AIDS: Focus on Youth
Donovan, Catherine, Canadian Journal of Public Health
Has AIDS disappeared? You might think so if you were the student who asked this question or many like her in Canadian communities.
In the late SOs and early 90s, AIDS was still relatively new. The epidemic was evolving quickly. At a time of health services restructuring, when the future of public health may have been considered tenuous, AIDS created a climate of excitement and urgency. Enthusiasm sparked imaginations and led to the creation of programs that were innovative and far reaching. In 1990, every child would have heard about AIDS, if not in school, then through TV, radio or magazines. Since then, the energy and enthusiasm that surrounded AIDS has faded for many public health workers in Canada. Our attention has been diverted as the stresses of restructuring have placed AIDS in a catalogue of priorities that is ever expanding. Youth who learned the "Facts of Life" in the early 90s wonder if they still should be concerned and ask where they can get the support they need to act on the safe choices they were encouraged to make. In some communities the facts about AIDS are still a mystery to younger children.
We know AIDS has not disappeared. Up to December 1997, it was estimated that 41,681 people had tested positive for HIV in Canada and the total number of AIDS cases was estimated to be 20,000.12 Although the annual reports of AIDS cases and deaths have been declining in recent years,' this is most likely attributable to improved treatments and delayed onset of disease.
AIDS has certainly not disappeared for the young: in Canada, the incidence of AIDS is steadily increasing among youth.2 We know that the proportion of AIDS cases attributed to injection drug use is increasing annually with the greatest increase in the youngest age group.2 Worldwide, at least a third of the 30,000,000 people estimated to be infected with HIV are 10 to 24 years old and every day an estimated 7,000 young people are infected with the virus.3
Young people are particularly vulnerable to the risks of acquiring HIV infection. They are exploring their environment beyond the safety of their home. They are seeking new experiences and testing their own boundaries as well as those of their parents and communities. However they often receive confusing messages. They are encouraged to explore, but are confined by standards and stereotypes that they feel powerless to effect. They are taking risks in all aspects of their lives. Often their behaviour is governed by formidable social pressures that they are not prepared to confront. Their world offers opportunities and choices, but we have not always made it possible for them to learn the skills they need to make the safest decisions. Nor do we offer support for their choices. Every day they are challenged by pictures and models that contradict the concepts of safety and health.
Risk behaviour among young people in Canada is still prevalent in spite of early efforts. Approximately 44% of youth between the ages of 15 and 19 are sexually active, many of these reporting having had sex without a condom.4 Among those who are sexually active, 47% of young men and 32% of young women report two or more partners in the previous year.4 In the US, a study of 65,000 adolescents indicated that approximately 10% of youth initiated sexual intercourse by the age of 13.5 Sexually transmitted disease rates directly reflect the prevalence of unsafe sexual behaviour. Young women between the ages of 15 and 19 have the highest rates of infection for chlamydia and gonorrhea in Canada.6 Worldwide, about half of the STD cases reported every year are in the under 25 age group.3
Youth in general are at increased risk of acquiring HIV infection, but there are young people who are even more susceptible. Globally, young girls often are defenseless in social structures which promote subordinate and dependency relationships between males and females. …