Adolescent HIV

India Perspective
-Current Research and
Future Scope

R.K. Baxi
Professor
Adolescent Pediatrician
Human Immunodeficiency Virus (HIV) affects 40.3
million people worldwide [(UNAIDS) & (WHO) 2005].
Sub-Saharan Africa, with an estimated 25.8 million
carriers, has the greatest burden of disease (64%)
[ (UNAIDS) & (WHO) 2005].

The prevalence is estimated at 5–15% in most other

Sub-Saharan countries Asia has an estimated
prevalence in the region of 8.3 million, with 2.5 million
being in India, giving an Indian adult HIV prevalence
of 0.36% (NACO; MOHFW, 2007).
 In India, young people in the age group 15 - 24
years comprise almost 25% of the country’s
population;
However, they account for 31% of the AIDS
burden. (NACO; MOHFW 2007)..
One youth is reported to be infected with HIV/AIDS
almost every 15 seconds (Population Foundation
of India, 2003).
HIV prevalence in the 15 - 19-year age category is
0.04%, while it is 0.18% in the age group 20 - 24
years (National Family Health Survey, 2005-
2006).
In India adult (15 years or above) HIV
prevalence is 0.36%. 
It is now thought that around 2.3 million
people in India are living with HIV. Of these,
an estimated 39% are female and 3.5% are
children.
National Family Health Survey
2005-2006, HIV statistics

HIV Prevalence
Age Group Male Female Total

15-19 0.01 0.07 0.04

20-24 0.19 0.17 0.18
Total Age 15-49 0.36 0.22 0.28
2009 3rd Quarter Data
NACO guidelines for Phase III include all under
age 18 as ”Children” and “youth” as age 15 to
19. Perhaps ,missing on either side the period
of sensitive transition- Adolescence.
No specific data set or information for
Adolescents is analyzed or reported.
Research with rural youth in Maharashtra
suggests that HIV knowledge is low. For
example, in a study, rural Maharashtrian girls
and women aged 15 to 24 years old, only 49%
indicated that they were aware of AIDS and
only 60% reported that AIDS could be
avoided.
 India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for
rural Indian youth
 Asha Banu Soletti1* , Vincent Guilamo-Ramos2* , Denise Burnette2* , Shilpi Sharma1* and Alida Bouris3* 1  School of Social
Work, Tata Institute of Social Sciences, Mumbai, India
 2  Columbia University School of Social Work, New York, NY, USA
 3  School of Social Service Administration, University of Chicago, USA
Sexual behavior remains the leading cause
of HIV infection in India, and complex factors
underlie rural youth's vulnerability to HIV.

In Maharashtra, many rural young men

migrate to cities, particularly Mumbai, in
search of economic opportunities. While
they are in urban areas, young men may
have sexual relationships with women,
including sex workers.
 India-US collaborative Stusy,November2009.
Some young women enter early marriages or
commercial sex work, and gender inequality
creates power differences that create
formidable barriers to consistent condom use.

Among young people aged 15 to 24 years, the

number of women with HIV/AIDS is estimated to
be almost twice that of young men. Taken
together, these factors suggest that rural
adolescents are a vulnerable group of young
people.
 India-US Study, November 2009
Adolescents though “invisible”, do not exist in
isolation.
Their capacities and opportunities dramatically differ
based on age, gender, schooling, economic and family
background, marital status, area of residence etc etc..
School going girls in age 14-17 yrs are mostly
unmarried and less likely to have sexual exposure as
compared to out of school girls of the same age,
married or unmarried! And we have around 25% girls
in this age group who do not go to school. Premarital
sex, school drop out and unwanted pregnancy are
interrelated.
 UNFPA-Pop. Council report-2005-06
Indian Minister of Health and Family Welfare and
the US Secretary of Health and Human Services
signed a bilateral agreement in 2006 to
collaborate on the prevention of sexually
transmitted infections (STIs) and HIV/AIDS in
India.
The overall goal of the bilateral agreement is to
"promote and develop cooperation in the fields
of HIV/AIDS and STI prevention, research,
treatment and care, infrastructure
development, training, and capacity-building on
the basis of reciprocity and mutual benefit”.

The bilateral agreement also identifies a

number of key areas for cooperation between
India and the US, including "developing
innovative intervention strategies for the
prevention and treatment of HIV/AIDS”.
Child Brides.
Though not legal ,child marriage is a grim
reality.
This means early sexual experiences, perhaps
unsafe, coming at a vulnerable time with
limited or no empowerment.
India has nearly 20% girls married before age
17
Although male adolescents report higher
rates of sexual activity than females,
female adolescents are also vulnerable to
HIV.

A complex combination of factors related

to increased biological susceptibility, low
levels of education, poverty and gender
inequality heighten vulnerability for many
females. Many young women do not
complete secondary school.
 NACO Phase III
HIV and AIDS affect young people
disproportionately. Nearly 33 per cent of the
reported AIDS cases till June 2005 were in the 15
to 29 years age group. Very young adolescents
or
children (10-14 years) or youth (10-24 years),
because of their lack of correct information
and life skills, behaviour of experimentation and
above all their biological predispositions,
are especially vulnerable to risks of HIV
infection.
NACO Phase III
In Summary,
RoL suggest that Information (if not
knowledge) about HIV among adolescents is
adequate, with wide variations among various
socio-cultural settings in different states
across India.
Regular Behavioral Surveillance Surveys
among adolescents-both school going and out
of school are indicated.
For majority of Adolescents and Youth mass
media, older friends ,peers, teachers and text
books appear to be the source of information
on Sexuality, sex and HIV

Teachers are not well equipped to carry on

with education on Sex n sexuality- we call it
Family Life Education!

Although NACO has put in place several

efforts, School based sex education is not
uniformly acceptable
Sexual Behavior and condom use:

Premarital sexual experience ranges from 3%

to 11.5% while 25% expressed favorable
attitude to it.

Though over 90% youths know about condom

use, actual use at the time of Sexual
encounter is reportedly as low as 10%

Multi-partner sex, group sex ,MSM and

visiting Brothels –all these behaviors are
reported
Attitude towards HIV testing and PLWHA

A significant improvement in attitudes towards

PLWHA has been reported by
NACO,BSS2006.

However, voluntary testing for HIV is very low.

(Low perception of Risk…)

Anita Nath, HIV/AIDS and Indian youth – a review of the literature (1980 - 2008)
Journal of Social Aspects of HIV/AIDSVOL. 6 NO. 1 MARCH 2009
Future considerations:
HIV epidemic is now Adolescent & youth
centered in both gender

Hence, working with Adolescents and Youth is a

window of hope & opportunity for effective
preventive strategy

Reducing stigma, promoting safer sex practices,

correct and consistent condom use
School based Sex and sexuality education
Peer group education and Training

Greater role and autonomy for NGOs to reach

the unreached

Teachers’ training/education in adolescent

friendly approach to risk mitigating
development

Empowering female adolescents and youth for

their sexual and reproductive rights.
I am fourteen and frail
But uncorrupt and fragrant
Full of dreams and desires
And, the’ ‘will to do’ like fires
Listen to me, give me some space
Protect my grace, brighten my face
For I am your future, - I am
Innocence, I am Adolescence.
R K Baxi