As UN member states meet to discuss the post-2015 sustainable development goals is there a danger that young people most at risk from HIV will be left behind by the new agenda?
From 25-27 September, UN member states will meet to discuss the post-2015 sustainable development goals (SDGs) which include one broad health-related goal. But is there a danger that young people most at risk from HIV will be left behind by the new agenda?
According to the World Health Organization, young people aged 15-24 account for 40 per cent of all new HIV infections. And HIV is the second leading cause of adolescent mortality in the world and number one in Africa (UNAIDS). In some developing countries, HIV and AIDS has reduced young people’s chances of living up to the age of 60 by 20 per cent.
Lawrence Ntchuwa, 24, from Ntcheu district in Malawi lives openly with HIV. He says that when someone accepts their condition and takes care of themselves the situation gets easier.
“Don’t get me wrong though. I’m human and I do have those days when I just feel like giving up and don’t want to take my medication anymore,” he says. “But it’s easy to deal with those days if you just keep yourself occupied.”
Lack of youth friendly services
Lawrence says he would love to see Malawi’s government focusing more on young people’s sexual and reproductive health needs and introducing new HIV medication with fewer side effects.
He adds: “If there is one more burden I face in living with HIV it is hospital visits to collect my meds. Sometimes I spend the whole day at the hospital. I have to miss work that day and it breaks my heart to see young people missing school because they have to go and collect their meds.
“A lot of young people would tell you that they don’t feel comfortable mixing with older patients at the antiretroviral therapy clinics. The government seriously needs to do something about young people’s confidentiality and privacy when accessing HIV/AIDS services. If you ask me about youth friendly services in this country, there are none.”
The fact that most local clinics are not youth friendly means many young people do not attend HIV and sexual and reproductive health services. Patrick Gwaza, a youth officer at Malawian reproductive health service provider Banja la Mtsogolo, cites the lack of young health staff in most facilities as a contributing factor. “A youth would be more comfortable to talk about health issues to a fellow youth than older male medical staff,” Gwaza says. “The government should step up its game in trying to understand sexual and reproductive health for the young face of the pandemic.”
Empowering young people
In an effort to improve young people’s sexual and reproductive health and rights, the International HIV/AIDS Alliance and its partners are working across Africa and Asia on the Link Up project. This is an integrated package of sexual and reproductive health and HIV services for young people most at risk in Burundi, Ethiopia, Uganda, Bangladesh and Myanmar.
Georgina Caswell, Africa regional adviser for Link Up, says: “Young people from key populations most affected by HIV, such as sexual minorities, sex workers and drug users, are citing stigma and discrimination as a barrier to accessing services. They are not comfortable speaking openly with healthcare workers because they are afraid of being judged, turned away from services and abused. Health facilities are not always welcoming spaces; and information and services are not necessarily tailored to the specific experiences and needs of young people.”
According to Caswell, it is vital young people are empowered to make informed choices and access services they need and want. She also believes young people should be at the heart of the new development agenda.
“Young people’s leadership is critical in ensuring that interventions are designed in ways that best meet their needs,” she says. “Specific targets are also essential so we can hold ourselves to account in achieving them.”
No stand-alone HIV goal
The new sustainable development goals do not include a stand-alone goal relating to HIV. Some experts think that ending AIDS can be achieved by increased integration of the HIV response into sexual and reproductive health services, while others believe this could make it harder to target those most at risk.
Dr Melissa Hope Ditmore, a research consultant on gender development, sex work and HIV from the USA, says: “Key populations are the first to be left behind and in particular young people from key populations.”
Dr Ditmore was also a member of the civil society working group on HIV in the post-2015 agenda. The new sustainable development goals do not refer to key populations, and because of this she says: “We have to work hard to ensure that young people, especially from marginalised groups, are specifically included.”
According to Caswell, those involved in the HIV response must develop a range of interventions tailored to the needs of different young people. “We need to understand different contexts and be responsive to the specific needs of individuals,” she says. “In some cases, that will mean taking services directly to young people where they live, work and play.”