In May, the Joint United Nations Programme on HIV/AIDS (UNAIDS) released its annual report, 2 0 06 Report on the Global AIDS Epidemic: A UNAIDS 10 th Anniversary Special Edition, in preparation for a United Nations high level meeting to review the Declaration of Commitment on AIDS (2001). The report presents the most up-to-date statistics available on epidemiology and documents the global expansion of prevention, treatment, and care interventions. It calls for overcoming current social and political barriers to the expansion of comprehensive prevention programs for young people.

The most recent estimates reveal that fully half of new HIV infections occur among people under the age of 25.1 As such, UNAIDS identifies all young people as a key group needing immediate HIV-prevention education and services:

Young people who need HIV prevention services include both males and females, school students and young people who do not attend school, sexually inexperienced young people and those who are sexually active, and a substantial percentage (especially among girls) who are already married.2

To be effective, HIV-prevention programs for young people should be “widely accessible, evidence-based, grounded in human rights, age-specific and gender-responsive, and should help build life skills to enable young people to reduce their vulnerability.”3 According to UNAIDS, a balanced and comprehensive prevention strategy will promote abstinence, faithfulness, women’s equality and empowerment, reduction in the number of partners, and consistent condom use.4 Such a comprehensive approach seeks to address both the public health imperative to stop the spread of HIV and an the human rights of individual young people: “for the many young people who are sexually active, access to comprehensive prevention services, including prevention education and provision of condoms, represents an urgent global health necessity and a fundamental human right.”5

Comprehensive education programming lays a foundation of basic understanding about the virus that causes AIDS, its modes of transmission, and tools for prevention. Such programming also presents an educational opportunity to address underlying gender norms, taboos, and fears that keep people vulnerable to infection and foster stigma and discrimination that undermine successful prevention, testing, and treatment programs.6 For example, UNAIDS argues that preventing HIV transmission on a large scale requires changing deep-seated traditions and social norms regarding human sexuality. This includes efforts to generate gender equity, especially in locales where status, economic dependence, and limited opportunities for education and employment render women disproportionately vulnerable to HIV infection.

UNAIDS suggests that following the evidence and human rights standards and implementing comprehensive prevention programs has the potential to turn the tide in the fight against AIDS. It estimates that as many as two-thirds of the new HIV infections expected to occur this decade could be averted by the implementation of a comprehensive range of evidence-based prevention measures.7 For example, by scaling up available prevention strategies in 125 low- and middle-income countries, the global community can avert an estimated 28 million new HIV infections between 2005 and 2015—more than half of those that are projected to occur during this period. This alone and would save US$24 billion in associated treatment costs.8

Despite the clear roadmap for successful prevention efforts and the potential benefits of following it, UNAIDS writes that current efforts are falling short and current ideological deadlocks are undermining progress:

Nearly twenty-five years of experience with HIV prevention and ten years of experience with effective antiretroviral therapy have produced mountains of evidence about how to prevent and treat this disease. Yet, these advances in the social and biomedical sciences, while vitally important to mounting an effective response, do nothing to mitigate the shortages of leadership and human compassion that frequently hinder progress towards our shared goals.9

UNAIDS addresses the abstinence-only-until-marriage approach championed by the current U.S. Administration and its new political allies in Africa, arguably the most glaring example of a failure to follow evidence and realize human rights in prevention. UNAIDS writes, “in recent years, programmes that promote abstinence as the sole HIV prevention strategy for young people have attracted considerable attention from researchers, programme implementers, policy-makers, advocates, and commentators.” On the basis of the evidence, however, “experts in adolescent health broadly agree that comprehensive HIV prevention programmes—which simultaneously promote condom use and delayed initiation of sex for those who are sexually active—represent the most effective approach to HIV prevention for young people.”10

In short, UNAIDS recognizes that HIV/AIDS is a sexual health issue for most young people and that failing to address sex keeps young people ignorant and therefore dangerously vulnerable. The report states, “open discussion of sex is necessary to the provision of effective HIV prevention for young people. In some cultures, many young people, especially girls seeking to preserve their virginity, may engage in anal or oral sex in the belief that such behaviors do not constitute sex. Veiled or euphemistic discussion of sexuality may inadvertently permit such misconceptions to persist, potentially placing young people at risk of HIV infection.”11 Political pandering and socially conservative mores are serving to proliferate programs that perpetuate mystery and shame around sex and AIDS, but according to UNAIDS, “access to HIV prevention, care and treatment is continually limited by unwillingness to address issues long considered taboo, such as sex, sexuality, and drug use. This must change.”12

To access the full 2006 UNAIDS report, please visit:
http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp

To read more about the current U.S. Administration’s opposition to “evidence-based” prevention, please visit:
http://www.siecus.local/policy/PUpdates/pdate0259.html

References

1. Report on the Global AIDS Pandemic: A UNAIDS 10 th Anniversary Special Edition (Geneva : Joint United Nations Programme on HIV/AIDS, 2006), 137, accessed 26 June 2006, <http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp>.
2. Ibid.
3. Ibid., 138.
4. Ibid.
5. Ibid., 137.
6. Ibid., 3.
7. Ibid., 5.
8. Ibid., 125.
9. Ibid., 3.
10. Ibid., 139.
11. Ibid., 138.
12. Ibid., 5.