‘All In’ in Asia-Pacific: supporting adolescents at risk of HIV

Today, UNICEF and UNAIDS are launching the ‘All In’ campaign to end the AIDS epidemic in adolescents by 2030. This is an exciting new stage in the fight against HIV and AIDS. The last decade has seen remarkable success in reducing HIV transmission from mother to child, and advances in treatment.
I have worked on HIV and AIDS in Asia-Pacific for 20 years and seen many of these changes first hand. To complete this work, I believe we now have to focus on adolescents.

Despite declining new HIV infections in most countries in Asia-Pacific, an estimated 52,000 new HIV infections occurred among adolescents, accounting for 15 per cent of all new HIV infections (350,000) in 2013. AIDS related deaths among adolescents has increased three-fold since 2001. Evidence suggests that adolescents who are at higher risk and those living with HIV are not receiving the attention and services they need.In order to end the epidemic by 2030, we have to start with targets for 2020. These include reducing new infections amongst adolescents at risk and AIDS related deaths among those already infected.In East Asia Pacific, we have to identify and reach the most at risk adolescents while investing in high-impact, proven interventions such as access to condoms, HIV testing and counselling, antiretroviral treatment, prevention of parent-to-child transmission of HIV and harm-reduction.At-risk populations

 

Adolescents in the Philippines protecting themselves through peer discussions
© UNICEF/UNI177053/Palasi

 

Adolescents at higher risk of HIV include those who purchase or sell sex from peers or adults, boys and men who have sex with other men, transgender adolescents and those who inject drugs.

Adolescents who are most at risk are often hidden under the radar. I have seen for myself that unlike their older peers, they do not come out for fear of revealing their sexual identity, for being bullied, rejected and for being caught or arrested by police. They are often rejected by their families and are vulnerable to sexual abuse, exploitation and diseases while at the same time having less access to health, education or other services.

“This group of young people do not open up. Working out how to reach them with effective interventions is a challenge”, Som, a social worker with the Thai NGO Issarachon Foundation, said recently.

Other than selling sex to survive, there is also a growing number who sell sex to buy luxury goods, such as a mobile phone, or a Gucci or a Prada bag.

The age of first sex has also declined over the years. Available data on adolescents show that comprehensive knowledge about HIV, condom use and HIV testing coverage is still low in most Asia-Pacific countries.

I have talked directly to street-based sex workers in Bangkok about this. “Young people do not have proper information and they don’t know how to correctly use a condom,” said Apple, 39, a Thai sex worker who started selling sex at the age of 18.

In several countries in Asia-Pacific, people under the age of 18 are considered too young to give consent to access HIV testing and other essential health services. They often require parental consent, which they are either unable or unwilling to ask for, and end up not getting the test.

In December 2014, following advocacy together with partners, the Thailand Medical Council revised the guideline to include the right of people under 18 to take a test without parental consent. The guideline also emphasizes maintaining confidentiality under careful consideration.

Thanh Tung‘s story

 

Thanh Tung, 24, found it difficult to find HIV information in Vietnam
© UNICEF EAPRO/2015/Jingjai N.

 

We recently met 24-year-old Thanh Tung from Vietnam at a youth forum for HIV activists in Bangkok. He struck us as a modest and a shy person.

Tung’s story was typical of many adolescents. “When I was 18 years, I went to Hanoi for the first time,” he said. “It was the first time I saw a lot of interesting and new things. I started to explore information through the internet and wondered why I was attracted to other boys. This was also the first time I got to know about HIV.”

Tung soon realised that he was at risk of HIV. “It was difficult time for me when my boyfriend told me that he also had sex with other people,” Tung continued. “I felt very nervous about my HIV status.  Because of stigma and discrimination, I could not ask anyone where I could get an HIV test. Then I met someone from an NGO. He asked me a lot of questions, did not judge me and offered to help.  He taught me how to protect myself.”

We asked Tung why he decided to become an HIV activist. “I wanted to support young people like me to learn about HIV and protect themselves,” he replied. “I want to be channel for other people and link them to health care services or an organization that can help them. I think in Vietnam, the policy on HIV is good but I hope that high-risk groups such as men who have sex with men can be accepted and supported.”

Respondent driven sampling 

In order to improve access to services for young people like Tung, one of the first things we need is accurate and reliable data about adolescents at risk of HIV. Missing information on this group leads to their absence from policies and programmes designed for youth in general.

It can be difficult to get information on a hidden population. Because of this, UNICEF recommends respondent drive sampling. This can be used where the number of adolescents or young people in identified subgroups is unknown.

We work on selecting a small number of “seeds”, who are initial survey respondents. They in turn recruit others through their network of friends and contacts, and this peer-to-peer recruitment continues in waves until the desired sample size is reached.

This year, UNICEF Thailand with partners produced a report on young people affected by HIV, using this respondent driven sampling method. The report found that Thailand is facing a new rise in sexually transmitted infections, with 70 per cent of all cases occurring in the 15-24 age group.

Thailand is one of three countries identified for the launch of the ‘All In’ in Asia-Pacific. The data from this report is timely and offers strong evidence to strengthen national capacities for improving policy and planning for adolescents at higher risk of HIV and those living with HIV.

It is my hope that, thanks to initiatives like this, adolescents and young people in the region can be free of HIV and AIDS by 2030,  and that every adolescent will feel safe, valued and supported to be who they are.

The author
Wing-Sie Cheng, Regional Adviser, HIV and AIDS for UNICEF East Asia and the Pacific

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