Young people: the centre of the HIV epidemic.

OBJECTIVES: This chapter reviews data on the situation of young people and HIV/AIDS. It assesses whether young people have access to the information, skills and services required to reduce their vulnerability and whether there has been any reduction in HIV prevalence among 15--24-year-olds.
METHODS: We reviewed the data on knowledge, behaviour, life skills, access to services and HIV prevalence among young people from nationally representative household surveys, antenatal care surveillance reports, behavioural surveillance surveys, a global coverage survey and other special studies.
FINDINGS: In countries where HIV is concentrated among sex workers, injecting drug users or men who have sex with men, high-risk behaviour commences for most during adolescence, and large proportions of these high-risk populations are younger than 25 years. In countries with generalized epidemics, the epidemic is also driven by young people. Half of all new infections in sub-Saharan Africa occur among this group. Many young people do not have the basic knowledge and skills to prevent themselves from becoming infected with HIV. Young people continue to have insufficient access to information, counselling, testing, condoms, harm-reduction strategies and treatment and care for sexually transmitted infections. Other socioeconomic factors beyond the control of individuals need to be addressed. Countries that have reported a decline in HIV prevalence have recorded the biggest changes in behaviour and prevalence among younger age groups.
CONCLUSIONS: The epidemic varies greatly in different regions of the world, but in each of these epidemics young people are at the centre, both in terms of new infections as well as being the greatest potential force for change if they can be reached with the right interventions.