Risk and Protection: Youth and HIV/AIDS in Sub-Saharan Africa

Executive summary

"Sub-Saharan Africa has been more devastated by the HIV/AIDS epidemic than any other world region. The epidemic is taking an enormous toll on the region’s youth: Nearly 10 million women and men aged 15-24 - roughly one in 14 young adults - are living with HIV/AIDS, and half of new infections in 2003 occurred among this age-group.

Economic, social and cultural factors contribute to Sub-Saharan African youths’ vulnerability to HIV/AIDS.

• Most countries in the region are among the poorest in the world; people living in poverty may place low priority on sexual and reproductive health and may engage in high-risk behaviors.
• Education can help adolescents avoid HIV/AIDS, but in many countries, fewer than 20% of women aged 15-19 and fewer than 30% of men this age have more than a primary school education.
• Traditional social values prescribe strict gender roles that may undermine women’s ability to protect their sexual and reproductive health, and condone promiscuity among men.

Adolescents’ knowledge, beliefs and behavior related to HIV/AIDS and other sexually transmitted infections (STIs) reveal areas where educational efforts may best be focused.

• About nine in 10 young people aged 15-19 in Sub-Saharan Africa have heard of HIV/AIDS, but most are not familiar with the ABCs of prevention: abstinence, being faithful (monogamy) and use of condoms.
• In the 10 countries with data, 1-9% of 15-19-year-olds who have heard of HIV have been tested for the virus; however, most untested women and men this age say they would like to be tested.
• The majority of young people who acquire an STI [sexually transmitted infection] take some action to prevent transmission, but many do not tell their partners about the infection.
• Many adolescents, especially in rural areas, do not know where to obtain condoms; young men are more likely to know of a source than young women.

Patterns of marital and sexual behavior among Sub-Saharan African youth highlight key areas for interventions.

• In most countries, women usually get married in their teens to considerably older men, who are likely to have had more sexual partners; thus marriage may increase young women’s risk of HIV/AIDS.
• In most countries, at least 80% of women have had sex by age 20; among men, the proportion ranges from 40% to more than 80%.
• Among sexually experienced 15-19-year-olds (both married and unmarried), larger proportions of men than of women have had two or more partners in the past year - more than 40% of men in some
  countries, compared with fewer than 10% of women in almost all countries.
• Condom use is rare among married 15-19-year-olds; it is much more common among unmarried sexually active adolescents, but in some countries, fewer than 20% of women and 40% of men used a condom the last time they had intercourse.

Young people are essential to the future of Sub-Saharan Africa, and investing in their health and well-being should be an urgent priority.

• Development and implementation of comprehensive national policies that address the provision of sexual and reproductive health information and services and promote gender equality are crucial first steps in the effort to protect young people.
• Programs to provide sex education to young people and public education campaigns to improve adolescents’ protective behaviors can help to curb the HIV/AIDS epidemic.
• Improved access to condoms and high-quality, affordable and confidential sexual and reproductive health services, including diagnosis and treatment of HIV/AIDS and other STIs, is imperative."