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Risk and Vulnerability for Children and Youth
The vast majority of infected children—well over 90%—live in developing world countries, and if current infection rates remain unchecked, AIDS may increase infant mortality by as much as 75% and mortality of children under age 5 by more than 100% in regions most affected by the infection. HIV infection leads to AIDS and death much faster in children than in adults, and pediatric AIDS results in death more quickly in developing countries, where there is widespread poverty, poor nutrition, and other contributing factors. Most infected children under age 14 acquire the virus from their mothers before or during birth or through breastfeeding. As more women of childbearing age have become infected, the number of children infected has also risen. Aside from the risk for MTCT, children and adolescents are also extremely vulnerable to infection through blood transmission; sex, including incest, other sexual abuse, and commercial exploitation; and injection drug use. In many countries, the first consensual sexual experience occurs before age 18, and young people may not have the knowledge or experience to reduce their risk for exposure to HIV/AIDS. Adolescents may lack knowledge about pregnancy and STI/HIV transmission and may be less likely to recognize potentially risky situations or negotiate safer sex behaviors. In addition, peer pressure, drug and alcohol use, and other factors may increase adolescents’ likelihood of engaging in high-risk behaviors. Young people of both sexes are vulnerable to infection for many reasons, including social, biological, behavioral, and demographic factors. For example, young men often face tremendous pressure to be sexually active and are, therefore, less likely to seek information about how to protect themselves and their partners for fear of appearing inexperienced. Young women, on the other hand, may be particularly vulnerable for biological reasons (for example, less mature tissues may be more readily permeated or damaged) and for social reasons, including lack of economic resources and negotiating power. Young women are often forced into relationships with older men for economic survival, and anecdotal reports from some high-prevalence countries indicate that older men may be seeking younger women and girls for sexual relations, believing that they are less likely to be infected. Wide age disparities in infection rates substantiate these social patterns, with young women in many places having infection rates equal to men 10 years older.
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AIDS
is very much a disease of the young. Although comprehensive data is lacking,
there is evidence that more children and young people under age 18 are
living with HIV/AIDS than ever before. UNAIDS and the World Health Organization
(WHO) estimate that more than 4 million children under age 15 have been
infected with HIV since the beginning of the epidemic, and in 2000 alone,
500,000 children under age 15 died an AIDS-related death.