Nonconsensual Sex

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Nonconsensual sex takes many forms, including forced sex, transactional sex, cross-generational sex, unwanted touch, and molestation. Perpetrators can be strangers, peers, intimate partners, family members, and authority figures such as teachers. In any form, nonconsensual sex has negative consequences among its victims.

In sub-Saharan Africa, transactional sex performed in exchange for material gifts and cross-generational sex between a woman under age 20 and a man at least 10 years older are increasingly prevalent. Concern about HIV has prompted older men to seek younger sexual partners under the assumption that they are less likely to be infected. Young women are often willing to participate in these partnerships for emotional reasons; perceived educational, work, or marriage opportunities; monetary and material gifts; or basic survival. Consenting young women may fail to realize their vulnerability to abuse, exploitation, and reproductive health risks. The power imbalance that exists between cross-generational partners, and the transactional nature of these relationships, often result in inadequate communication about risk and decreased condom use. This and the higher likelihood that an older male partner is HIV positive increase the risk of HIV infection among these young women. In sub-Saharan Africa, young women ages 15–24 are three times more likely to be infected with HIV than young men of the same age. Additional risks include anxiety, depression, social isolation, academic trouble, sexually transmitted infections, unintended pregnancy, abortion, and increased propensity for risky behavior in the future.
Young age, financial need, drug and alcohol consumption, previous abuse, and involvement with multiple partners are personal risk factors for sexual coercion of youth. Environmental and structural risk factors include poverty, patriarchy, gender inequity, early marriage, weak educational and health systems, and ineffective policies and laws. More research is needed on how to effectively address nonconsensual sex among young people. Experts stress the importance of policy support for altering social norms of gender inequity and power imbalance and recommend community-based, youth-specific interventions that use education, livelihood programs, and social marketing campaigns to empower young women.

Youth-friendly Services

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Young people, especially those who are sexually active, need access to a variety of reproductive health and HIV services. Frequently, youth seek services only when there is an acute illness or problem, such as a symptomatic sexually transmitted infection or pregnancy.

Youth often avoid using HIV prevention and other services because of inconvenient hours or location, unfriendly staff, and lack of privacy and confidentiality. Since many young people avoid using these services, special efforts must be made to attract, serve, and retain young clients. When youth do go to health sites, efforts need to be made to meet both the pregnancy and STI/HIV prevention needs of youth, even where clinical services are often separate. Also, youth have said they like to receive services when possible at pharmacies, and some programs are working with pharmacies to serve youth better.
Researchers have found that youth-friendly services generally share the following traits:
  • Providers are trained to communicate with youth in a respectful and nonjudgmental manner
  • The facility has policies of confidentiality and privacy for youth
  • The facility has convenient hours and location for young people, as well as a nonthreatening environment
  • The fees are affordable
  • Youth participate in developing policies and implementing services through an advisory board, as peer educators, and in other roles

Young Men Who Have Sex with Men

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The risk of HIV infection disproportionately affects certain groups of young people, including young men who have sex with men (YMSM).  The term YMSM encompasses a diverse array of individuals, including:

  • Young men who identify as gay, bisexual, or otherwise same-gender oriented in sexuality and sexual practice
  • Young men who do not identify as same-gender oriented, but who have sex with other men because of economics (e.g., sex workers), environments (e.g., prisoners), or societal constraints (e.g., gender separation or gender norms)
  • Male-to-female transgender individuals who are biologically male but self-identify as female
Young MSM are present in every country in the world, yet homophobia—and related stigma, denial, discrimination, violence, and criminalization—often prevent these young men from receiving critical HIV prevention and treatment information, services, and support.  As a result, many YMSM are not equipped to protect themselves from becoming infected with HIV and other sexually transmitted infections. Additional risk factors resulting from the isolation often experienced by YMSM include homelessness, substance abuse, and multiple partners.
Also, the biological risk of HIV transmission is five times greater through anal intercourse than vaginal intercourse.  For these reasons, MSM are on average 19 times more likely to be HIV-positive than the general population.  The young age at which MSM often initiate sexual activity and the fact that many who become HIV-infected do not learn of their status until late in the course of infection highlight the urgency of addressing the needs of YMSM.
More research is needed to understand the unique needs of YMSM.  The wide range of risk factors demonstrates the need for programs that address both individual behaviors and structural changes.

Providing Comprehensive Support to Adolescents Living with HIV

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In 2012, an estimated 2.1 million adolescents were living with HIV. Young people ages 15 to 24 accounted for an estimated 40 percent of new nonpediatric HIV infections worldwide, and perinatal HIV transmission remains a major cause for HIV infection among adolescents. Before antiretroviral therapy (ART) was developed and expanded, children infected with HIV did not usually live to adolescence. But today, thanks to widespread HIV care and treatment programs, they can lead long, healthy, and productive lives. The same is true for those who are infected as adolescents — young people ages 10 to 19 — as long as they know their HIV status. As HIV infections among adolescents continue to rise and more children living with HIV are surviving into adolescence, the unique needs of adolescents living with HIV
require much more attention.

Adolescents who are newly diagnosed (or who have only recently learned of their status) have wide-ranging needs—some of which are unique to people their age. They require accurate information about their diagnosis and care and treatment options. They need information about preventing transmission to others, guidance about adhering to treatment, and support in making decisions about disclosure. Adolescents living with HIV (ALHIV) also need long-term treatment, counseling, and support —to come to terms with their diagnosis, to discuss what it means grow up living HIV, and to transition from pediatric to adult care.

Most of all, it’s important to remember that adolescents living with HIV are first and foremost adolescents. Like all young people, they are eager to learn how their bodies are changing; about their sexual identities; and about their reproductive health, including safer sex, prevention and treatment of sexually transmitted infections (STIs), pregnancy prevention, and planning for safer pregnancy options. As the number of HIV-infected youth increases, more programs are needed to provide age-appropriate care and treatment, psychosocial support, reproductive health counseling, and advocacy.

We invite you to join us July 29-30 for an online discussion about taking a comprehensive approach to meeting the unique needs of ALHIV. Moderated by experts from USAID, FHI 360, Makerere University College of Health Sciences, Baylor International Pediatric AIDS Initiative (BIPAI) and the Botswana-Baylor Children’s Clinical Centre of Excellence, this forum will provide participants an opportunity to discuss the reproductive health needs of ALHIV, disclosure, antiretroviral therapy treatment and adherence, stigma and discrimination, and successful programs for ALHIV. To learn more, click here!


Celebrating the Interagency Youth Working Group’s Accomplishments Over the Past Eight Years

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Today, as we observe International Youth Day, we look back on the past eight years of FHI 360’s involvement with the U.S. Agency for International Development (USAID)’s Interagency Youth Working Group (IYWG), the only source of global information about preventing both unintended pregnancy and HIV among youth. Our work managing the technical content for the IYWG was conducted under USAID’s Preventive Technologies Agreement, which ends this month.

During this time, we have made many contributions. The IYWG tools and resources have been used by thousands — more than 30,000 people from 199 countries have visited our website, over 6,000 have participated in our e-forum discussions, and more than 1,000 have attended our annual technical meetings. Since 2007, we have distributed InfoNet twice monthly to approximately 5,000 individuals and developed 21 issues of YouthLens; 1,219 users follow us on Twitter; and 2,444 people like our IYWG and Answer the Call Facebook pages.

We are grateful to the many dedicated individuals who helped us produce, synthesize, and disseminate evidence on youth sexual and reproductive health, and to our partners for sharing their work and supporting ours. To all who have helped us provide practical, evidence-based resources and tools in the service of improving the lives of young people around the world, thank you!