Complex issues are fueling HIV transmission among young people, particularly young people of color. In order to address that, interventions must address individual behavior and the social and cultural issues that fuel HIV transmission. The following critical components for HIV/STI prevention are drawn from research.
- Teach skills. The ability to use condoms, negotiate safer sex, build relationships, communicate with steady and casual partners, make decisions, and say "no" strengthens teens' ability to make healthy choices.
- Involve young people. Involving young MSM in creating and carrying out programs reduces risky behaviors while building their spirit of self-determination and self-worth. Plus, research has shown that identifying peer leaders is an effective way of reaching young people.
- Use risk reduction strategies. Programs should include information about reducing the number of partners, the relative risk of specific behaviors (e.g., anal sex vs. oral sex), understanding one's own level of risk, and other ways to reduce HIV risk beyond abstinence and condom use.
- Support comprehensive sexuality education. Many students encounter misinformation and harmful stereotypes in HIV prevention education and sexuality education. Abstinence-only programs often rely on stereotypes of gender roles and use heterosexual relationships as models. This not only ignores lesbian, gay, bisexual, and transgender (LGBT) young people, but contributes to stigma against those who don't fit a traditional masculine role. Comprehensive sex education should include instruction on risk reduction for all teens, including LGBT young people.
- Adopt an ecological approach to prevention. An ecological approach attempts to create more effective and culturally competent programs by looking at a young person's entire world (family, community, relationships, and influences) and by creating peer, group, and family-level interventions.
- Support structural interventions. These approaches promote health by changing the environment -- creating social norms that address behavior and encourage HIV testing. This could lead to a lower community viral load and result in fewer HIV transmissions. Some interventions require changes to law and policy in order to link HIV-positive youth to care, ensure continuity of care, promote treatment adherence, and improve standards on when to start HIV medications. Policymakers must also address LGBT young peoples' increased vulnerability to negative health outcomes. This includes creating policies that protect against bullying and discrimination, and youth-led programming to reduce social isolation and stigma. Providers can also participate by creating youth-friendly services and contributing to efforts to reduce the stigma around HIV.
No single strategy will work to reduce HIV among young people. But research has shown that culturally competent programs that include information about abstinence, contraception, and condoms can be effective in helping young people reduce risk behaviors. In addition, open and honest parent-child communication about HIV can help them make good decisions. Finally, resources must be directed at understanding the epidemic's impact on the young, addressing the issues that contribute to the epidemic, and developing and testing a vaccine.
Jennifer Augustine is the Division Director of Health and Social Equity at Advocates for Youth. Emily Bridges is Director of Public Information Services at Advocates for Youth.