Ahead of World Aids Day on 1 December, LSE’s Rachel Deacon calls for a new approach in tackling the epidemic among young people.
Another World Aids day, another conference. On 7 December, over 10,000 delegates will congregate at the International Conference on Aids in Southern Africa (ICASA) to discuss efforts to tackle the virus in the region. Before the conference, a youth programme, ICASA Youth Front, will discuss the new UN campaign and its report, ‘Young People Today’ . The campaign calls for a high level commitment on comprehensive sexuality education and sexual reproductive health services for adolescents and young people in the region.
Why the focus on young people and adolescents?
Young people have been one of the groups hardest hit by the epidemic. According to this latest report, an estimated 430,000 15-24 year olds in the region are infected each year, with 50 young people being infected every hour. Add to this a growing interest the role of youth in development more generally and young people are now seen as key actors in pushing back the epidemic.
What does the report say?
The report outlines 10 recommendations focusing on scaling up comprehensive sexuality education and improving access to health services for young people as well as addressing the issue of gender-based violence.
All seems like common sense?
Very true. It is hard to argue against providing young people with access to information and services. That is certainly not what I will do here. Rather the concern around the report is that it has all been said before. Despite being a new campaign, much of what is in the report will not be a surprise to anyone who has spent any time working in the HIV/Aids ‘industry’.
Does that matter?
Well, yes, it does. I am not saying that there is no mileage in using previously held ideas, but it is important to ask if they actually work. And the answer is we do not really know. Despite years of programming we actually have little knowledge about what leads to effective behaviour change among young people. We know what increases knowledge, but it has been shown that that often does not lead to behaviour change.
One of the problems is that evaluations still depend on self-reported data, which is hugely problematic, not least due to social desirability bias. I have seen this in my own research with young people in South Africa where they quite openly talk of the different responses they give to different people when talking about their own behaviours.
In fact a systematic review conducted in 2010 found that there were only five studies which measured biological outcomes, with only one finding a significant impact, and even then there were serious concerns about the sample. The report itself acknowledges that existing evidence is still ‘very limited’.
Of course that is not to say that we should stop educating people about HIV and their rights and ensuring that they have access to services. This will, and should be, a key element of any HIV programme. But what evidence we do have also tells us that on its own it is not enough.
But surely something is better than nothing?
Well, yes, sometimes. The problem comes with the repetition of the same message which fails to resonate with young people leading to their disengagement. During my own research many young people continually complained of Aids fatigue, with one participant declaring her anger at being “tricked” into attending a meeting “and what did they say, that same old stuff. I was so mad I walked out. I didn’t even wait for the food. Seriously, I’ve heard it so many times”.
Policy makers and practitioners need to start thinking more critically about engaging with young people in a way which has meaning in their lives. This will entail challenging our view of young people and talking about things which might currently be a little uncomfortable, such as sexual pleasure. In my own work, it was clear that, for many, it is within this discourse of pleasure (both physical and emotional) that conversations about sex, and HIV, take place.
Importantly it will also entail creating an environment where it is possible to talk about everything we do not know as well as what we do. This will require not only rethinking how programmes and policies are evaluated, but also opening up a space where it is safe to talk about failure as well as success.
An offer of hope can be found in one of the report recommendations. It calls for an “open, frank and evidence-informed discussion that examines the realities facing young people”. This offers a good place to start but it needs to go beyond our current very narrow definitions of what such a discussion should, and can, look like.
Rachel Deacon is a research student in the Department of Social Policy at LSE and spent a number of years working for youth-based NGOs in the UK, South Africa and India on a range of issues including HIV/Aids, participation and climate change. Follow her on twitter @rachdeacon.
 Mavedzenge, S, Doyle, A and Ross, D, 2010. HIV Prevention in Young People in Sub-Saharan Africa: A systematic review p.56
 UNESCO, 2013 p.25