HIV/AIDS. Other Diseases

HIV has caused the most devastating pandemic in history. Adolescents, specifically young women, are at the epicen­ter of this global crisis. WHO estimates that 2 million young people are infected each year, representing half of all new infections. Nearly one-third of the 40 million people infected worldwide with HIV are between the ages of 15 and 24 (WHO, 2004). Sub-Saharan Africa has the highest rates of HIV where transmission is mostly via heterosexual intercourse, unlike most of the world where HIV is common in certain high-risk groups.

The Carib­bean is another emerging exception to this rule, where heterosexual sexual activity is the most common means of transmission, and HIV prevalence is rapidly increasing, especially among young people. In most of Asia and the Americas, those who engage in unprotected sex, men who have sex with men, intravenous drug users, and sex work­ers are at highest risk to acquire HIV. Adolescents who are not HIV positive are also affected by the epidemic as they lose family members, are orphaned, and become heads of households.

There are a myriad of social, economic, and biologic factors underlying the HIV epidemic in young people. One of the hazards of the virus is its long latent period, as most people with HIV are unaware of their infection early in the course of the infection. Not only can this make adolescents less likely to use protection to prevent transmission to others, but they do not access antiretro­viral medications. Lack of information about protecting oneself from HIV is widespread (Table 3).

Table 3. Percentage of youths aged 15-24 who understand HIV prevention and transmission

According to the Joint United Nations Programme on HIV AIDS, 20% of young women and 33% of young men know effective ways to prevent the spread of HIV. In every country surveyed, no more than half of the young people had a complete understanding of HIV transmission. In sub-Saharan Africa, some believe that having intercourse with a virgin can cure HIV, leading older men to infect young women.

Teenagers may not seek out HIV testing or use barrier protection because they think they can judge partners to be ‘clean’ based on their appearance, or esti­mate themselves to not be at risk. To many adolescents who feel invincible, HIV is a disease that happens to other people.

Fortunately, certain programs have been found to be effective in stemming the epidemic. In countries such as Brazil and India, public health programs promoting health education have stabilized or reduced the HIV prevalence rates. Successful interventions spanning multiple sectors are tailored for the specific population at risk for HIV, based on their exposure and patterns of behavior.

Once infected, HIV-positive young people are often margin­alized, and social supports are necessary to improve their health. Anti-retroviral therapy (ART) is crucial in prolonging high-quality, disease-free life and is very effective in preventing spread from a mother to her baby. Most youth who live in countries of low or middle income do not have access to ART, despite efforts like the ‘3 by 5’ campaign of WHO and UNAIDS designed to improve availability in high-risk regions.

Adolescents infected with HIV also need access to modern health services that can address both their routine and complicated medical problems. Vaginal microbicides are currently under development and may offer young women an opportunity to prevent infection with HIV without having to convince their partner to wear a con­dom. Unfortunately, despite these interventions, HIV/ AIDS continues to negatively shape the economic out­look, social behavior, and health of millions of young people all over the world.

Other Diseases. Infectious diseases remain an important source of mor­tality and morbidity in many developing countries. Poor access to health services, overcrowding, and poverty complicate disease for adolescents who are eco­nomically and socially disadvantaged.

Many of these diseases are preventable by vaccines or treatable using therapies readily available in the industrialized world. Infectious diarrhea and respiratory infections all cause a significant number of deaths among young people, mostly in the developing countries.

The worldwide prevalence of tuberculosis (TB) increases sharply during adolescence. The diagnosis and management of adoles­cent TB is complicated by frequent coinfection of HIV, especially in developing countries. Drug resistance is an emerging crisis, causing progression of disease in many young people.

The vast majority of deaths due to malaria occur in sub-Saharan Africa. In many areas, youth do not have access to insecticide-treated bed nets, whose widespread use would prevent a large proportion of malaria-related deaths. Drug resistance has also become a problem in certain regions; artemisinin-based combination therapy should be used in these areas for maximum effectiveness, but its higher cost is often prohibitive.

In industrialized countries, there has been an increas­ing amount of attention regarding chronic diseases in adolescence. Due to advancements in health care, many conditions that were previously untreatable in childhood are now managed with medication or surgery. As a result of improved child mortality, many teenagers now live with chronic diseases that affect not only their health but also their social, financial, and emotional well-being.

Effective management of conditions such as cystic fibro­sis, diabetes, and congenital heart disease requires more than medical treatment, necessitating multidisciplinary approaches ideally involving the entire family.

Living with chronic disease can be emotionally drain­ing and stressful for an adolescent. They may feel angry or resentful for having the condition. Many act out and engage in risky behaviors, including sexual activity or substance use. As adolescents grow older, their parents have less control over their disease-related behaviors; this coupled with poor judgment and impulsivity often cause teenagers to refuse to comply with medical care.

A chronic disease may isolate a young person at a time where belong­ing to a peer group is extraordinarily important; noncom­pliance with treatment may be a way that adolescents try to be ‘normal.’ For some adolescents with more disabling conditions such as certain types of cerebral palsy or spina bifida, defining their adult identity may be difficult while they struggle to separate from their parents, find a romantic partner, and become financially independent.