Youth and HIV

As of 2007, an estimated 33.2 Million people were living with HIV, 5.4 million of whom were young people 15-24 years of age (UNAIDS, 2007). 40% of new infections are amongst 15-24 year olds, most of them female (WHO/UNICEF 2007). In Sub-Saharan Africa, 3.2 million young people are living with HIV and three young women are infected for every young man (UNAIDS, 2006). Gender inequality reduces the ability of young women (especially those who are married) to negotiate condom use and access services.

This disproportionate impact of HIV and STIs on young women is due both to biological and socio-economic factors. An adolescent's cervix is physiologically less mature than an adult's and, therefore, more vulnerable to infection.

In many societies, girls are discouraged from learning about their bodies. They don't have adequate or accurate reproductive health information, nor do they have the negotiating skills or power to protect themselves from HIV.

Because of cultural and economic factors, young women are often involved in cross-generational relationships that can increase their risk for HIV infection. Some women are married at an early age, usually to older men. Older and more sexually experienced men also seek out young girls for sex. Some girls engage in sexual relations with older men in exchange for school fees, gifts, or money. Cultural norms in many settings give women little, if any, power to determine the circumstances in which sex occurs, including whether or not condoms are used.

What Are Microbicides?

Microbicides (mi-KRO'-bi-sidz) would provide young women with a method of protecting themselves from STI and HIV infection that is under their direct control. As gels, creams, suppositories, films or lubricants applied topically to the vagina, microbicides are designed to kill or disable HIV and some other STI pathogens on contact. Because they are applied before sex and do not require partner cooperation, microbicides would offer a whole new prevention option to women unable or unwilling to insist on condom use.

Microbicides DO NOT YET exist. Scientists are currently testing over 50 possible products, but no safe and effective microbicide is yet on the market. Lack of resources and the political will to adequately fund microbicide research have been slowing their development. Despite these barriers, three candidate microbicides are now entering the final stages of clinical testing. If one of these leads proves to be effective, a microbicide could be ready for distribution in a handful of countries within 2 to 3 years. If the current set of products does not prove effective, the time horizon will be longer (although there are several second-generation leads already in human testing). It is now more critical than ever that the voices of youth are

The Need for Youth Involvement in Microbicide Advocacy

Young advocates all over the world are raising their voices in the growing public demand for microbicides. Youth involvement is important in shaping microbicide research and ensuring access to safe and effective microbicides as soon as possible. In particular, youth can get involved in advocacy around the following critical issues:

• Young people need increased access to comprehensive reproductive health education and more opportunity for unbiased, informed discussion about ways to protect their health.
• Very few microbicide acceptability studies focus on the needs, behaviours and preferences of youth. Youth advocates need to continue to push microbicides developers to explore and address the particular needs of younger users.
• Clinical trial advisory bodies and capacity-building initiatives deal with how a clinical trial takes place, who participates in the trials, and how the entire community is involved and affected. Young voices must not be absent from these important community involvement functions.
• Research on safety and efficacy of microbicides for younger women is critical. At the same time, youth participation in clinical trials is complicated by ethical, legal and practical issues. Youth advocates can be part of national and international dialogues that help policy makers, researchers and communities decide how to resolve these dilemmas in ways that protect young people without excluding them from important research.
• Younger potential users need to play a key role in determining how microbicides will be introduced to the youth market. Marketing messages and strategies should be designed with youth input and targeted specifically to youth in order to assure rapid uptake and correct, consistent, and frequent product use.
• Once microbicides are on the market, they must be affordable and easily accessible to young women and men so they can protect themselves from HIV. Younger advocates need to target donors and their governments to make sure that youth needs will be included in their distribution and pricing strategies.