Millions of young people around the world face a high risk of HIV infection as a result of behaviors that they adopt or are forced to adopt. Three groups of young people considered most at risk of HIV are young men who have sex with men, young people who sell sex, and young people who inject drugs.
Most -at-risk young people are among society’s most marginalized groups. They general have few connections with social institutions such as schools and organized religion, where many youth programs are provided. Behaviors such as injecting drug use, sex work, and even homosexuality are illegal in many countries. Furthermore, young people in general are more easily exploited and abused than adults and have less experience coping with marginalization and illegality. Young people most at risk of HIV can be difficult to reach and most sexual and reproductive health programs fail to meet their unique needs. Young people may be less willing to seek out services, and service provides may be less willing to provide services to most-at-risk young people because of legality concerns.
Young people account for a large proportion of the three most-at-risk populations. Approximately 70 percent of the world’s injecting drug users and the majority of sex workers are under 25 years of age. Young people not only constitute large proportions of most-at-risk populations but also many have higher HIV infection rates than older people within these groups. According to the Asia Commission on AIDS approximately 5 percent of young people are considered high risk; yet , most-at-risk young people account for 95 percent of the new HIV infections among young people in Asia. For example, the highest rates of HIV infection in Myanmar occur among most-at-risk young people; 41 percent of female sex workers and 49 percent of injecting drug users age 20 to 24 are HIV positive. Among children commercially exploited by traffickers, HIV infection rates range from five percent in one study conducted in Vietnam to 50 to 90 percent among children rescued from brothels elsewhere in Southeast Asia. In some countries, such as Thailand and Russia, HIV incidence is increasing faster among young MSM than among older MSM.
Worldwide, the HIV infection rate among most-at-risk young people is staggering. If we, the sexual and reproductive health community, are truly dedicated to meeting the needs of young people and curbing the HIV epidemic, we need to take the sexual and reproductive health needs of young people most at risk seriously. More advocacy efforts are needed at both the policy and program levels on behalf of most-at-risk young people. Better statistics at the country level would help highlight how many young people are most at risk. More research and more evidence on program success are needed. Policies need to be developed and implemented that protect vulnerable young people and ensure that they have access to the services they need. Finally, most-at-risk young people need to be engaged in planning and implementing programs that address their unique needs.
Join our online discussion Lives at Stake: Meeting the Needs of Young People Most at Risk of HIV July 26-July 28, 2011. This e-forum, hosted by FHI 360 on behalf of the IYWG, will bring together experts who work with young people most at risk of HIV from WHO, UNICEF, amfAR, Youth R.I.S.E., and the Nossal Institute for Global Health at the University of Melbourne.The e-forum will give participants an opportunity to discuss ways to meet the sexual and reproductive health and HIV prevention needs of most-at-risk young people.