HIV Prevention in Young People: Current Context, Opportunities and Challenges

Prepared for the web conference: Mass Media for HIV Prevention Among Young People in November 2010, this outline was created to guide the presentation in the following areas:

1. Global epidemic in young people.
2. New opportunities
3. Key challenges
4. Where does mass media fit in?

The slides illustrate a map of the HIV/AIDS epidemic based on 2008 statistics showing locations, numbers, and the gender ratio of HIV by region. Infections are characterised by the following:

Of the estimated 33 million people living with HIV globally, about 4.9 million are young people aged 15 - 24 years.

• Two-thirds of all young people living with HIV are young women
• 80% (4 million) of all young people living with HIV are in sub-Saharan Africa
• Globally, predominant modes of exposure to HIV infection are:
  • Sexual transmission
  • Injecting drug use
  • Perinatal infection

Twenty-five countries account for 85% of the epidemic in young people, led by South Africa, India, and Nigeria.

Opportunities for addressing the epidemic among young people include:

• "Declining prevalence in some high burden countries: Noted in 22 of 30 high burden countries.
• Male circumcision: Since 2007, 14 priority countries (high HIV prevalence, low circumcision) initiated national plans to scale up access to medical male circumcisions. At least 175,000 performed by May 2010.
• Investment in health systems: Improving quality and availability of key services has brought more people into care. ART access scaled up through improvements from VCT/PITC [voluntary counselling and testing/provider-initiated counselling and testing] to patient monitoring.... Need to show that services are ready to ensure that young people benefit proportionately from service scale up.
• Increasing school enrolment rate: More young people accessible for strategically timed support for prevention. Must be combination of information, skills and services. Quality and adequacy of these need to be reviewed."

Challenges include:

• "Leadership commitment: Insufficient leadership support for responsive prevention services for young people (harm reduction, prevention of sexual transmission).
• Coverage and Access for Young People to Services: Barriers to access to health services including age of consent laws. Inadequate investment in service delivery for young people. Improved age-disaggregation of service data will help highlight inequity in access and service gaps. More rigorous evaluation will inform changes required for better impact.
• Reaching young people where they are: Underutilization of schools as an entry point for improved service delivery to young people. Need for partnership arrangement between health and education sectors.
• Young People in the Margins: Continued discrimination against and marginalization of adolescents most at risk for infection (young people who inject drugs, young women who sell sex, young men who have sex with men)."

According to the report, mass media provides the opportunity to promote behaviour change and service access and uptake through consistent messaging by challenging norms, attitudes, and practices that increase the prevalence of HIV. Media can support mobilisation on a large scale and penetrate, reaching those hard-to-reach groups with messages that promote combination prevention:

1. "Reducing risk for exposure - behaviour change such as reduced frequency of sex or injection drug use, reduction in multiple partners;
2. Reducing probability of transmission - through use of commodities (condoms, clean needles and syringes) and services that lower efficiency of transmission (male circumcision); and
3. Reducing infectivity - through services that decrease viral load."

Lessons learned from reviews of mass media programmes 1998-2010 include:

• Mass media interventions had significant immediate impact on use of services for HIV testing.
• Mass media was effective in promoting use of effective health services and discouraging use of non-proven services.
• Mass media programmes had greater effect when they ran longer and when combined with service scale up, interpersonal interventions (letters, calls, face-to-face support) and a supportive policy and legal environment.

The key lesson:
"Mass media effective in driving important short term changes but the quality of the intervention, its duration and the intensity of the programme, the degree to which it is linked to and reinforced by complementary interventions has a significant impact on the effect size."

The presentation concludes with key resources.