By Sally Beadle
Good afternoon and a very special welcome to all young people and youth force participants we have here today. It is my pleasure to report on the strong and vibrant youth programme that has made a significant contribution to AIDS 2014. I would like to say a special thank you to my amazing team of youth rapporteurs – Jeffry Acaba, Gareth Durrant and Joanna Williams who have worked tirelessly and enthusiastically throughout the week.
This conference calls for more strategic investment in adolescents and young people. Globally, adolescents (10-19) are the only age group in which HIV-related deaths are increasing. They are more likely to die from AIDS than any other age group. AIDS2014 has highlighted that adolescents and youth have not received sufficient attention in programming, policy or research efforts. Without significant attention and investment in this area, we will not be track to achieve an AIDS free generation. Despite this, the conference has shown that many adolescents and young people themselves are stepping up as leaders. They are making positive changes in their communities. And they are calling for more meaningful involvement of diverse communities of youth in the overall response. They are producing evidence about what is possible when this happens.
Last week, 100 passionate young leaders from 56 countries engaged in the Youth Pre-conference, coordinated by the Melbourne Youth Force. Skills-building and knowledge exchange workshops explored ways in which youth can put the health, well-being and human rights of young people at the heart of the post-2015 development agenda. The pre-conference showed that young people have the courage and capacity to speak out on issues that need addressing. They are not just the emerging leaders of tomorrow – they are leaders and advocates in their communities now. This global team of young leaders developed the Youth Action Plan, presented to UNAIDS and The Global Fundon Tuesday. The action plan has four themes: treat, educate, reform and love. With permission, I will now use these four themes to structure the remainder of my presentation.
We have seen that as treatment becomes more readily available, more children are surviving into adolescence. Several sessions highlighted the importance of facilitating a smooth transition for these children from paediatric to adult care. Many adolescents struggle as they move from familiar child-centred environments into unfamiliar and less supportive adult clinics. This contributes to poor adherence practices amongst young people. Young people at this conference are calling for youth-specific and youth-friendly treatment services. They want health workers who communicate with them rather than tell them what to do. At the same time, health workers want tools and training to help them work appropriately and effectively with adolescents and youth. The Baylor-Uganda Clinical Centre of Excellence was highlighted across several sessions as a positive example. It provides a peer-support program to young people living with HIV in which young people can open up, encourage and support one another to live positively and adhere to their medication.
There is an urgent need for legal reform. In many countries laws and policies restrict young people’s access to HIV and other sexual and reproductive health services, including harm reduction.
The age of consent to access services has been a key focus of discussion. Requirement for parental consent for testing was raised by many as a deterrent for young people who cannot or do not want to discuss drug use or sexual behaviour with their parents or guardians. Findings from a recent online parental consent survey launched by the PACT – a collaboration between 25 youth-led and youth-serving organizations – was shared, calling for parental consent to be a choice, not a requirement.
Strong arguments were made that laws and policies should recognize the evolving capacity of young people to make independent decisions regarding their own health. South Africa, which has reduced the age of consent for HIV testing to 12, was shared as a positive example.
Age restrictions and parental consent requirements to harm reduction services, along with abusive law enforcement practices to young people who inject drugs were emphasised in many sessions as increasing risk. YouthRISE has stressed the need to remove barriers to harm reduction for young people under 18. Harm Reduction International and partners introduced ‘Step by Step – a tool to help harm reduction service providers deal with the practical, legal and ethical issues of working with young people who inject drugs.
Advocates for young people who sell sex are calling for expanded access to HIV prevention and treatment and urgent dialogue on the issues of protection and safety. One panellist said we need to look closely at ‘what the evidence actually shows, in terms of whether laws that are supposed to protect children from exploitation actually cause more harm’.
To assist action on these issues, WHO and partners have released draft technical guidance briefs for young people from key populations – based on widespread international consultation. Young people are also included in the WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations launched this week.
We can’t treat our way out of the epidemic and education is an important aspect of PREVENTING new infections.
Ignorance and denial are health issues. Young people point to the continuing silence around sexuality, and the denial that many young people are sexually active. But young people do have sex – while some wait until they are married, many do not. Some have sex with the same sex, some with the opposite sex and some with both. Young people want information about sex and sexuality. In the Opening Ceremony, Ayu Oktariani – an inspiring young leader from Indonesia – said that many young people like herself are vulnerable because they are neither given the information they need nor the means to protect themselves.
Young people from key populations called for sex education that ‘thinks outside the box’ goes beyond hetero-normative assumptions and recognises and celebrates multiple sexualities and gender identities. Research presented this week underscores that to effectively promote the sexual health of young people, programs must go beyond raising awareness and increasing knowledge, and address critical perceptions and beliefs that shape experiences and guide behaviour. For example sexual health campaigns should promote positive attitudes and perceived advantages of sexual health behaviours and address perceived disadvantages.
Also in the area of prevention – social protection is emerging as a potentially powerful tool. New research from South Africa found that combined, unconditional economic and psychosocial protection provision reduces HIV-risk behaviour for adolescents. There has been a strong voice of Indigenous young people at AIDS2014. This week saw the launch of ANTHYM – The Aboriginal Nations Torres Strait Islander HIV Youth Mob (ANTHYM). They join a global indigenous youth HIV movement seeking recognition of their unique needs, including culturally appropriate education that reaches indigenous young people.
Last but not least – Love.
Young people are calling for acceptance, respect and love from their communities, their peers, their teachers, their health workers and their governments. They see that stigma and discrimination fuels this epidemic. They see that respect for difference and diversity is at the heart of change. Throughout the youth program they have stepped up to show what this love looks like in action. They have shown us that they are working hard but are ready to be more meaningfully involved in the design, implementation and evaluation of policies and programs that target them. They are the experts on their communities. And they have the passion, determination, courage and energy that is needed play a critical role in moving us closer to an AIDS free generation.