Coming 'Youth Bulge' Presents HIV Responses With Impetus, Obstacles, Opportunities

They are curious, impulsive and renownedly reckless. Studies have indicated they remain blissfully unaware of their risks, and unequipped to face them. Now, their numbers are growing fastest in countries that are home to great risks -- where rates of HIV infection are among the world's highest and where current approaches to testing and treatment already fall short of need. Soon, the coming generation of teenagers will be, Dr. Shannon Hader pointed out here on Wednesday, "the largest group of young people ever to walk the face of the planet."

The prospect of that coming "youth bulge," an explosion of teenagers, particularly in southern Africa, across the landscapes of countries that are struggling now to control the spread and impacts of HIV, is daunting, Dr. Hader, who is director of the Division of Global HIV and TB at the U.S. Centers for Disease Control and Prevention, noted in an opening talk here. But it is one that offers a choice, she added, between viewing its potential outcomes as "dividend or disaster."

The disaster outlook is, perhaps, easier to envision. Dr. Hader cited findings collected through the ZIMPHIA door-to-door surveys and testing coordinated by ICAP at Columbia University, in Zambia, Malawi, and Zimbabwe, showing that people who know they have HIV do well -- getting treatment and staying on it -- but that the people least likely to know they have HIV are young people -- boys and girls -- and men. Dr. Hader cited findings from the Centre for the AIDS Programme of Research in South Africa showing a vicious circle of teenage girls and young women getting HIV from relationships with slightly older men -- the girls and the men remaining unaware of their own infection -- and the young women eventually having relationships with, and transmitting the infection to men of their own age. And Dr. Hader cited findings from the Ring and ASPIRE trials which could not determine whether month-long topical HIV protection through vaginal rings were effective for teenage girls and young women because they didn't use the devices, and indicated that they did not believe they needed to be protected from the virus. Adding to those vulnerabilities, Dr. Hader said, are fast-growing trends of urbanization across southern African countries exposing young people to situations that can include isolation from support systems, unemployment, transactional sex, and sexual violence,with challenging access to health services.

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