Prevention for Young People

What Works

Encouraging Behavior Change
  • Sex and HIV education with certain characteristics (see introduction to 5A) prior to the onset of sexual activity may be effective in preventing transmission of HIV by increasing age at first sex and, for those who are sexually active, increasing condom use and reducing the number of sexual partners.
  • Training for teachers to conduct age-appropriate participatory sexuality and AIDS education can improve students’ knowledge and skills.
  • Mass media and social marketing campaigns are modestly effective in persuading both female and male adolescents to change risky behaviors.
  • Communication between adults and young people about reproductive health information can increase protective behaviors.
Increasing Access to Services
  • Providing clinic services that are youth friendly, conveniently located, affordable, confidential and non-judgmental can increase use of clinic reproductive health services, including VCT.

Young people ages 15 to 24 account for an estimated 45% of new HIV infections (UNAIDS, 2008), yet “‘few young people receive adequate preparation for their sexual lives….’ Being sexual is an important part of many people’s lives: it can be a source of pleasure and comfort and a way of expressing affection and love or starting a family” (UNESCO, 2009: 1 and 4).

Prevention Efforts for Young Women are Critically Needed

Young women are especially at risk in some regions of the world. In many sub-Saharan African countries, young women ages 15-24 “are between two and six times more likely to be HIV-positive than men of a similar age” (UNAIDS, 2006: 88). In Cambodia, three times as many young women ages 15-24 are living with HIV compared to young men the same age (UNICEF, 2008 cited in IWHC, 2008). Women account for approximately half of all infections in the Caribbean (UNAIDS, 2009d: 54). However, among 15 to 25 year olds in Latin America, 0.3 percent of women and 0.5 percent of men are living with HIV (PAHO and NORAD, 2007).

Globally, the median age of sexual debut is below the age of 20 for young women and men in numerous developing countries (DHS, 2009).  Many young people, especially young women, have their first sexual experience before the age of 15. DHS data from 60 developing countries show that 25% of girls and boys had sexual intercourse before age 15 (DHS 2007 cited in IWHC, 2007). Data collected in 2006 from 26 countries in all regions of the world found that individuals who had not planned their first sexual experience were 75% less likely than those who had planned it to use condoms at first sex (Roach and Fontes, 2008). Ensuring that young people have the appropriate information to plan to protect themselves—before their first sexual experience—is therefore vitally important. 

Young women have limited power in sexual relations and many young women experience sexual coercion, often from older partners. For example, a 2008 study interviewed pregnant and never-pregnant women under the age of 17—twenty-four in rural Rakai District, Uganda and thirty-two in urban Jamaica—about their sexual experiences and found that many young women were pressured to have sex at an early age, did not make a conscious decision to do so, and later regretted it. In Jamaica, all of the interviewed young women indicated that they “should have been older the first time they had sex” (Geary et al., 2008: 18). In Uganda, where 9 of the 24 interviewees first had sex at age 14 or younger, half described coercion during first sex. Many Ugandan girls believed that men are entitled to demand sex, especially in marriage. As a married 17-year-old Ugandan indicated, “sex is ‘an obligation because you are married.’” (Geary et al., 2008: 22).  Delayed sexual debut is associated with girls’ education, which may play a crucial role in improving their self-esteem and options, enabling them to say no to unwanted sex. [See also Chapter 11E. Strengthening the Enabling Environment: Advancing Education]  

In addition to those in Chapter 3. Prevention for Women, interventions that work specifically for adolescents can be broken down into two main categories: