Young People and HIV/AIDS in Asian Cities: Challenges and Actions

Mr. Sultan A. Aziz
Director, Asia and Pacific Division, UNFPA

HIV/AIDS in Asia is one of the great challenges. Over a million new cases were diagnosed in Asia in 2004. In India, five million people have AIDS. Before, commercial sex workers and injecting drug users usually contracted it, but now it is spreading among the general population. Young people are particularly affected, and 60 percent of the world's young people live in Asia. There is nothing inherent in Asia's customs and traditions that will protect it from an HIV/AIDS epidemic, unless governments, communities and individuals take action.

Asia is also witnessing the feminization of AIDS. Nine out of ten women in India who have AIDS had no other sex except with their husband.

Investing in young people is critically important. However, the picture is not all bleak. In fact, it's the opposite. A girl born today is more likely to stay in school, and delay childbirth, than she would have been 20 years ago.

Young people need information about HIV/AIDS and how to protect themselves. Condoms - both kinds (male and female). Clean needles. Encouragement to have just a single partner. Abstinence. Monogamy. They need to able to find services in youth-friendly settings, that are inexpensive and convenient. Young people need to be able to safely and easily access information, without stigma or abuse.

Young people in poverty are underserved. Almost one fourth of the world's young people live in extreme poverty. The future of young people could define the future of our countries. Fertility differences between the poor and the rich are among the largest of the health indicators.

Education is the key to breaking the cycle of poverty, but poor people are the least likely to finish school. Maternal deaths are also closely associated with poverty. Poverty, underdevelopment, and illiteracy are the principal factors in the spread of HIV/AIDS. In poverty, HIV/AIDS is almost a death sentence.

There is also the factor of gender inequality. Women are more susceptible. There are 7.3 million young women with AIDS, and 4.5 million young men. Poverty drives people to risky behaviors or to being victims of sexual exploitation. Many of the men are very sexually experienced. Biologically, the risk is two to four times higher for women than men during unprotected sex.

In urban areas, the rates of infection are rising, except in Bangkok. The changes of urbanization bring new challenges. More than half of migrants to urban areas are less than 25 years old, and women are the largest proportion. They are driven to cities from rural poverty, and end up living in a poor urban neighborhood. Reproductive health services are very poor in these areas. The urban adolescent is less likely to use a condom.

What is the way forward? A partnership between city governments and young people is crucial. We need to engage and empower young people.

When we asked young people for their recommendations, they said:

1. Scale up funding
2. Provide more youth-friendly services and information
3. Government should work in partnership with young people - both local and national governments.

Young people have strength and energy. They are vital resources for driving grassroots initiatives. We need to engage young people who live on the streets. City governments often criminalize the urban poor. We need to integrate them into the political and economic life of the city.

Urban governments need to translate the national policies on the eight Millennium Development Goals into local action.

One Millennium Development Goal is to significantly improve the lives of 100 million slum dwellers. A critical component of this is sexual and reproductive health. To make progress in that area, we need to:

1. Improve health information services.
2. Increase access to service delivery points.
3. Encourage community involvement
4. Take measures to improve conditions for the working poor, especially women.

Young people are a vital resource. They are a key to economic growth. Don't destroy the potential of Asia's future.

Questions and Answers

Q: Can we get help from UNFPA for anti-retro viral treatments? Women who can't get access to this treatment are often abandoned by their families.

A: Governments and people are just coming to grips with the "it can't happen to us" feeling. The truths are right in our own back yards. Abandonment or the social stigma seen is the most terrible part of this disease. We are dealing with the burden of culture, history and attitudes. If we are concerned about saving lives, there is no place for stigma. These raise profound policy issues. If there is no comprehensive national policy on the issue, then there is no anti-retro viral treatment available. So far, there hasn't been enough effort on this. The UNFPA focus is on prevention. In Danang, you should contact the WHO about this and bring this to their attention.

Q: We have no anti-retro viral treatments. What do you tell a patient when they ask if they can buy it a pharmacy?

A: There is so little information about what is going on. Philippine's politicians won't lift a finger to help. We must choose life over death.

Q: Do you see a remedy for Islamic societies, where we can't talk about sex lives?

A: If the final word is about saving a life, then we can suspend all other norms. What is the consequence of people not being informed? I don't think Islam is going to fall apart if we talk about these things.

Q: How can we afford multiple agencies? I don't even know how many agencies are already at work in my city.

A: Governments need to think critically about health infrastructure. Clarity and simplicity deliver results. Sometimes we add to the confusion. India is the model the rest of Asia is watching. There is a correlation between the economy and poverty. If you have a lot of capital, it raises the problem of resource allocation. Don't despair. You're on the right road. But be more demanding of local government.

Q: Why is the UNFPA not funding the program in Chittagong?

A: The funding is coming through the Asian Development Bank.

Q: Why don't we take families and teach them all about sexual and reproductive health, instead of youth?

A: Families do need to be empowered. Because of cultural attitudes, often whatever the father has to say is the last word. So how do we educate people without disrupting the family? Many religions and societies are very conservative, and believe in family values. We pat ourselves on the back for being that way, but we are closing our eyes to a raging torrent. The power of culture transcends borders. You have to look at the information you are coming to them with.