception.8 For
example, a study in Kenya found that three-fourths
of family planning workers were unwilling to provide
contraceptives to young women who had not given birth.8
- In sub-Saharan Africa,
only half of the population has easy access to health
care. Africa has one-third as many nurses per capita
as the rest of the world. Moreover, the current ratio
of doctors is lower than one per 10,000 population;
the world average is one per 800.8 Limited
budgets, problems imposed by the HIV epidemic, and
few health care providers mean that improving reproductive
health services is a challenge for most sub-Saharan
African countries.8
Sexual Health Attitudes and
Behaviors Greatly Affect Adolescents' Risk of Infection.
- In sub-Saharan Africa,
as in other regions of the world, a culture of silence
surrounds most reproductive health issues. Many adults
are uncomfortable talking about sexuality with their
children. Others lack accurate sexual health knowledge.5
- Many Africans feel unable
to discuss sexuality across perceived barriers of gender
and age differences.3 Many
Africans are also reluctant to provide sexually active
adolescents with condoms.3
- In several African countries,
some people believe that men are biologically
programmed to need sexual intercourse with more than one woman.
Polygamy is a central, social institution that
reinforces this belief. Moreover, some men believe that this "biologically
programmed need" makes high-risk sex unavoidable.3
- In some impoverished communities,
high HIV infection rates may be partly explained by
early sexual initiation, consensual or coerced. For
example, in a survey of 1,600 urban Zambian youth,
over 25 percent of 10-year-old children and 60 percent
of 14-year-old youth reported already having sexual
intercourse.6
- One study of adolescents
in 17 African countries showed that those with more
education were far more likely to experience casual
sex and to use condoms for casual sex when
compared to less educated youth.6
Cultural, Social, and Economic
Factors also Fuel the HIV Epidemic.
- Some faith traditions
in Africa teach that AIDS is a shameful disease and
a punishment for those who have been sexually promiscuous,
and many adults are reluctant to admit to a disease
that seems to imply promiscuity.3 One
study showed three quarters of Nigerian Christian leaders
believe that AIDS is a divine punishment.3
- Poverty and HIV transmission
are linked in a variety of ways. Poverty often leads
to prostitution or to trading sexual favors for material
goods. Young women may be especially vulnerable due
to societal practices that deny them education and
work opportunities. Poverty also leads to poor nutrition
and a weakened immune system, making poor people more
susceptible to tuberculosis and to STDs.2,6,8
- The costs of providing
treatment for people with AIDS drains resources from
education, agriculture, and other domains important
to gross national product. By 2005, AIDS treatment
costs are expected to account for more than one third
of Ethiopia's government health spending, more than
half of Kenya's, and nearly two-thirds of Zimbabwe's.9
- In sub-Saharan Africa nearly
eight million children, ages 14 and under, had been
orphaned by AIDS by the end of 1997. Many of these
youth must drop out of school.1,6
References:
- UNAIDS. Listen,
Learn, Live! World AIDS Campaign with Children and
Young People: Facts and Figures. Geneva: UNAIDS,
1999.
- Akukwe C.
HIV/AIDS in African children: a major calamity
that deserves urgent global action. J HIV/AIDS Prev
Educ for Adolesc & Children 1999; 3(3):5-24.
- Caldwell JC.
Rethinking the African AIDS epidemic. Popul Develop
Review 2000; 16:117-135.
- Population Reference
Bureau [and] Population Services International. Social
Marketing for Adolescent Sexual Health: Results of
Operations Research Projects in Botswana, Cameroon,
Guinea, and South Africa. Washington, DC:
The Bureau, 2000.
- Pathfinder International,
Africa Regional Office. Adolescent Reproductive
Health in Africa: Paths into the Next Century.
Nairobi, Kenya: The Office, 1999.
- UNAIDS. Report
on the Global HIV/AIDS Epidemic. Geneva:
UNAIDS, 2000.
- UNAIDS. Force
for Change: World AIDS Campaign with Young People:
1998 World AIDS Campaign Briefing Paper.
Geneva: UNAIDS, 1998.
- Rosen JE,
Conly SR. Africa's Population Challenge: Accelerating
Progress in Reproductive Health. [Country
Study Series, no. 4] Washington, DC: Population
Action International,
1998.
- UNAIDS. The
UNAIDS Report. Geneva: UNAIDS, 1999.
Written by Tawa Jogunosimi
February 2001 © Advocates
for Youth
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