August 18, 2014 marked a milestone, 500 days left until the target date set (end of 2015) by the United Nations and other countries around the world to achieve the Millennium Development Goals (MDGs) which seek to tackle some of the main problems facing the world today:
Millennium Development Goal 6 (MDG 6) seeks to combat HIV/AIDS, malaria, and other diseases. MDG 6 was established in the 2000 Millennium Summit which aimed to accelerate the global development progress. There are three strategies used to achieve MDG 6, these include HIV infection prevention among young people through providing them with information, condoms, and testing; prevention of mother-to-child-transmission; and the improvement of treatment and care of children and young people infected with HIV.
Millennium Development Goal 6: Target 6 A States: By 2015 have halted and begun to reverse the spread of HIV/AIDS:
Globally today, there are 1.6 billion people aged 12-24 years. New infections in young people aged 15-24 years have declined globally with the exception of East Asia, Middle East, and North Africa where they have increased between 24-50%. There are also increased rates among bisexual/men who have sex with men (MSM), injection drug users (IDUs), and sex workers. Most new infections among young people are acquired through sex, but many adolescents acquired the infection through perinatal transmission. As of 2010, young people aged 15-24 years old made up 42% of new infections among people aged 15 years and above. Most (80% or 4 million) of them live in Sub-Saharan Africa. Young women in this age group are twice as likely to be infected as their male peers.
Additionally, adolescents who use or sell drugs are at higher risk of infection, and may not have access to information on how to prevent the infection, sterile injection supplies, and testing and support services. Adolescent girls are more susceptible to infection because they are likely to have sex with older males, get married early, be exposed to violence and rape, and maybe unable to insist on condom use. In 2010, 12% of children born were to young women aged 15-19 years, and another 32% were born to those aged 20-24 years. In countries with high HIV prevalence, 30-50% of girls had their first child before they were 19 years old. Young people continue to have risky behavior and insufficient knowledge of HIV prevention and transmission. Condom use in Sub-Saharan Africa, the region most hit by the disease, was only 57% and 37% among young men and women respectively at the last sexual encounter with a non-regular sexual partner. This falls short of the 95% target set by the United Nations General Assembly Special Session on HIV and AIDS in 2001. In recent surveys, only 24% of young women and 36% of young men correctly answered questions about how HIV is prevented and transmitted:
The challenges of controlling and preventing the spread of the disease among adolescents and young people are many. These include early sexual debut (below 15 years in many countries), inadequate access to high quality youth-friendly HIV, sexual, and reproductive health services, sexual violence directed towards girls and young women, and poor confidentiality and medical privacy. Also, there is inadequate comprehensive sex education being provided to adolescents and young people although it’s been shown to delay sexual debut and increase condom use among those who are sexually active. This undermines efforts extended to protect adolescents and young people from acquiring HIV.
How Do We Address these Challenges to Achieve Success of Millennium Development Goal 6 by 2015?
At the 2006 United Nations High Level Meeting on AIDS, countries across the world committed “to ensure an HIV-free future generation through the implementation of comprehensive, evidence-based prevention strategies, responsible sexual behavior, including the use of condoms, evidence and skills-based youth-specific HIV education, mass media interventions, and the provision of youth-friendly health services.” The global declines seen in new HIV infections since 2001 are verification of the effectiveness of the prevention efforts extended this far. However, we should:
- Continue to implement and maintain services that are achieving declines in HIV prevalence among adolescents and young people by encouraging behavioral changes such as delaying sexually debut, reducing sexual partners, and increasing condom use among those who are sexually active, and more so among those who have multiple partners. Countries that see or are seeing an increase in new HIV infections among their adolescents and young people should investigate why this is occurring and network with other regions/countries that are seeing declines so that they can create and implement strategies that work at counteracting the rise in numbers.
- Provide age-appropriate sex education aimed at increasing the knowledge of adolescents and young people on HIV because it contributes to more responsible sexual behavior. Fifty percent of sex education programs evaluated in 2006 showed a decrease in sexual risk-taking behavior among adolescents and young people.
- Address results of surveys when conducted. Population surveys have shown that in many countries, sexual activity is initiated early during adolescence before a child reaches 15 years of age. Since evidence indicates that adolescents and young people are having sex, we need to empower them to make responsible informed decisions about their sexual and reproductive health.
- Create and offer comprehensive youth-friendly one-stop programs which provide sex education aimed at increasing and improving adolescents and young peoples’ access to HIV information, sexual and reproductive health services, and that also discuss unsafe sexual and cultural practices. These programs should also address violence against adolescent girls and young women, early marriages among girls, contraception and teenage pregnancy prevention, injection drug use, and risky sexual behavior among bisexual/MSMs, IDUs, and sex workers.
- Increase efforts directed towards emerging and/or identified increases in sexual risk-taking behavior by providing intensive, accurate, HIV-related information and services aimed at mitigating the spread of HIV infections among adolescents and young people. In most countries, new HIV infections are transmitted through sex. Therefore, encouraging safe sex in the best way to prevent the spread of the disease. There are signs in some countries of increases in risky sexual behavior, such as decreased condom use and/or increased number of sexual partners. Adolescents and young people should be taught early and regularly about the ongoing risk of contracting HIV and other STDs before and after the age of sexual debut.
- Actively engage adolescents and young people in the design, implementation, monitoring, and evaluation of HIV policies, services, and programs because this enhances buy-in of the programs, increases and improves program participation, improves leadership skills, and equips them to demand youth-friendly health services and programs.
- Try new strategies that reduce adolescents and young peoples’ susceptibility to HIV. Randomized controlled studies is Lesotho and Malawi which provided cash incentives for safe behaviors reduced the probability of acquiring HIV infection by 25% and 60% respectively among young girls. Although controversial, this and other out of the box strategies merit further research to determine which ones might be most effective in the prevention of HIV infection among adolescents and young people, especially in highly prevalent countries.
What are you and/or your organization doing to help meet the MDG 6 goal by 2015? What additional efforts can you perform? Let’s step up our #MDGMomentum so as to ensure Millennium Development Goal target 6 A. “by 2015 have halted and begun to reverse the spread of HIV/AIDS” among young people is achieved by the end of 2015.
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