UNAIDS - 07 February 2012
When Palitha Wijebandara from Sri Lanka found out he had tested
positive for HIV, he was shocked and confused. He had been tested
as part of a company policy at his work, without his specific
consent or proper counseling, and he did not understand the
implications of his test result.
Palitha is one of many thousands of people in Asia and the
Pacific who have faced the challenge of discovering their HIV
status in their youth. At only 23 years old, he was alone. He did
not know how to face his family. He feared discovery of his
status and of the fact that he had been having relations with
In Asia and the Pacific, evidence indicates that 95% of all new
HIV infections in young people in the region are among young
people from key affected populations--young people who buy and
sell sex, young men who have sex with men, young transgender
persons and adolescent drug users.
Specific data on young people at higher risk of HIV in the region
is sparse. But estimates that do exist give cause for concern. In
some Asian countries, three out of five female sex workers, and
almost half of all men who have sex with men, are younger than 25
years. In the Lao People's Democratic Republic, 82% of sex
workers are in that age group. In Nepal, half of all people who
inject drugs start injecting in their late adolescence, when they
are between 15 and 21 years old. By the time someone has been
injecting for a year, there is a 33% chance that they will have
Despite high vulnerability to HIV infection, young people at
higher risk find it difficult to obtain information on HIV,
sterile injecting equipment, or other services such as HIV
testing and support. Across Asia-Pacific, programmes focusing
specifically on young people most at risk are often scarce.
"Prevention campaigns don't reach out to young female sex workers
as often we do not come out to access the information, and if we
do, it doesn't speak to us," said Ms Fulmaya*, a 16 year old sex
worker from Nepal.
"As a young gay man, some things are hard to say openly and you
worry that if you say those things, people will discriminate
against you. The first time I wanted to get an HIV test, I had no
idea where to get it and I was too scared to go to the hospital,"
said Xiao Chen*, 21, from China.
Stigma, the criminalization of certain behaviours and other legal
hindrances mean that young people from key populations at higher
risk are often difficult to reach. In many countries, taking an
HIV test, going on HIV treatment, or using reproductive health or
harm-reduction services requires the consent of a parent or
"I can't get the free HIV test because I don't want my mother to
know what I'm doing and so I cannot provide the clinic with
parental consent. All I want is to know my HIV status," said
Bugoi a 16-year old transgender sex worker from the Philippines.
Many adolescents find sexually transmitted infection clinics and
HIV clinics intimidating, and feel uncomfortable talking about
personal issues with clinical staff who are much older than them,
and who can be judgmental. Harm-reduction programmes for drug
users generally focus on male adults, despite statistics that
show some young drug users start injecting as early as 12 years
old and the fact that young women also need services.
"I have heard of organizations that give out needles but many are
far and they only target the boys," explained Payal, an 18 year
old woman from Nepal who uses drugs.
An often-expressed frustration of young people from key
populations at higher risk in Asia is that they often feel they
are robbed of the voice to describe, discuss and alter their
"Young people have plenty to say, but their voices aren't heard.
I think if people paid more attention to HIV and strengthened the
voice of the community a bit, more people would learn about HIV
and understand the issues and what we need," Xiao Chen* said.
Time to lead
Some significant action is being taken to bring the voice of
young key affected populations to the foreground -organizations
and networks of young people from key populations at higher risk
are gradually becoming strengthened.
Sri Lankan Palitha Wijebandara, who discovered his status through
an unauthorized HIV test, drew strength from his involvement in
peer support and, recently, from his efforts to promote the
rights of young people from key populations at risk through Youth
LEAD. This Asia Pacific regional network set up in 2010 is
helping develop youth leadership in key populations at higher
risk to strengthen their involvement in community, national and
regional programmes. Representatives from Youth LEAD and other
youth at risk organizations are increasingly being able to take
their place at the table in regional policy arenas and debates.
From 6-8 February in Bangkok, Thailand, the need for increased
focus on and involvement of young people from key affected
populations in the Asia-Pacific AIDS response is one of the
central areas of discussion at a high-level United Nations
meeting. Young people from key affected populations are joining
government leaders and senior officials from across Ministries of
health, justice, law enforcement, social development and drug
control agencies as well as their older civil society
counterparts from key affected populations and people living with
HIV to address legal and policy barriers that impede access to
HIV services in the region.
According to UNAIDS Director of the Regional Support Team for
Asia and the Pacific, Steve Kraus, the regional UN gathering on
AIDS provides the ideal opportunity for young people from key
communities to "Be loud, be heard and be honest about the
critical things you need to make Getting to Zero a reality in
For 24-year old Ayu Oktariani from Indonesia who is living with
HIV, and participating in the Bangkok meeting with Youth LEAD,
the message is simple: "We need to be empowered and supported so
that we can take ownership of AIDS. We are here to say please
include us, listen to us, work with us and together we can
achieve great things."
A longer version of this feature first appeared in the UNAIDS
publication: HIV in Asia and the Pacific - Getting to Zero,
* Some names have been changed on request to protect the
identities of the interviewees
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