The emerging generation in the developing world will play a critical role in the future, and the U.S. Agency for International Development (USAID) works to help equip them for the challenges ahead. A USAID official discusses the emphasis placed on youth and HIV prevention in the President's Emergency Plan for AIDS Relief.

Numbering 1.7 billion, today's youths ¹ are the largest generation ever to enter the transition to adulthood. Comprising 30 percent of the population in the developing world, young people present a set of urgent economic, social, and political challenges that are crucial to long-term progress and stability. The values, attitudes, and skills acquired by this generation of young men and women—and the choices they make—will influence the course of current events and shape our future world in fundamental ways.

Youths are encountering formative stages in life. When given a chance to participate, youths have played a catalytic role in promoting democracy, increasing incomes, helping communities develop, and slowing the AIDS epidemic. In Uganda and Zambia, teens and young adults have been key to reducing HIV infection rates through their adoption of more responsible behaviors.

Those who lack opportunities for education and advancement are more susceptible to crime and to being co-opted into armed conflict and terrorism, undermining social cohesion. Marginalized youths are also more likely to engage in risky behaviors leading to unintended pregnancy, chronic substance abuse, and HIV infection. When young men and women lack the skills, support, and opportunities to become productive citizens, their potential to contribute to society is underused. Youths in these circumstances are more likely to be a long-term drain on public and private resources in terms of increased unemployment, higher health and social welfare costs, and lower economic growth. An intangible cost is the diminished quality of leadership available to countries and the international community.

As a multisectoral development agency, the U.S. Agency for International Development (USAID) addresses youth issues across many dimensions. Youth unemployment rates have been rising in recent years. In many developing and transition countries, one-third to one-half of 15- to 24-year-olds are unemployed. Political violence and deteriorating poverty and social cohesion disrupt community and family structures, leaving millions of young people abandoned, orphaned, or forced into military service. In response, USAID is making skills-training for young adults more relevant to their daily lives, equipping them to earn a livelihood. In the Central Asian Republics, USAID targets youths in an effort to foster democratic values and develop a constituency for economic and political reform. Health and lifestyle issues also demand our attention. Worldwide, USAID is committed to helping developing countries provide young people with the knowledge, skills, support, and services they need to protect themselves from HIV.

Youth and AIDS

HIV/AIDS is now a major threat to the lives of young people. About half of all new HIV infections occur among those aged 15 to 24. In the hardest-hit countries, nearly 75 percent of individuals now age 15 are projected to die eventually of AIDS. Yet youths represent a window of opportunity for reversing HIV rates, especially when effective prevention programs reach them before they engage in risky behavior.

The President's Emergency Plan for AIDS Relief, a $15-billion, five-year plan announced in 2003, reinforces the United States' commitment to HIV prevention. It seeks to avert seven million new infections and includes a special emphasis on youths through abstinence and behavior-change interventions. Twenty percent of the President's Emergency Plan funds are set aside for prevention, and one-third are for abstinence-until-marriage programs. USAID is expanding support for activities that reflect this focus.

The environment in which young people live profoundly influences their behaviors. USAID seeks to strengthen protective factors in society that help youths make healthy choices. In particular, close relationships with parents and other adults, school attendance, and supportive community norms lay foundations for positive youth behaviors. Conversely, young people who experience family instability, practice other risk behaviors, and have negative peer role models are more likely to engage in early and unsafe sex. Poverty, including the impact of AIDS on family income, forces many young people out of the protective environments of home and school, increasing their risk of exploitation and unsafe sexual behavior. Street youths and displaced and orphaned youths are at particular risk. Young people may also fail to recognize their personal risks because of a lack of knowledge and understanding of HIV.

Young women are at considerably higher risk of HIV infection. In some African communities, young women aged 15 to 19 have HIV rates six times higher than young men the same age. Poverty, vulnerability to sexual exploitation and coercion, and relationships with older, more sexually experienced men put girls at risk. Economic factors also pressure girls to trade sex for money. USAID helps communities recognize and address social norms that put young women—and youths more generally—at risk of HIV infection.

Changing Behaviors

Behavior change is the cornerstone of HIV prevention. More than 70 percent of premature adult deaths are linked to behaviors begun in adolescence, such as smoking and risky sexual behavior. USAID endorses the "ABC" model, made famous by its success in Uganda. "A" stands for abstinence (including delayed sexual initiation among youths), "B" for being faithful, and "C" for correct and consistent condom use. The ABC approach must be adapted to a particular country context or target population. For youths specifically, USAID gives primary emphasis to A and B. USAID supports skills-based HIV education to provide young people with a basic understanding of HIV, help them personalize risk, and develop the self-esteem, communication, and decision-making skills they need to make positive life choices.

In many countries hardest hit by HIV/AIDS, sexual activity begins early, before marriage. Surveys show that, on average, slightly more than 40 percent of women in sub-Saharan Africa have had premarital sex before age 20; among young men, sex before marriage is even more common. Moreover, a significant minority of youth have their first sexual experience before age 15. Abstinence-until-marriage programs are a particularly important resource for young people because fully half of all new infections occur in the 15- to 24-year-old age group. Delaying sexual debut by even a year can have significant impact on adolescents' health and well-being and on the progress of the HIV/AIDS epidemic.

In 2004, USAID initiated $117 million in new multicountry central agreements for abstinence and behavior-change programs for youths in 14 of the 15 focus countries of the President's Emergency Plan. Thirteen organizations won the five-year grants through a competitive awards process. One new faith-based partner will work with more than 1.8 million youths in Haiti, Kenya, Mozambique, and Rwanda, and with parents, churches, schools, and other local partners to support youths in choosing abstinence as the best means of HIV prevention. Another new partner will collaborate with Red Cross branches and volunteer networks in Guyana, Haiti, and Tanzania to reach more than 760,000 youths with an interactive peer education curriculum. Theatrical, sports, and musical events will help mobilize communities in support of healthy behaviors.

USAID's decentralized nature allows it to respond to varying needs in diverse settings, harmonizing prevention messages at the community level. Mass media campaigns involve the creative use of videos, concerts, radio, and television programs that appeal to young people. In Tanzania, 35,000 youths recently celebrated Youth Week, a popular holiday, by participating in sports, music, drama, and writing competitions. More than 1,000 participants, 40 chosen from each of 32 primary schools, wore T-shirts that said, "Praise work, exercise and studies, NOT SEX" or "One minute of pleasure does not pay, WAIT." Educational messages on abstinence and faithfulness in sexual relations were integrated into the competitions, and there were quizzes, question-and-answer games, and other activities. In Jamaica, a mass media campaign encouraging abstinence for younger youths and responsible behavior for older youths has produced a significant decrease in teen pregnancies.

Peer education builds on existing youth-oriented networks to provide a safe and comfortable environment for adolescents to explore sensitive issues. In Kenya, USAID supports the national Girl Guides Association to raise HIV awareness among its membership by holding HIV contests and having guides work toward merit badges relating to various aspects of HIV. The program provides a forum for girls and young women to discuss HIV and support each other in avoiding risky behaviors.

While prevention is paramount in working with youths, programs must include the continuum of HIV services, including care and treatment. HIV-positive youths need an array of services, including psychosocial support, prevention of mother-to-child transmission, palliative care, and antiretroviral therapy. USAID supports expanding access to services for sexually active youths, including education on correct and consistent condom use, treatment for sexually transmitted infections, and HIV testing.

HIV testing is important for youths to learn their status and adopt safer behaviors. In Zimbabwe, USAID supports 14 New Start centers that provide high-quality HIV counseling and testing services. These services are promoted to individuals at risk of HIV, including young couples and adolescents. For HIV-positive and -negative clients, New Start provides counseling to encourage behaviors that avoid and reduce risk.

Our Future

Youth today are our most precious resource, and their well-being in the world now and in the future is a cornerstone of continuing development. The world's poorest and often most politically unstable countries will have the largest youth populations through 2020. Accordingly, USAID and its partners are striving to expand youth programs across health, education, skills-training, democracy and governance, and other areas. Investing in youths will help developing countries advance healthier lifestyles, equitable economic growth, and stronger civil society. Investing in these young men and women will create hope for a better future for generations to come.

¹ Youths are individuals in transition from childhood to adulthood. This figure refers to 10- to 24-year-olds.

Constance A. Carrino, Ph.D., is the Director of the Office of HIV/AIDS in the Bureau for Global Health at the U.S. Agency for International Development. Dr. Carrino holds a Ph.D. in economics, with emphases in public finance and trade, and is a recipient of the Arthur Fleming Award for excellence in administration in the U.S. government.