Welcome to Week 1 of the online Youth Forum on Pregnancy Prevention in a Time of AIDS. As pointed out in the forum's introductory message, we have an exciting schedule for this online forum that will run for four weeks, ending April 15, 2005. This week's topic of discussion is "The Needs of Youth for Pregnancy Prevention in a Time of AIDS."
We have the privilege this week of having Dr. Ward Cates, MD, MPH, as our guest panelist. Dr. Cates is the president of the Institute for Family Health of Family Health International. Prior to joining FHI in 1995, he was the Director of the Division of Sexually Transmitted Diseases and HIV Prevention at the Centers for Disease Control (CDC) and later became the Director of the Division of Training at CDC. Dr. Cates is an Adjunct Professor of Epidemiology at the University of North Carolina, Emory University, and the University of Michigan's School of Public Health. He has authored or co-authored over 400 scientific publications, including co-authoring Contraceptive Technology and Sexually Transmitted Diseases (2nd Edition). In addition, Dr. Cates has been on the editorial boards of eight scientific journals.
Dr. Cates begins our week with opening remarks below. Throughout the week, feel free to send questions or comments to Dr. Cates, as well as submit your own experiences, findings or lessons learned on the topic of the week.
I look forward to our discussions this week from around the world! Thanks for participating.
Best regards,
Ed Scholl
Forum Moderator
On behalf of YouthNet, The INFO Project, and the Implementing Best Practices in Reproductive Health Initiative/World Health Organization
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Thank you to YouthNet, The INFO Project and WHO for inviting me to be the guest panelist this week for the online Youth Forum and to address the topic of the needs of youth for pregnancy prevention in a time of AIDS. This is topic near and dear to me, as I have worked throughout my career at CDC and FHI on both pregnancy prevention and preventing sexually transmitted infections (STIs) and HIV/AIDS. And of course focusing on the needs of youth is tremendously important because young people are so vulnerable and so exposed to unplanned pregnancy and STIs/HIV, and they represent the greatest needs among various age groups. To cite but a few statistics, approximately 1/3 of the estimated 38 million people living with HIV/AIDS in the world are under the age of 25. Half of all new HIV infections are estimated to occur in young people under age 25. More than 13 million adolescent girls have unintended births each year in the developing world. Teenage girls over 15 years of age are twice as likely to die from childbirth as are women in their 20s, while girls under 15 are at five times greater risk.
The needs are huge for helping young people avoid pregnancy and STIs/HIV. But before we can begin to address those needs through policies and programs we also need to differentiate those needs, because all young people are not alike and require different responses. For example, some of the primary needs to be addressed for different groups of young people include the following:
Young People Prior to Sexual Initiation
- Self-esteem, communication and self-protection skills to continue abstaining
- Information about fertility and contraception, including emergency contraception
- Information about STIs/HIV and means of prevention
Sexually-experienced Young People, Unmarried
All of the above, plus:
- Access to reproductive health services and contraceptives, including condoms and emergency contraception
- Access to STI detection and treatment
- Access to HIV counseling and testing
- Access to post-abortion care services
- Access to perinatal care when pregnant
- Skills to communicate with partner
Married Young Women
All of the above, plus:
- Information and services about delaying first birth and spacing subsequent births
- More emphasis on access to perinatal care
Young Men
- Similar to young women, except for access to perinatal care and post-abortion services
- More emphasis on education and access to condoms
- More emphasis on responsible male sexuality and violence prevention
Youth Especially at Risk of HIV
- Education and skills on how to avoid risky behavior
- More emphasis on education and access to condoms
- More emphasis on access to STI detection/treatment and access to HIV counseling and testing
As this brief breakdown illustrates, young people are a heterogeneous group with differing needs when it comes to pregnancy prevention and prevention of STIs/HIV. What they all need, however, are three basic things: 1) sexuality and family life education; 2) support from parents, the community and policies that enable them to practice responsible sexuality; and 3) and access to quality services and contraceptives when they are needed.
I'd like to say a few more words about this last point — access to quality services and contraceptives. I believe that in the environment we live in today with the attention that has been focused on HIV prevention and treatment, we cannot lose sight of the need for greater access to pregnancy prevention services and products for young people.
First of all, we need to do more to integrate HIV and pregnancy prevention services for youth. HIV counseling and testing centers or maternity centers offering PMTCT services (for preventing transmission of HIV from mother to infant) are great venues for introducing contraceptives. Likewise, family planning or maternal child health clinics that offer family planning and prenatal care should also counsel clients about how to avoid STIs and HIV and either provide, or refer, for STI treatment and HIV testing. The majority of young people have both concerns on their minds (pregnancy and STIs/HIV) and we do them a disservice when we separate and fragment services addressing them.
Secondly, we need to do more to make contraception available to young women with HIV. The pregnancy prevention needs of young HIV positive women are very real and not to be overlooked. Offering a wide array of contraceptive options to HIV positive women who do not wish to become pregnant is important for their health (to avoid the stresses of pregnancy and to allow for provision of some ARVs that cannot be used by pregnant women), for their families' welfare, as well as to prevent future AIDS orphans and HIV-infected infants.
Lastly, I believe we need to do a much better job of getting information out about emergency contraception. This is particularly important for young people who are more vulnerable, more risk-taking, more exposed to sexual coercion and less likely to have access to contraception. In spite of the advances that have been made in many countries to have dedicated emergency contraceptive pills available in clinics and on pharmacy shelves, there remains a great unmet need to educate providers, the public and young people especially about this backup form of contraception and to assure its availability.
I look forward to receiving questions you may have on what I've presented in this message, as well as to hearing about successes and lessons learned from your programs concerning how to meet the pregnancy prevention needs of youth in a time of AIDS.
Sincerely,
Ward Cates
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