5. PROGRAM IMPLICATIONS
HIV-related prevention with young people must continue to be given high priority in developing parts of the world, since by working with young people it will be possible to have a significant impact on the future course of the epidemic. Those working with young people now have access to an increasing body of knowledge about successful approaches to use. The most effective programmes
• respond to diversity of young people and their needs;
(Piot and Aggleton, 1998)
There is increasing information about the kinds of work which are less successful. Programs which fail to recognize diversity in young people and provide opportunities to think about and talk about gender and sexuality, for example, are rarely if ever successful. It is important for adults to suspend their stereotypes and presuppositions about young people and listen to the expressed needs of young women and young men. Additionally and importantly, young people must become genuine partners in dialogue and decision-making (Hoffman and Futterman, 1996). While in much development work the importance of participation of by primary stakeholders is increasingly recognised, young people are still infrequently included in the design and development of programs designed to help protect their sexual health.
It is important that future programs foster greater trust and more open communication between young people and adults. Where open channels of communication are absent, or where there are suspicions about the motives of adults, young people may be hindered in protecting themselves from HIV infection. Young people recently interviewed in Kenya, for example, suggested that AIDS was a scare campaign perpetrated by older people to prevent them from enjoying sex (Balmer et al, 1997).
Until relatively recently, much work with young people in developing countries has centred on the prevention of pregnancy and sexually transmitted diseases including HIV and AIDS, rather than the promotion of sexual health. Only rarely have programmes focused on the positive aspects of human sexuality including sexual pleasure. It is important to shift the emphasis from pregnancy and disease prevention towards multi-dimensional and rights-orientated conceptions of sexual health (Dixon-Mueller, 1993). Programs which do not offer relevant and realistic accounts of sexuality are unlikely to be well-received by young people.
Variations in rates of HIV infection among young people cannot be accounted for by differences in levels of knowledge and skills alone. Instead, some groups of young people experience greater risks by virtue of their position in society. Structural factors such as gender relations, the distribution of income and wealth, and relationships between young people and older people, systematically render some people more vulnerable than others (Piot & Aggleton, 1998). In many parts of the developing world, the broader social, economic and political context within which young people live constrain their ability to protect themselves. Young people who are marginalised from mainstream society may not be able to access the health services and resources which can help them protect their health. Work needs to be undertaken to promote the social inclusion of such young people.
Gender inequalities have serious consequences for adolescent sexual health. In many parts of the world, women and girls are economically dependent on men, may face domestic violence and non-consensual sex, and are encouraged to remain ignorant and passive. So long as women and girls are denied access to information and education, economic resources and health services, they will continue to face increased risks of HIV infection. The needs of young men have until recently been relatively ignored by program planners, with consequences both for the health of young men concerned and that of their sexual partners. It is unlikely therefore that young people will be able to maximise their sexual and reproductive health unless there are major changes in relation to gender and other inequalities which facilitate the transmission of HIV. Those concerned with the prevention of HIV and adolescent health must seek to influence public policy agendas to lay the foundations for greater equity in the future.
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