We know how! Responding to HIV and the youth bulge with youth voices
On International Youth Day (12 August), we look at the importance of youth involvement and safe spaces to respond to the HIV challenge associated with the youth bulge.
The population of young people (15-24) living in sub-Saharan Africa is expected to double by 2050, a demographic shift dubbed the ‘youth bulge’, or ‘youth wave’, depending on the country.
For those working in the HIV response, it presents a worrying challenge, as we have so far failed to control HIV in young people on the continent.
This is particularly true for young women in sub-Saharan Africa, who make up 58% of new HIV infections among young people globally and 67% of new infections in Africa. They are also eight times more likely to be living with HIV than their male counterparts in the region.
But complacency, not the bulge, is our biggest enemy. As the population of young people increases, so does our need to reach people, prevent, diagnose and treat HIV. The time has come to think innovatively about how to deliver programmes that speak to young people and give them what they actually want and need.
“We are the people that see and feel what is happening on the ground,” said Nancy Chishimba, a youth representative of Avert’s Young Voices Africa project, speaking at the #PasstheMic session with Charlize Theron at the International AIDS Conference (AIDS 2018) last month. “Because if you leave us behind and approach people that are higher than us. They don’t know what we feel, they don’t know what is happening to us.”
Indeed, the subject of youth engagement was a ‘hot topic’ at AIDS 2018, which saw the largest contingent of young people ever in attendance. But youth advocate, Bruna Martinez, told UNAIDS, “it's important that we are not being catered to but rather that we are recognized... HIV should not be in a vacuum, we are a generation that can discuss sex and that's a great thing; so give us the tools that tip things in our favour."
Also a hot topic was the idea of ‘safe spaces’. It is here that in an impassioned address about vulnerable populations, Dr David Malebranche asked: if you own a restaurant, and nobody is coming, you don’t go away and do a study about the customer. You ask yourself, does the food taste good? Is it convenient for the customer? Are my staff friendly? The concept of a population being ‘hard to reach’ is potentially stigmatising and “absolves the medical systems from holding themselves accountable for not just access, but the quality of health services we provide.”
AIDS 2018 demonstrated multiple, successful programmes that innovated to reach youth with HIV prevention and treatment services. Recognising that young people can play a critical role in demand creation and service uptake.
At one session, Tackle Africa demonstrated how they use the power of football to deliver sexual health education to young people on football pitches around the continent – by training coaches to use fun, interactive football drills with inbuilt health messaging with young people in their clubs and communities.
The Girl Power project in Malawi showed us how integrated youth-friendly health services lead to more young women getting tested, accessing condoms and hormonal contraceptives.
The Young Women Lead, Evidence, Advocate, Research, Network (LEARN) showcased their project which organises mobilisation activities and creates safe spaces for adolescent girls and young women to learn about pre-exposure prophylaxis (PrEP). With the peer educators they also created a fact sheet designed for and by young women.
Avert’s Young Voices project presented their methodology to co-create sexual and reproductive health and rights (SRHR) materials with young people from five countries in southern Africa, promoting decision-making around key topics that were chosen by them, and therefore relevant to them.
We know that young people face significant challenges to access SRHR services, including inequalities, discrimination, exclusion and violence. What is also clear is that ‘safe spaces’ are more than about physical spaces, they are about giving young people the voice to say how they want HIV information and what interventions they think would work for them.
UNAIDS’ new three-lens approach to youth participation – working for youth as beneficiaries, engaging with youth as partners, and supporting youth as leaders – is an important step to bringing young people to the table. They know how, and they can help us to ensure that the youth bulge in sub-Saharan Africa is the economic opportunity that it should be, not the public health crisis envisioned by some.