HIV and other STIs
Preventing sexually transmitted infections (STIs), including HIV, is a central goal of youth reproductive health policy. Approximately 2 million young people ages 10 to 19 are living with HIV, and young females are disproportionately affected. Eighty-two percent, or 1.6 million, of the 2 million adolescents living with HIV live in sub-Saharan Africa, where 7 in 10 of new HIV infections among young people ages 15 to 19 occur in girls. The concentration of new infections among youth has created immense health problems and threatens the economic and social underpinnings of the countries hit hardest by the epidemic.
In addition, more than 100 million young people each year contract curable STIs. An untreated STI can cause infertility, chronic pain, stillbirth, and ectopic pregnancy and heighten the risk of HIV infection. Yet rates of reinfection are substantially higher among young people than adults, partly because they are less likely to use a condom and to seek effective treatment. Young people are generally less informed about STIs, less likely to recognize symptoms, and more averse to seeking treatment due to stigma and societal pressures. Training health providers on how to provide youth-friendly services can help ensure young people are properly diagnosed and treated for STIs.
HIV and STI prevention efforts aimed at young people focus on the following goals:
- Access to condoms, education, and information on safer sex and HIV/AIDS
- Care and support for people living with HIV (YPLHIV)
- Reaching orphans and vulnerable children (OVC)
- Prevention of mother-to-child transmission of HIV (PMTCT)
- Prevention and treatment of STIs
- Prevention of stigma and discrimination
- Access to youth-friendly HIV testing and counseling
Key Areas for Policy Action
Because of the importance of voluntary counseling and testing (VCT) in combating HIV and AIDS, health ministries in many countries now support VCT through national policies. To address the special needs of youth, a number of key policy actions are warranted. These include the following:
- Allow minors to consent to VCT without requiring the consent of a parent or other adult. In addition, policy should direct counselors to encourage all minors to consult parents or other trusted adults about their decision to test, where such consultation would be conducive to testing.
- Protect the confidentiality of HIV test results for minors consistent with the obligation to protect their right to privacy. Policy should prohibit the disclosure of information on the HIV status of minors to third parties including parents without the consent of the minor. At the same time, policy should direct counselors to encourage minors to discuss test results with their parents or guardians, in the case of those minors who have supportive relationships with parents or guardians.
- Reassure counselors and other health care workers that they can provide VCT to adolescent minors who request it, without fear of retribution.
- Modify operational guidelines. VCT policy should support adjustments to training, communications, referral, and other systems to make services more attractive to adolescents and to improve their quality and effectiveness.
- Encourage a youth-friendly approach in all VCT centers. Young people seek VCT services regardless of where the services are provided. Thus, policies should ensure that all VCT services provide appropriate care to young clients.
- Support the development of VCT services for especially-vulnerable youth. Policies should make it a priority to serve vulnerable groups such as young people who sell sex, young people who inject drugs, orphans, and street children.
- Encourage the involvement of young people as VCT peer educators.
- Forge links between VCT and other aspects of young people's lives. VCT services are an opportunity to connect young people with other health care and to services that help meet job and education needs.
- Develop stand-alone youth and VCT policy. Particularly in high HIV prevalence countries, it is important to have a stand-alone policy that addresses youth and HIV issues, as opposed to addressing youth within a larger HIV policy.
- Include VCT within national YRH policies.
- NGO policies are important too. In some countries, NGOs are the main provider of VCT care. Such NGOs should develop their own policies-ideally based on a national standard-for serving youth with VCT services.
The urgency of addressing HIV/AIDS has somewhat overshadowed policy and program action on other STIs. Policies should reflect the importance of STI treatment and diagnosis for young people. Some key policy actions include:
- Position STI diagnosis and treatment as a health problem that shares priority with and complements HIV/AIDS prevention efforts.
- Allow minors to consent to STI examinations and treatment without requiring consent of parent or other adult.Parents are an important source of emotional support and clinic-based counselors should encourage all minors to consult with parents or other trusted adults. Consent and disclosure requirements for mature minors should be similar to those recommended for voluntary counseling and testing programs.
- Promote comprehensive sexuality education programs in schools to enable youth to recognize STI symptoms and choose to seek treatment.
- Encourage youth friendly reproductive health care through stand-alone clinics or "youth corners." Sexually active, unmarried youth tend not to utilize existing reproductive health services for fear of being judged.
- Promote affordability of STI treatment. Young people often have limited financial resources and would be reluctant to borrow money from friends or relatives.
- Encourage comprehensive reproductive health services that provide STI care, family planning, and voluntary counseling and testing for youth.
The State of Policy Making
Recent advances in HIV and AIDS policies present an opportunity for the inclusion of STI considerations. Many HIV policy documents also address STI diagnosis and treatment, but few explicitly address the needs of young people.
The major international policy documents on VCT, while applying equally to young people, generally lack youth-specific provisions. One of the international agreements with most relevance to VCT and youth is the Convention on the Rights of the Child. The Convention defines a "child" as a person below the age of 18, unless the relevant laws recognize an earlier age of majority. Article 24 of the Convention affirms that children have the right to attain the highest standards of health and to health care, including family planning education and services (a right also recognized in earlier conventions and conferences).
The Convention on the Rights of the Child also acknowledges that children's ability to make important decisions, including decisions about their health, increases with age and experience. Article 5 calls on governments to respect the rights and duties of parents, legal guardians and extended families or communities (if empowered by local custom) to guide and direct children in the exercise of their rights "in a manner consistent with the evolving capacities of the child". The ICPD similarly noted the need to balance the responsibilities and rights of parents or guardians with the "evolving capacities" of "adolescents" (a term not in the Convention but used throughout the ICPD Programme of Action). (adapted from State of World Population, UNFPA, 2003)