AIDS hits young people the hardest

Awareness campaigns must aim at curbing HIV infection rates among sub-Saharan youth

By Jacqueline Irving


The HIV/AIDS epidemic "disproportionately" affects the world's children and young adults, particularly girls and young women, says the Joint United Nations Programme on HIV/AIDS (UNAIDS). With rising rates of HIV infection in the general population, new infections are increasingly concentrated in young people, according to the AIDS Epidemic Update: December 1998, issued in November by UNAIDS. Half of all new HIV infections worldwide are occurring in those aged 15-24, with the epidemic inflicting an especially heavy toll on girls and young women living in sub-Saharan Africa.

Nearly 70 per cent of all new infections this year occurred in sub-Saharan Africa, with the majority of the world's worst-affected countries in Southern Africa, the "global epicentre" of the epidemic. HIV surveillance data gathered in sub-Saharan Africa reveal that the region's girls and young women often are more prone to acquiring the HIV virus at younger ages than are boys and young men. For example, the results of a recent study conducted in one area of Kenya showed that 22 per cent of girls versus just 4 per cent of boys in the 15-19 age group were HIV positive. In a study conducted in Ethiopia for the 20-24 age group, 35.4 per cent of the young women tested HIV positive compared with just 10.7 per cent of the young men.

Females became infected as many as five to 10 years earlier than males on average — in areas both where the epidemic was mature and where it was newly emerging, according to the results of a UN Development Programme (UNDP) study carried out in 1992 (Young Women: Silence, Susceptibility and the HIV Epidemic). This was attributed to "biological, immunological and/or virological" factors that possibly make young women especially susceptible, as well as to the subordinate status of females in many societies.

Young women "are often unable to negotiate safe sex with their partners, and in many cases are subjected to abuse, including rape," said Dr. Nafis Sadik, Executive Director of the UN Population Fund, speaking on the occasion of World AIDS Day, 1 December. "This violence against women is exacerbated by a new form: the infection of women with HIV by spouses or partners who acquire the virus through their exploitation of sex workers," she added.

HIV/AIDS is also taking a severe toll on African children. As many as 10 per cent of all new infections are occurring in children under age 15 and 90 per cent of these young children reside in Africa, the UNAIDS report says. Progress in raising child survival rates has been reversed in many parts of sub-Saharan Africa, where nearly 94 per cent of the world's 3.2 million child AIDS deaths have occurred. For example, the UNAIDS report says that by 2005-10, 72 of every 1,000 infants born in Namibia are expected to die of AIDS before reaching their first birthday; in the absence of AIDS, the infant mortality rate would have been a significantly lower 45 per 1,000.

Most of the children who have lost their lives due to AIDS are believed to have become infected by the HIV virus at or before birth or while breastfeeding. In Zimbabwe, a country especially hard hit by the epidemic, blood taken from pregnant women at 23 of the total 25 surveillance sites set up for anonymous HIV testing showed that between 20-50 per cent of women tested in 1997 were infected with HIV. The prognosis for the unborn children of these mothers is alarming: mother-to-child transmission occurs in at least one-third of all cases where the mother is HIV positive.

Prevention versus care


While noting that transmission rates can be cut if HIV-infected women are treated with certain drugs during pregnancy and avoid breastfeeding after giving birth, the recent UNAIDS report stresses that the "ultimate aim" must be "effective prevention" so that young women avoid getting the HIV virus. But a recent decision by the South African government to cancel a project to administer the zidovudine (AZT) drug to HIV-infected, pregnant women, sparked a passionate debate on striking the right balance between prevention and care.

Until October, a pilot project in Johannesburg had been administering a short course of AZT to 2,500 HIV-positive pregnant women, based on evidence that the treatment could cut the risk of mother-to-child transmission by as much as 50 per cent. However, South Africa's health minister, Dr. Nkosazana Zuma, cancelled the pilot project, primarily on grounds that, at a cost of $50 per treated woman, it was too expensive. Dr. Zuma argued that the money would be better spent on public prevention campaigns and condom distribution. Critics of the decision say that it has tipped the scale excessively in favour of measures that emphasize prevention over treating those already infected.

South Africa accounts for more than half of new HIV infections in sub-Saharan Africa and a 1997 national survey showed that one in seven pregnant women was HIV positive. South Africa is now estimated to have the second largest population of HIV-positive people worldwide (topped only by India). In addition to the subordinate status of women, factors driving the epidemic in South Africa include the end of the country's isolation in the post-apartheid era, with particularly high rates of transmission by the many migrant workers from within and outside the country, and slow progress in implementing public information campaigns.

AIDS orphans


Another disturbing trend, indicative of how HIV and AIDS are disproportionately affecting young people, is the rising number of children orphaned by AIDS. Moreover, 95 per cent of the world's "AIDS orphans," defined by UNAIDS as children under 15 who have lost both parents or their mother to AIDS, reside in sub-Saharan Africa, according to the recent UNAIDS report.

Because new infections are increasingly concentrated in young adults — those who are likely to be raising families — the epidemic has dire implications for their children. A study conducted in Mutare, the third-largest city in Zimbabwe, already showed that nearly 15 per cent of the city's children were AIDS orphans in 1995, up from a rate of just over 10 per cent in 1992.

And when AIDS orphans turn to their extended families, they do not always get help. One study mentioned in the UNAIDS report found that, in the case of 88 per cent of households headed by orphans who had surviving adult relatives, the relatives were unwilling to care for the orphans. Nearly half of the adult relatives who do care for orphaned children are grandparents and many of these caregivers are hindered by age, sickness and/or lack of income.

A study published by UNDP in late 1997 looked at the case of children orphaned by AIDS in Kisumu and Siaya districts in Kenya and concluded that it is in the best interest of orphans to be "retained in their own communities and under the care of an adult." Moreover, the study recommended that the entire community become involved in caring for AIDS orphans in villages.

UNAIDS has pointed out that "solutions have to be found in the community," noting that many communities in Zimbabwe have made strides in this area. Several Zimbabwean village heads have set aside land for cultivation by all villagers for the purpose of feeding orphans and others suffering from AIDS. And some Zimbabwean church groups have trained women to pay regular visits to the neediest orphan-headed households within their communities. According to UNAIDS, these efforts also have the advantage of being affordable because they are community-based.

Force for change


In recognition of the growing threat that HIV/AIDS poses to young people, as well as the potential power they hold to change the epidemic's course, this year's World AIDS Campaign adopted the theme "Young People: Force for Change."

Because young people's sexual habits are more subject to change, AIDS awareness campaigns geared specifically for them have proved effective in encouraging them to adopt safer behaviour from the beginning of their sexual lives. Campaigns aimed at young people in Uganda, Tanzania and Senegal — countries that have succeeded in curbing infection rates — are often held up as models for other African countries. Intensive efforts to educate young people and distribution of free condoms are the key elements behind the success of these campaigns.

AIDS specialists consider awareness campaigns to be the only way in which the epidemic can be brought under control in developing countries, in the absence of a viable vaccine.

New vaccine projects target African HIV strains

Two innovative research projects launched in November aim to develop cheap, safe and effective AIDS vaccines targeted specifically at HIV virus strains most common in Africa.

These initiatives — a UK-Kenyan partnership and a US-South African collaboration — intend to produce a successful vaccine priced cheaply enough for widespread use in poor countries, in exchange for total start-up funding of $9.1 mn raised by the International AIDS Vaccine Initiative (IAVI). A small, US-based non-profit organization, the IAVI aims to expedite HIV vaccine testing in developing countries.

Scientists consider the start-up funding sufficient to begin human testing in Kenya and South Africa within the next few years.

The UK-Kenyan project, which joins researchers at Oxford University and the University of Nairobi, is developing a two-step vaccine using genetic matter extracted from the HIV virus and genetically engineered animal vaccinia virus. (A strain of vaccinia virus was used to eradicate smallpox.)

The US-South African project links the University of North Carolina and AlphaVax, a small US-based biotechnology company, with the University of Cape Town. The vaccine being developed uses an altered strain of Venezuela equine encephalitis virus, a tropical microbe.

In early lab and animal tests, both vaccines appear to successfully trigger the immune system to produce cells that hinder HIV infection.

Because the HIV virus is highly variable, many consider the development of a viable vaccine to be a remote dream. Nevertheless, some 30 vaccines reportedly are at various stages of research and/or testing.

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