Adolescent HIV India Perspective -Current Research and Future Scope

1. Adolescent HIV India Perspective -Current Research and Future Scope R.K. Baxi Professor Adolescent Paediatrician

2. Human Immunodeficiency Virus (HIV) affects 40.3 million people worldwide [(UNAIDS) & (WHO) 2005]. Sub-Saharan Africa, with an estimated 25.8 million carriers, has the greatest burden of disease (64%) [ (UNAIDS) & (WHO) 2005]. The prevalence is estimated at 5–15% in most other Sub-Saharan countries Asia has an estimated prevalence in the region of 8.3 million, with 2.5 million being in India, giving an Indian adult HIV prevalence of 0.36% (NACO; MOHFW, 2007).

3. In India, young people in the age group 15 - 24 years comprise almost 25% of the country’s population; However, they account for 31% of the AIDS burden. (NACO; MOHFW 2007).. One youth is reported to be infected with HIV/AIDS almost every 15 seconds (Population Foundation of India, 2003). HIV prevalence in the 15 - 19-year age category is 0.04%, while it is 0.18% in the age group 20 - 24 years (National Family Health Survey, 2005-2006).

4. In India adult (15 years or above) HIV prevalence is 0.36%.  It is now thought that around 2.3 million people in India are living with HIV. Of these, an estimated 39% are female and 3.5% are children.

5. National Family Health Survey 2005-2006, HIV statistics

6. 2009 3rd Quarter Data

7. NACO guidelines for Phase III include all under age 18 as ”Children” and “youth” as age 15 to 19. Perhaps ,missing on either side the period of sensitive transition- Adolescence. • No specific data set or information for Adolescents is analyzed or reported.

8. Research with rural youth in Maharashtra suggests that HIV knowledge is low. For example, in a study, rural Maharashtrian girls and women aged 15 to 24 years old, only 49% indicated that they were aware of AIDS and only 60% reported that AIDS could be avoided. India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for rural Indian youth Asha Banu Soletti1* , Vincent Guilamo-Ramos2* , Denise Burnette2* , Shilpi Sharma1* and Alida Bouris3* 1  School of Social Work, Tata Institute of Social Sciences, Mumbai, India 2  Columbia University School of Social Work, New York, NY, USA 3  School of Social Service Administration, University of Chicago, USA

9. Sexual behavior remains the leading cause of HIV infection in India, and complex factors underlie rural youth's vulnerability to HIV. In Maharashtra, many rural young men migrate to cities, particularly Mumbai, in search of economic opportunities. While they are in urban areas, young men may have sexual relationships with women, including sex workers. India-US collaborative Stusy,November2009.

10. Some young women enter early marriages or commercial sex work, and gender inequality creates power differences that create formidable barriers to consistent condom use. Among young people aged 15 to 24 years, the number of women with HIV/AIDS is estimated to be almost twice that of young men. Taken together, these factors suggest that rural adolescents are a vulnerable group of young people. India-US Study, November 2009

11. Adolescents though “invisible”, do not exist in isolation. Their capacities and opportunities dramatically differ based on age, gender, schooling, economic and family background, marital status, area of residence etc etc.. School going girls in age 14-17 yrs are mostly unmarried and less likely to have sexual exposure as compared to out of school girls of the same age, married or unmarried! And we have around 25% girls in this age group who do not go to school. Premarital sex, school drop out and unwanted pregnancy are interrelated. UNFPA-Pop. Council report-2005-06

12. Indian Minister of Health and Family Welfare and the US Secretary of Health and Human Services signed a bilateral agreement in 2006 to collaborate on the prevention of sexually transmitted infections (STIs) and HIV/AIDS in India.

13. The overall goal of the bilateral agreement is to "promote and develop cooperation in the fields of HIV/AIDS and STI prevention, research, treatment and care, infrastructure development, training, and capacity-building on the basis of reciprocity and mutual benefit”. The bilateral agreement also identifies a number of key areas for cooperation between India and the US, including "developing innovative intervention strategies for the prevention and treatment of HIV/AIDS”.

14. Child Brides. Though not legal ,child marriage is a grim reality. This means early sexual experiences, perhaps unsafe, coming at a vulnerable time with limited or no empowerment. India has nearly 20% girls married before age 17

15. Although male adolescents report higher rates of sexual activity than females, female adolescents are also vulnerable to HIV. • A complex combination of factors related to increased biological susceptibility, low levels of education, poverty and gender inequality heighten vulnerability for many females. Many young women do not complete secondary school. • NACO Phase III

16. HIV and AIDS affect young people disproportionately. Nearly 33 per cent of the reported AIDS cases till June 2005 were in the 15 to 29 years age group. Very young adolescents or children (10-14 years) or youth (10-24 years), because of their lack of correct information and life skills, behaviour of experimentation and above all their biological predispositions, are especially vulnerable to risks of HIV infection. NACO Phase III

17. In Summary, • RoL suggest that Information (if not knowledge) about HIV among adolescents is adequate, with wide variations among various socio-cultural settings in different states across India. • Regular Behavioral Surveillance Surveys among adolescents-both school going and out of school are indicated.

18. For majority of Adolescents and Youth mass media, older friends ,peers, teachers and text books appear to be the source of information on Sexuality, sex and HIV • Teachers are not well equipped to carry on with education on Sex n sexuality- we call it Family Life Education! • Although NACO has put in place several efforts, School based sex education is not uniformly acceptable

19. Sexual Behavior and condom use: • Premarital sexual experience ranges from 3% to 11.5% while 25% expressed favorable attitude to it. • Though over 90% youths know about condom use, actual use at the time of Sexual encounter is reportedly as low as 10% • Multi-partner sex, group sex ,MSM and visiting Brothels –all these behaviorsare reported

20. Attitude towards HIV testing and PLWHA A significant improvement in attitudes towards PLWHA has been reported by NACO,BSS2006. However, voluntary testing for HIV is very low. (Low perception of Risk…) Anita Nath, HIV/AIDS and Indian youth – a review of the literature (1980 - 2008) Journal of Social Aspects of HIV/AIDSVOL. 6 NO. 1 MARCH 2009

21. Future considerations: HIV epidemic is now Adolescent & youth centered in both gender Hence, working with Adolescents and Youth is a window of hope & opportunity for effective preventive strategy Reducing stigma, promoting safer sex practices, correct and consistent condom use School based Sex and sexuality education

22. Peer group education and Training • Greater role and autonomy for NGOs to reach the unreached • Teachers’ training/education in adolescent friendly approach to risk mitigating development • Empowering female adolescents and youth for their sexual and reproductive rights.

23. I am fourteen and frail But uncorrupt and fragrant Full of dreams and desires And, the’ ‘will to do’ like fires Listen to me, give me some space Protect my grace, brighten my face For I am your future, - I am Innocence, I am Adolescence. R K Baxi