Brazil is a country of contrasts, of great wealth and of crushing poverty from which young people find it hard to escape. Around a third of the 31 million Brazilians aged between 15 and 24 come from families living below the poverty line. Only one adolescent in 12 completes high school, and many of the rest–half of the boys and as many as three-quarters of the girls–remain jobless. Across the country, some two million people aged 15-19 neither work nor go to school.
Undereducated and underemployed, these young people are easy targets for adults selling drugs or buying sex. In fact, they are easy targets for adults wanting sex but unwilling to pay for it. Research in São Paulo, Brazil’s largest city, indicates that one girl in five has been sexually abused in her own home or in the surrounding community.
Girls who have lived through sexual abuse are more likely than others to drift onto the streets, into prostitution, and onto the waiting list for HIV infection. In Brazil’s impoverished northeast, communities are trying to head off this danger by identifying girls who are at risk of violence or abuse in the home. These girls are invited to join support groups that teach them skills that will help them make a living as well as defend themselves against violence and unwanted sex. Of 850 girls who have been helped by one such programme, so far there are no reports of any of them ending up in prostitution or in a street gang. With HIV rates running as high as 17% among poorer sex workers in some cities, supporting young women with alternatives to a life on the streets is an important way of protecting them from HIV infection.
However, much remains to be done. In the USA, for example, 3 million adolescents a year contract a sexually transmitted disease, a clear indicator of unsafe sex. In developing countries, where the likelihood of encountering a partner infected with a sexually transmitted disease is high, STD infection rates in young people are often much higher.
Young people are vulnerable to HIV for many reasons–they do not know about HIV or STDs, or they know about them but do not know how to avoid infection. Those with the information may be unable to get hold of condoms, or may feel unable to discuss condom use with their partner. Young people, and especially girls, may be unable to defend themselves against unwanted sex. In the Democratic Republic of Congo, nearly a third of young women in a large study reported that they had been forced by their partners into first sex. Similar statistics on coerced sex are reported from many parts of the world.
What is more, adolescence is a time when many people experiment–not only with different forms of sex but with drugs. Apart from the HIV risk connected with needle-sharing, it is known that alcohol and other drugs can affect sexual behaviour and increase young people’s risk of becoming infected with HIV or the other STDs. Excessive drinking, for example, diminishes inhibitions, increases aggression, diminishes the ability to use important information learnt about AIDS prevention, and impairs the capacity to make decisions about protection.
Whether or not young people’s drug-using habits change over time, the consequences of risk behaviour at this age can be irrevocable, as can be seen in data from places as far apart as Asia and Europe. In Myanmar over 60% of teenage drug injectors are infected with HIV–indeed teenagers are the only group of drug users in which HIV prevalence has continued to climb steadily since the early 1990s. In Belarus, over four-fifths of registered HIV infections are in drug users in their teens and twenties. In Lithuania, over half of HIV infections registered in injecting drug users are in people under 25. Regardless of whether these young people continue their drug use or abstain, they will carry HIV with them till their premature death.