Striving for an AIDS free generation of adolescents

A series of articles by guest writers for World AIDS Day Part of AVERT's World AIDS Day 2012 campaign, ‘Reflections on the Epidemic’ are a series of articles by guest writers. Our guest writers range from global leaders, writers, experts, activists, physicians and people personally affected by HIV and AIDS; and they represent various countries, experiences and backgrounds from all over the world. We are grateful to all our guest writers for their effort and the diverse and insightful viewpoints that they contributed to the world’s response to HIV and AIDS. We will be re-featuring these articles over the next few weeks on a weekly basis. Browse through this week’s featured articles, and see the full list below.

This past July Secretary Clinton gave an inspiring speech at the IAC applauding the progress we, as a global community, have made to get closer to the goal of achieving an AIDS free generation. The strides made in preventing mother to child transmission are remarkable. This World AIDS Day we should all feel proud, inspired, and renewed in our commitment to fight the disease. Amidst this excitement we must also ask ourselves, “who is falling through the cracks?”

Firstly, it's important to note that the idea of an HIV free generation is not quite as close as it may seem. Yes, the biotechnology is here, but there are many women and girls lacking access, both physically and socially, to PMTCT programs.  The infrastructure needs to catch up and it is not yet where it needs to be. I am confident that we will get to a point where all HIV positive women and girls will have safe access to treatment, but that is not the reality at this moment in time.

Fast forward…once we do have a generation of babies born HIV free, how do they continue to stay safe? This is where the hard part comes in.  Ah, the dreaded world of “behaviour change”.  Here’s the good news:  This isn’t a challenge that will surprise us or emerge once we have an HIV free generation.  The challenge of keeping young people safe from HIV is present now.  The only difference between now and the future is that there will be a much larger population of youth to keep safe from the virus.

It is for this reason that we need to focus even more on the particularly vulnerable demographic of adolescence.  I am going to nerd out a little bit on the adolescent brain so just bear with me.  Of the six regions of the brain, the frontal lobe is still maturing during adolescence.  One particular part of the frontal lobe, the prefrontal cortex, is one of the last regions of the brain to mature.  Among other things, the prefrontal cortex is responsible for impulse control, balancing short and long-term goals, initiating or inhibiting appropriate behaviour, and weighing consequences of actions.  In the most basic terms, the prefrontal cortex gives an individual the capacity to exercise good judgement.  Remember that feeling of invincibility that we all had up until about the age of 25?  You guessed it…our brains were still working on developing the ability to realise that we are not indestructible.  The point is that risky behaviour is one of the key reasons that HIV will remain a threat to young people, and if the brain does not have the capacity to make sound decisions, there needs to be support systems in place to ensure that there is access to information, skills, and resources to guide young people and help them keep each other safe.

Many focus on the fact that the age group with the highest HIV prevalence in South Africa is 30-34 in males and 25-29 in females, but what is often overlooked is when these particular individuals contracted the virus.  According to research done by the Medical Research Council, a quarter of South African children under the age of 13 are having sex and by the time they reach high school, 50% of pupils will have had sex.  Another study by the Human Sciences Research Council and Save the Children International reported that the average age of sexual début for both South African boys and girls is 14, often without their parents’ knowledge. This is a demographic that lacks sexual and reproductive health education, and yet many are having sex.

It is easy to back away at this time in a child’s life – they are notorious for being difficult to reach (who wasn’t a difficult teen?).  But this is also why they are MOST important to reach.  This period of sexual début mixed with an inability to exercise good judgement and a lack of sexual and reproductive health education is a dangerous combination.  So how do we reach them?  We must rely on those who know youth the best.  And who knows about the needs of young people better than the families and communities that surround them?  By supporting communities and organisations that understand how to reach youth and utilise a multi-pronged approach, adolescents can be engaged at multiple points of contact with education, skills, psychosocial development, and health services.  We also should not discount the youth themselves, but rather seek out their input.  They are intelligent, innovative, and resourceful assets in a complex environment.  If we are going to maintain the HIV free generation through adolescence, it is imperative that the youth are included in the process and that communities and organisations are supported in their efforts to keep young people safe. 

Lorrie Fair is a former professional soccer player dedicated to promoting peace, social development, anti-racism, women’s issues, and health education. Lorrie joined the Charlize Theron Africa Outreach Project as Head of Programmes in 2011.

For further information on HIV in South Africa, see AVERT's page.

Image copyright: AVERT