[T]he global community will never deliver on ending AIDS if young people are not fully engaged and in the lead. Young people are the most effective engine for social change.”
Grounded in the conviction that participation and inclusion are core human rights principles, this Joint United Nations Programme on HIV/AIDS (UNAIDS) report presents a 3-lens approach to youth participation in the HIV response that centres on: working for youth as beneficiaries, engaging with youth as partners, and supporting youth as leaders. This approach helps categorise the current state of the HIV epidemic and the response to it in order to understand if and how programmes, services, and policies are engaging young people and thus ensuring that services are effectively tailored to their needs. This commitment is in line with the emphasis placed on the importance of youth participation within the Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fights against HIV and to End the AIDS Epidemic by 2030, adopted by Members States in 2016.
According to UNAIDS and the data shared throughout the document, young people face substantive challenges to access HIV and sexual and reproductive health (SRH) services, including inequalities, discrimination, exclusion, and violence. Harmful laws and policies such as age of consent requirements to access SRH services, HIV testing, and treatment are among the challenges. Only 36% of young men and 30% of young women (age 15 to 24 years) had comprehensive and correct knowledge of how to prevent HIV in the 37 countries with available data for the period of 2011 to 2016. More efforts are needed to tailor programmes to meet the specific needs of young people in all their diversity: Young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, young people who sell sex, and young people who inject drugs) are at a higher risk for HIV infection. In many settings, young key populations and their behaviours are criminalised. These same groups also experience discrimination in school and healthcare settings, which creates barriers to their access to information and services for HIV and SRH.
Thus, UNAIDS proposes that we see and amplify:
Young people as beneficiaries – Some areas that particularly affect young people in the context of the HIV epidemic and its response are:
- Knowledge: The document provides new indicators on access to comprehensive sexuality education (CSE). In short, young people often do not receive the necessary preparation to make autonomous and informed decisions about their own sexuality and relationships.
- Treatment: As noted here, the limitations of treatment registers and health information systems when it comes to compiling age-disaggregated data related to treatment continue to pose a substantial challenge to identifying gaps and addressing challenges related to HIV treatment access for adolescents.
- Discrimination: The document provides new indicators on consent requirements to access services. UNAIDS contends that “national dialogues between government authorities, civil society partners, youth-led organizations and other stakeholders must be brokered to review and reform (where necessary) restrictive laws and policies in order to establish and maintain young people as the prime beneficiaries” of HIV and other SRH and rights services.
Young people as partners – Globally, 71% of reporting countries stated that young people participate in developing policies, guidelines, and strategies that relate to their health; this varies across regions. “Further efforts are needed to ensure the development of emerging youth leadership and that youth receive the necessary tools and opportunities to participate in spaces where implementation and policy direction are decided.”
Young people as leaders – UNAIDS feels that young people living with HIV, young women, and young key populations must be supported to: organise into networks of affected populations; strengthen their capacity to mobilise and advocate; develop grant proposals; manage resources; and establish periodic monitoring and evaluation and other accountability mechanisms. As reported here, youth participation in the HIV response has often been supported to the extent that young people are encouraged to mobilise and advocate for an agenda. Often, however, these agendas are not designed by young people themselves, and the results do not trickle down to concrete country-level action. UNAIDS calls for investment in youth organising, in particular.
As several examples provided in the document illustrate, young people can play a critical role in demand creation and service uptake. From identifying and promoting youth-friendly services to mobilising peers in school and community settings in order to access HIV and SRH services, young people can make substantial contributions to stronger community responses. Their participation in demanding the creation of care and linkages to it also can occur through youth-led organisations or youth participation in community-based organisations that have a youth component. For instance, ACT!2030 is a youth-led social action initiative to inspire a new wave of activism in the HIV response by using youth-led research and data collection to establish accountability mechanisms for SRH and rights. Several successes from this initiative, active in 12 countries, are detailed.
In conclusion, UNAIDS stresses that young people are making substantive contributions to the HIV response through their advocacy and community responses. However, the capacity of youth-led networks and organisations working in the HIV response must be supported with technical and financial resources to ensure that their efforts are sustainable, and that young people are empowered to lead the end of AIDS by 2030.