ICMR BULLETIN VOL. 29-No.-12-DECEMBER-1999
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- ICMR BULLETIN VOL. 29-No.-12-DECEMBER-1999
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ISSN 0377-4910
Vol. 29, No. 12
December, 1999
CHILDREN AND YOUNG PEOPLE IN CONTEXT OF HIV/AIDS:
LISTEN, LEARN, LIVE I WORLD AIDS CAMPAIGN WITH
CHILDREN AND YOUNG PEOPLE
“You have to start from the ground (Children and youth)
with education, so the youth will grow fruitfully and be
protected from AIDS. If not, the tree will die,”-Youth
delegate to the 4th International Congress on AIDS
in Asia and the Pacific, Manila, 1997.
“In my country Botswana, there is serious problem of
communication between parents and their children. This is
a cry from our hearts. Parents talk to us. Without your
communication, guidance, dialogue, we are a lost generation.
Come to our aid” - A 14 year old girl addressing the
International Conference on STD/AIDS in Africa,
Kampala, 1995.
"We strongly believe that our energy, idealism and
commitment can be used to stop the future spread of the
AIDS epidemic that is devastating the social and economic
fabric of our own countries" - Delegation of young people to
the International Conference on STD/AIDS in Africa, Marrakeh,
1993.
These are voices of children and young people who
constitute nearly a half of the world’s population and they
represent the future of all the nations facing the AIDS
pandemic. In the last two years, the theme for the World
AIDS Day has focussed on children and the young
people.The third year reiterates the relevance ofprotecting
children and the youth from this fast spreading epidemic
with an apt slogan ‘.Listen, Learn and Live! World AIDS
Campaign with Children and Young People. The UNAIDS
acknowledges these voices of the young giving three
reasons to single out young people1:
(i) Special vulnerability ofyoung people to the epidemic;
of all those infected after infancy, at least half are
young people under 25 years.
(ii) Young people account for hundred millions of people
in the developing world, where the epidemic is con
centrated.
Young
(iii)
people are a force for change, at a stage of
experimentation, can learn more easily than adults
to make their behaviour safe or to adopt safe practices
from the start.1
Recently, it has been emphasized, “Young people must
most importantly be treated as major actors in the response
to this epidemic, not just objects of education campaigns.
This is to be brought through society-wide movement”2.
It becomes imperative thereby, that prevention efforts
should focus on children and young people who would
impact on the future of any community or a nation. In
Division of Publication & Information, ICMR, New Delhi -110029
This issue commemorates the World AIDS Day (December 1, 1999)
some countries including India initiatives in that directions
have already been made. It is pertinent to learn and share
experiences from other countries vis-a-vis the global
situation in developing policies and plans for our own
country.
Children and Young People in a World of AIDS
Pandemic
According to estimates by UNAIDS, by the end of
1999 there were already over 33.6 million people world
wide living with HIV. Of these 46% are women; with
a significant number of pregnant women attending
antenatal clinics in urban areas being HIV infected3.
Altogether, more than 4 million children under the
age of 15 yr and more than 10 million young people
(15-24 yr) have been infected with HIV since the
epidemic began. During 1998, more than 8500 children
and young people became infected with HIV each day,
six every minute. Of the 2.5 million people who died
of AIDS in 1998, 510000 were children under the age
of 15 yr. An estimated 6.2 million orphans under the
age of 15 were alive at the end of 1997, struggling to
survive after the death of their mother or of both parents
from AIDS. More than 95% of these children live in
Africa4.
Around half of all new HIV infections occur in
young people. This is an age when most people start
their sexual lives. In 1998 nearly 3 million young people
became infected with the virus4. In societies like India,
where the epidemic is heterosexually driven, young
women are more exposed to the risk of HIV infection
than young men for both physiological and societal
reasons. This is especially true of women (both married
and unmarried) who have sexual relationships with
men for socio-economic survival. For some women a
major source of earning is through commercial sex eg
women in prostitution and the devadasis in India. As
a tradition these young adolescent girls from lower
socio-economic strata are called devadasis when they
are given away by the parents to the temple through
the practice of theogamy, ie being married to gods.
After getting this ritual sanctity they move outside to
bigger cities and engage in commercial sex activity5.
Another route of transmission in the young is through
drug-use where, drug injectors in developing countries
are mostly males, although women drug users are now
being reported6. Major behavioural interventions for
126
the children and youth are required in the absence of
an affordable cure or likelihood of a vaccine in the
near future. This is a formidable task as sex behaviour
and motherhood are related to basic instincts and rights
of the individual needing a multi-faceted approach
working at several levels.
Concerns for Children and Young People
The children of the world face a lifetime of risk
from HIV infection at different life stages as they grow
into adulthood due to circumstances such as sexual
exploitation and abuse or simply due to violation of
their rights to information, education and services7.
Also, it is being realized that there is ignorance and
general lack of respect for young people's basic rights
eg exploitation through child labour, lack of opportunity
to access formal education, health services; compounded!
further with gender discrimination favouring males that
begin at an early age. All these factors have contributed
in some degree in making children and young people
vulnerable to infections like sexually transmitted
diseases/HIV (STDs/HIV).
Figures reported at the 1996 World Congress
against Commercial Sexual Exploitation of Children
indicated that more than 1 million children world-wide
enter the sex trade every year. An unknown number
of children are at risk of sexual abuse by relatives,
other members of the child's community or strangers.
Very few concrete steps are being taken except for
making noises through the media about the safety of
a child in the family. A large number of children and
adolescents in the world, working or living on the street,
face physical and mental abuse, increasing the
likelihood of engaging in risk taking behaviour and
thus their vulnerability to HIV5.
A UNAIDS review of over 50 studies has shown
that sexual health education programmes among young
people do not encourage sexual experimentation. When
quality criteria such as responsible decision making
are met, such programmes actually help to delay the
age of first intercourse. They also reduce sexually
transmitted diseases and unwanted pregnancies in
sexually active adolescents. Success stories of school
AIDS education programmes that include family life,
life skills education and sexual health education are
reported, for example, in parts of India, Zimbabwe and
the Caribbean4.
Children and HIV/AIDS
Children are* infected with HIV through all the modes
of transmission at different stages of their life. This
begins while th sy are in the womb, at the time of delivery,
while being breast fed or when they get a blood
transfusion in case of thalassaemia or haemophilia or
as a result of sexual abuse. Irrespective of the mode of
transmission, HIV infected children face great trauma
of being isolated, discriminated, and stigmatized in
formal and informal settings; In communities where
power dynamics works on the basis of gender, age, class,
caste, etc. the vulnerability of children to HIV infection
increases as sexual relationships .are unequal and
negotiating for safe sex is not possible. Uninfected
children who have lost one or both parents due to AIDS
may be discriminated and denied the basic rights that
^pther children enjoy eg schooling and health care facility.
"Also, sometimes parents have a problem of disclosing
the HIV status to a child for societal fears.
In India, the response to HIV and AIDS in children
is still in its infancy with only a few interventions to
check transmission being reported. Scientific
developments have contributed to the possibility of
reduction in transmission from mother to child through
medical interventions. Such intervention though possible
may not be available for most women. In India, pregnant
women from lower socio-economic backgrounds are
more vulnerable to HIV infection and bear the burden
of passing the infection to their new-born child. This
results in having infected children, which can possibly
be avoided if subsidized AZT for reducing HIV
transmission is available in the government run hospitals
often accessed by those from these lower socio-economic
^groups.
Children in Special Circumstances
Thalassaemia is a fatal combination of hereditary
and acquired disease with repeated blood transfusions
increasing the risk of HIV infection. In India more than
one tenth of the patients from Mumbai, Manipur and
Delhi with haemophilia and thalassaemia are at increased
risk of AIDS as they approach adolescence8”. In order
to reduce the risk of transmission of HIV virus policy
of universal voluntary blood donation, screening of blood
for hepatitis B virus (HBV) and HIV by sensitive tests
need to be strictly adhered10’”. Future studies should
stress on the importance of early recognition and
therapeutic intervention in this high risk paediatric
population as in the coming decade India is certain to
face a major problem of paediatric HIV/AIDS. The time
has come to plan and equip ourselves to effectively
manage these children11,12.
There is a need for training of paediatricians and
paediatric surgeons to handle paediatric HIV infected
cases without discrimination. Also, trained counsellors
catering for this specialized category of the population
are urgently required for improving counselling services
for HIV positive children and their parents. The HIV/
AIDS epidemic has affected the men, women and children
and has resulted in their stigmatization, isolation and
discrimination. It is imperative that response to this
epidemic changes. This is specially so in relation to
children, as Munro puts it, there is a need for
“normalization of HIV in society”13. The children are
resilient and have the capacity for understanding and
care. Major challenges for programmes for children are
to ensure that children themselves participate in a manner
that is appropriate, ethical, and culturally sensitive. The
breadth and diversity of interventions required to respond
adequately to the needs of children in families affected
by the HIV epidemic present particular challenges to
programme development and implementation. Networks,
and shared experiences cutting across cultural and ethnic
differences at the local to global level may prove to be
valuable’3-’4.
Adolescence in the Era of AIDS
Adolescence refers to the developmental period
between childhood and adulthood, a time of rapid
biological, cognitive, and psychosocial maturation.
Ingersoll15 defines adolescence as a period of personal
development during which a young person must establish
a personal sense of individual identity and feelings of
self-worth which include an alteration of his or her body
image, adaptation to more mature intellectual abilities,
adjustments to society's demands for behavioural
maturity, internalizing a personal value system, and
preparing for adult roles. An individual is identified as
a sexual being through these qualities. Youth and
adolescents are at an increased risk of developing AIDS
because of their sexual curiosity, an urge for exploration,
drug experimentation and lack of knowledge.
Depending on the culture and the context, adolescents
are commonly known as teenagers, young people, or
youth, and the age range varies, 10-20+ years being the
widest definition in common use. A perspective plan
for the next 25 years for the young population starting
from the preadolescent stage and onwards is being made
by experts from different fields in India under the Ministry
127
of Human Resource Development. This focusses on youth
develdp-ment and their involvement in life style
education including substance abuse (alcohol, drugs,
smoking), reproduction health, sexuality education/
sexual health for safer sex practices to avoid unwanted
pregnancy, STDs/ HIV/AIDS. It is based on the premise
that given a chance young people have a great deal to
contribute to acommunity response to HIV/AIDS
epidemic as they are a “Force for Change”16.
Youth Sexuality in Context of AIDS
While adolescence is either the end of childhood or
the start of adult life, it reinforces the notion of
adolescence as the healthiest period. This is also the
period of sexual experimentation which puts the young
to health risks through drugs, alcohol, smoking,
irresponsible sexual behaviour, etc. There is a need to
help young people delay initiation of sexual activities
and increase condom use among those who choose to
be sexually active. There are encouraging results from
the National Youth Risk Behaviour Survey (YRBS) in
USA where it has been shown that preventive education
through schools, family and community produced
leveling of sexual intercourse rates and increase in
condom use. However, in this study it was worrying
that many high school students from lower income
groups chose to be sexually active putting themselves
at risk of HIV infection. These students require specific
interventions to delay initiation of sex and increase in
condom use ,7. On the other hand in rural areas more
resistance to AIDS and sexuality education is seen due
to lack of cultural relevance to the potential stakeholders.
. Drishtikon Study on Youth of Delhi
This study was prompted by a chance finding when
after an intervention, 3 out of 8 male students between the
ages 16-19 yr who opted for testing were found to be positive
for mixed STD infections. The free sexual services were
provided by the housewives in the conventional residential
areas, who were apparently positive for STDs. It was seen
that 88% students perceive AIDS threat as real in India,
sexual activity is common among students, heterosexual
encounters are considered as a greater risk for HIV
transmission than homosexual ones. A large number were
unaware of link of STDs with AIDS; and do not have a
clear concept of STD symptoms.lt is significant to note that
adolescent youth are sexually active and is at a potential
risk of contracting STDs and HIV infections. Therefore it is
imperative to integrate the STDs related information with
all interventions, targeted at adolescent youth to prevent
AIDS in India.1B.
128
NARI Study in Pune
This study using insider's perspectivefemic viewpoint)
aimed at understanding college youth (from rural and urban
areas) sexual behaviourandpossible risks toAIDS/HIV using
qualitative and quantitative methods arid strict ethical
procedures of maintaining confidentiality, informed consent
and anonymity. Interactions of both boys and girls ranged
from social to physical relationships; sexual experience
reported with those of same and opposite gender, more so
by boys including having sex with CSWs. One-third reported
condom use, only a fifth its consistent use. Knowledge of
STDs was limited; few seeking treatment for their reported
STDs. The youth expressed a need for interactive
communication on reproductive health issues to clarify their
doubts and worries. It is of major concern that despite
adequate knowledge ofAIDS, youth reported risky behaviour.
AIDS awareness needs to be integrated with youth
programmes where sexuality, gender relationships,
reproductive health matters and responsible behaviour are
openly discussed with boys and girls. Participatory
approaches like workshops for information dissemination
through peer leaders representing both genders should be
planned for youth enabling democratic and responsible
decision making by both, boys and girls19.
This comes from the top-down approach with a lack ofinvolvement of young people in the project design and
implementation. In both urban and rural areas it is seen
that once these aspects are taken into account then the
youth in even rural communities do not want to be left
out in the programme17-20
Some interventions to increase AIDS awareness were
initialized in India among youth. These were covered in
urban areas through the University Talk AIDS Programme
in more than 160 universities, and in rural areas by the
Nehru Yuvak Kendra for the rural youth (personal
discussion). Some experiences of working in the field
have shown, that despite increase in knowledge levels,
HIV as a problem has not been perceived by youth as
risky behaviour.
The two studies mentioned above among the youth
in India highlight the need for developing interventions
for the youth that need to be integrated with other health
and youth programmes. They may serve as an aggressive
advocacy tool involving the youth at varied levels.
Drug Use and Young People
Innovative interventions to prevent HIV infection
and substance use are necessary in both formal sector
and informal settings. Street children, and other especially
vulnerable youth population (EVYP); in which HIV and
substance use risk practices are prevalent are a difficult
to reach population21. Evaluation of WHO programme
on substance use in 25 countries, including India indicated
that this programme targeted to street children in differing
circumstances is well suited for operationalizing HIV/
AIDS prevention. Consequently, in association with
UNAIDS, this programme has been expanded to strengthen
HIV prevention interventions. It is emphasized that the
general training package aimed at EVYP can be effective
in particular sites if it is not too proscriptive, but allows
for local adaptations based on rapid assessment, youth
participation, community involvement and informal
strategic planning activities. Trained service providers
are needed to work with drug abusers and offer a range
of services that do not require abstinence from drugs but
expand services that treat all menand women with respect
and dignity eg syringe/needle exchange22-23 .
Planning Intervention for Young People
Youth can be influenced to change their current levels
of knowledge, attitudes, behaviour and practices towards
HIV and AIDS if they are provided correct scientific
knowledge. The youth also need to be imparted sex
education which is lacking both in non-formal and formal
settings. This involves developing the communication
skills of parents, teachers, AIDS programmers and also
through peer educators. The education programmes are
found to be more successful when they actively involve
the youth and children and are tailored to their needs
and suggestions.
Base-line studies help in understanding the target
population and its knowledge, misconceptions and fears.
W This database is useful for developing indigenous
intervention strategies. Also, keeping with gender
composition and sensitivities is essential for successful
implementation of the programme targeted for the youth.
This includes involvement of both boys and girls and
ensuring that both genders meaningfully contribute in the
programme as also the use of local language, as
acquaintance with local sexual language facilitates
behavioural change. The involvement of people living
with HIV/AIDS (PLWA) as change agents in youth
programmes to spread information about the disease, has
also shown relevant impact19’ 24‘27.
Special Groups
Street children, an EVYP are particularly important
as they are vulnerable to HIV/AIDS infection through
frequent change of sex partner, negligible condom
usage, unfriendly medical systems, lack of sufficient
infrastructure for a social support and addictions
including drug use. Empowering children to run
programmes, after adequate training and using them
as peer educators is a useful method for spreading
awareness about HIV/AIDS and reducing the risk taking*
behaviours among street children. It is, however,
pertinent to note that the success of any programme
designed to educate the youth requires strong political
support and an understanding and commitment of the
local authorities28-29 .
Intervention for the young requires their direct
involvement using participatory approaches like peer
education and encouraging dialogue between parents,
teachers and young people. AIDS education is required
at varied levels. It can be provided through electronic
and print media to cover a large population with specific
goals. The media should find out which social and cultural
norms increase vulnerability to HIV in a community,
undertake an anhalysis of negative stereotypes, create
messages that do not stereotype but develop new norms,
promote positive male and female role models and also
encourage children and young people to make their views
known on HIV related issues through young people's
media. These should be done in keeping with the ethical
norms of the society and help in projecting a partnership
with the community rather that creating fear that works
negatively with the young population30
Communication between Parents and Children
In the context of HIV/AIDS communication between
parents and children needs to be understood at several
levels. At the very start, parents talking with children
on issues related to sexual health, gender and responsible
sexual behaviour helps children to be better prepared
for their future. On the other hand parents find it difficult
in communicating their own HIV status and that of their
children within the family . If one parent or both the
parents are positive then the apguish of informing the
child of their HIV status is obvious. The children may
not understand the future implications this disease may
have on their own lives. Where no other social support
is available, children from lower socio-economic
background sometimes may assume the responsibility
of taking care of a single parent without knowing about
the consequences of the disease sometimes at great
personal cost. The preadolescent child could be the
caretaker of seropositive parents, where support is not
available, at the cost of their studies without even knowing
about the disease and its consequences.
In Africa,. HIV positive mothers are desperate to
communicate with their children on this issue despite the
personal anguish the process may have caused 31. A
pertinent issue whether the children should be informed
of their parents’s HIV sero status has not reached any
consensus, but this is a question that haunts many families.
Break down of trust between children and their par
ents can be avoided if honest and appropriate communi
cation is possible. On the other hand, the parents also
have difficulty in letting their adolescent child know his/
her own HIV status. They keep this matter confidential
in a social system where they fear that the child may be
deprived of his basic rights related to educational and
health services.
Intervention programmes to establish a dialogue
between parents and children should be taken up early.
The potential success of these programme would depend
on adequate research on parent child communication. More
research keeping HIV/AIDS in focus, should be under
taken in this important, yet unexplored area. Further,
responses from research must be tailored to specific needs
ofthe community for developing intervention programmes.
Youth: A Force for Change
Youth programmes implemented by youth, the peer
educators (PEs), are more successful because sensitive
communication barriers such as verbal and non-verbal
language, discussions on hitherto tabooed topics like
sex, are eliminated .This strategy empowers youth,
especially when they can appropriately reflect on their
efforts based on the developmental goals through the
system and structures that are children and youth
friendly32. These youth to youth programmes should
also have a component of counselling through peer
educators and community influencers to promote harm
reduction behaviour like safer sexual practices,
responsible behaviour for self, their partner and condom
use. Given the prevailing risk factors such as multiple
sex partners, homosexuality, sex abuse, rape among
children and young people, appropriate action needs to
be taken to stem the spread of HIV infection among
them. Besides giving information through peer
education, the programmes must include intensive
130
investments in life and decision making skills in the
context of HIV/AIDS prevention. Such programmes can
have significant and durable impact leading to proactive
advocacy for social change, sustained behaviour change
and integrated interventions for risk reduction 33.
Things that Work with Young People
Peer education and developing life skills are
important aspects that enable young people to make the
appropriate choices about their behaviour. Interactive
role playing, exercises, puzzles and games help students
learn and practice skills such as communication,
overcoming peer pressure, decision making, emotional
management, relationship skills, self-esteem building,
assertiveness, gender sensitivities, etc. Evaluating the
process of monitoring and training help to understand
the changes during the programme. This has been
demonstrated among schools where a shift in the
behaviour of the students and surprisingly even in the
attitude of teachers was observed. The students were
actually engaged in the programme and the number of
students involved was increasing with every session.
This study demonstrates that PE is a powerful tool for
the programme and it is imperative that experienced
leaders design, manage and evaluate the programme
closely to ensure quality of sessions in terms of the
messages given, receptivity, participation of youth and
gender composition during the sessions34 .
Monitoring and Evaluation of Intervention
Assessing the impact of an intervention is crucial
in continuing a strategy, making mid-term corrections
and also advocating the replication of the knowledge.
The most basic form of test in the process of monitoring
and evaluation is which intervention is doing what it is
supposed to do. This is possible through establishing a
monitoring indicator system that develops tests for
measuring the efficiency of the specific intervention
through the designing and monitoring tools in accordance
with the reality in the community; the feasibility and
replicability through a pilot model of monitoring. This
has been vividly shown through the success story of
STAND: Students Together Against Negative Decision,
where promising interventions for both virgin and
sexually active teenagers in rural areas had a substantial
direct diffusion effect. This was seen through the increase
in risk behaviour knowledge, modest shift in HIV
prevention attitude, decrease in unprotected sex as
compared to their peers from non-STAND group35.
Similarly, RAPP (Rochester AIDS Prevention
Programme) intervention follow up in short term had, a
powerful effect on the knowledge of all students and a
moderate effect in sexual self-efficacy and safe behaviour
intention for high school students. In this programme the
peer educators were found to be equally and for some
variables more effective than the highly trained adult
educators. This study also indicated the importance of
an early implementation of a school based sexuality
programme through peer education that can prepare the
young better for safer sex practices in future 36.
Youth, AIDS and Condoms
Youth programmes that included condom promotion
faced difficulties and hostile resistance as they were
perceived to promote sexual behaviour at an early age.
In view of the increasing HIV prevalence among youth
it is imperative that knowledge of the safer sex practices
be imparted to them. One of the safer sex practice is the
use of condoms. However, studies to assess the
knowledge and attitude of youth indicated that only a
small number use condoms. Majority of young people
lacked the knowledge about the proper use of condoms.
The reasons for not using condoms given by both boys
and girls were: (i) they cause embarrassment while
purchasing; (ii) it is only used to avoid unwanted
pregnancy; (iii) unreliable during usage: can break or
there be a spillage; (iv) unaffordable; (v) used only with
partners perceived at risk like sex workers/ mobile
population; and (vi) a male controlled method (reported
by girls). On the other hand the female condom is a new
concept in India and are not yet available while in other
countries they are reported to be expensive and still not
marketed19’37.
The youth need reliable information on proper usage
of the condom and also for removal of their
misconceptions. It is pertinent that knowledge on
condom use must be given to students in culturally
appropriate settings and should be ensured that it does
not promote sexual behaviour. While providing youth
with information on condom usage, it is important to
make them responsible about their own behaviour and
that of their partner so that they , learn to differentiate
between love and sex. The involvement of youth in
condom education should be encouraged; special
education programmes should be designed to enhance
condom acceptance in appropriate context through peer
educators38
Decision Making in Youth
In making sexual choices today, young people must
consider not only issues of identity, personal growth,
and relationships, but also the growing danger of AIDS.
These need to be understood in the context of young
people’s meaning of sexuality, the process of
male-female friendship network and implicit negotiations
and perception of danger. A ten year study of the sexual
behaviour of college students in Canada shows that
students choose among three sexual subcultures: celibacy,
monogamy, and free experimentation. Since 1980, there
has been some shift from casual sex toward committed
partnerships, but the basic outline of this sexual “plural
society” has remained unchanged. Despite having the
knowledge of AIDS, most students have not adopted
careful sexual practices, either in the number of partners
or use of condoms. This evaluation paves the way for
modification in intervention strategy that addresses harm
reduction. This study explored the reasons behind sexual
choices and investigated whether the possibility of
contracting AIDS will eventually lead adolescents to
balance better their needs for information on sexual
matters, expressing their emotions through love yet
differentiating between love and lust, the freedom to
express their needs in an ambience free from fear, discuss
matters without embarrassment, and self-preservation
of their identities through responsible decision making39.
Working against the choice of caution is the fact
that, sexual expression is an important element of
becoming an adult and young people do not perceive
problems that may come in the future, especially when
they concern them as sexual beings. This is compounded
by the fact that decisions related to choosing a marriage
partner are not made by the young people themselves
and often are prescribed by parents in India. This may
later affect the individual’s family life and limit the young
as sexual beings in marital relations19. There are several
examples where lack of reliable information on STDs/
HIV, lack of timely treatment and counselling and socio
cultural pressures in young men are detrimental for their
decision making through narrowing of their options.
Discussions during counselling sessions subsequently
help these young people to make relevant decisions
related to marriage, disclosing HIV status to spouse;
safe sex practice, etc.
Decision making is not only about having
information, but this is done within a social and culture
131
setting keeping with the ethical sensitivities, values and
rights. Empowering young boys and girls for responsible
decision making through information, developing
communication skills, with gender and ethical
sensitivities within a cultural setting can help them change
their behaviour and prevent harm'to themselves and their
partners.
of children are required at different levels where the
programmes for children are carried out, such as
addressing the issue of child labour, sexual abuse and
blood safety initiatives, etc. Campaigns to promote the
rights and its full implications in the context of HIV/
AIDS in a social setting are important and they should
be strengthened by involvement of children, youth and
their families41'44.
Rights of Children and Youth
The rights of groups considered to be vulnerable
such as women, children and HIV infected come to
limelight when they are violated and someone fights
for them to get what they are entitled to. People living
with HIV/AIDS , women and children are the major
victims of AIDS because of ignorance of their rights.
The information on rights of the children and young
people is also lacking with the health care providers
(HCP). Provision of knowledge about these rights to
the HCP is helpful; counsellors and other HCP can clearly
think and operate for the benefit of the client in all
situations, especially when it concerns PLWAs, women
and children. It has been demonstrated that providing
knowledge on rights related to AIDS has promoted the
status of HIV positive women to gain more and equal
power with men40
Similarly, the challenge to promote children's right
is a process that begins with the acknowledgment of
their rights followed through with persistent advocacy
with the group who are meant to serve children’s welfare41.
Certain conflicts emerging between therapeutic and
preventive goals and rights can be avoided by maximizing
the convergence of the tools, that is by developing legal
instruments, procedures and rights that promote
therapeutic and prevention efforts without compromising
rights and also the normative and cultural concerns in
the society.
Those campaigning for the rights of children affected
by HIV should use the UN Convention on the Rights of
the Children which guarantees right to life, survival,
social benefits and development. The rights and freedom
of children should be respected, with emphasis on
removing policies which may result in children being
separated from their parents or families. Children should
have access to HIV/AIDS prevention education and
information both in school and out of school, irrespective
of.their HIV/AIDS status. Measures should be taken to
remove social, Cultural, political or religious barriers
that block children’s access to these. Advocacy
programmes that promote the fulfillment of the rights
■*•32
Participation of Youth in Policy Planning, Research
and Development and Implementation of Intervention
Although youth participation is effectively realized
in peer education, no examples of youth participation in
the policy making process are reported. Initiatives in that
direction have been made in Africa and some of the
developed countries where the youth are infected and
affected by the AIDS pandemic in large numbers 45. A
youth network, with representatives from Kenya was
initiated in 1995. Since then, this network has spread to
include the entire continent. Advocacy, lobbying, and
securing resources were network’s initial endeavours.
Some lessons from Africa may be useful in the Indian
context. Training programmes were not adequately
monitored to ensure that lessons are shared with those
from other countries, who may be at risk of HIV/AIDS
for different reasons. It is significant to realize that this
nascent network of inspired youth throughout Africa has
already begun to address the vital issues related to youth’s
increased vulnerability46.
Community planners on the other hand, struggle with
how to effectively involve youth as equal partners in
decision making processes, even for programmes targeting
youth. A pilot programme was initiated with support from
the Centers for Disease Control and Prevention (CDC)
to enable five U.S. communities to apply a research based
prevention marketing process to design HIV prevention
programmes for youth. Each community was encouraged
to invdlve youth in the planning and decision making
processes in varied and significant ways. Youth were
involved in the planning process of developing a HIV
prevention programme in their community by constantly
monitoring their efforts and continuing a strong
commitment to youth involvement. The key components
of this programme's success were established through
developing and monitoring a youth involvement plan,
entrusting one person to provide leadership to youth
involvement activities, organizing a parallel youth advisory
team and providing incentives. These lessons have been
translated into technical assistance workshops and
documents on youth involvement for programme
-
planners47*48. In India informal networks of youth through
the National Service Schemes and Nehru Yuvak Kendra
exist but their potentials have yet to be realized in the
context of AIDS. Lessons from other countries can be
replicated jn the Indian situation as well if the process is
viewed from a youth development perspective.
(
Listen, Learn and Live with Children and Young People
\
It is imperative that we:
To build up this significant human resource, young
people must be provided reliable information in both formal
and informal settings. This should start early where parents
and teachers are involved in giving information on hith
erto tabooed topics such as sex, so that they develop
positive attitudes to face obstacles of child abuse, rape,
etc. This should be done in culturally appropriate situa
tions where values are inculcated in young people that
encourages responsible behaviour.
Involving youth in the planning of multi-faceted HIV
prevention programme requires providing youth with
opportunities to learn and build skills and to meet other
developmental objectives. Additionally, adults must be
prepared to respect and be cognizant of their actions
and language which can unintentionally be detrimental
to youth involvement.
Listen to children and young people, hear their views and concerns,
and understand what is important in their lives.
Learn from one another about respect, participation,support and ways
to prevent HIV infection.
Live in a world where the rights of children and young people are
protected and where those living with HIV/AIDS are cared for and do
not suffer from discrimination.
Youth participation should start from the planning
to the implementation stage. Empowering children to run
programmes through training and using them as peer edu
cators has demonstrated to be a useful method for spreading
awareness about HIV/AIDS for reducing risk taking
behaviour among the vulnerable young people.
Important Life-Skills in the HIV/AIDS Era
'How to make sound decisions about relationships and sexual inter
course, and stand up for those decisions and to deal with pressures
for unwanted sex or drugs.
'How to recognize and avoid a situation that might turn risky or violent.
'How to negotiate protected sex or other forms of safer sex when
Where they have been able to acquire appropriate
knowledge, skill and means, today’s young people have
shown a remarkable propensity to adopt safer behaviour,
more so than previous generation or older adults.
ready.
'How to show compassion, solidarity and care towards young people
with HIV/AIDS._______________________________________________
Source: UNAIDS: Key issues and ideas for Action. 1999 World AIDS
Campaign with Children and Young People.
.
Experiences with interventions have shown that by
following the youth recommendations that include frank
two way discussions on sex, peer-to-peer approach with
adult leadership as backup, integration of HIV/AIDS
awareness education into other programmes, appropriate
sex education to start by age 10; education of parents;
involvement of persons with HIV/AIDS in prevention
education, a variety of innovative education material and
interactive methods would pave the way for the success
of the programme. Scarce tactics do not work according
to youth as they are away from reality.
Lessons Learned
It is important to emphasize that the young adults
are the pillars of society. Any investment on them from
an early age goes a long way for the future. Youth can
be prepared to have positive health attitudes that enables
them for better mental, physical and spiritual health. They
are also successful in building community leadership and
human resources.
However, the role of young people does hot stop there.
They can help take the sting and shame out of AIDS where
it is still stigmatized; they can bring kindness and prac
tical help to those already infected with HIV or living in
households touched by AIDS. If they get support from
the adults in their lives and from society at large, young
people can change the course of the epidemic.
Conclusions
At the turn of the century, it is significant to realize
that the AIDS pandemic has globally affected the children
and young people who are the harbingers of change and
their involvement can strengthen the future of a nation.
An investment in youth through'their development and
meaningful participation from planning to implementation
would serve as a useful strategy. Provision of basic services
like education, health, protection from exploitation of
children and young people without gender discrimination
should be initiated early. Such plans would enable a strong
foundation to establish the good practices of providing
basic rights within a cultural value system that young
people are entitled to. Experiences from other countries
133
have demonstrated that interventions programmes with
such approaches are more sustainable. However, this may
require advocacy within the health, educational and
political system for appropriate response. As Peter Piot
of UNAIDS recently said3, “...there is a need for
intervention strategies to promote a supportive, enabling
environment........ governments have a choice, they can
make a policy that promotes the virus or they can make
policies that promote the response.” It is time to respond
to this important challenge to stem the epidemic.
There is an urgent need to open a dialogue in response
to this epidemic, a dialogue between children, young people
and adults, between adults and among children and youth
to foster HIV prevention among this young population
who represent almost half the global population. It is
imperative that a world-wide campaign ofAIDS prevention
be made by listening, learning and living with the children
and young people who are a force for change!
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This write up has been contributed by Dr. Nita Mawar, Assistant
Director, Dr. Reva M Kohli, Ms. Neelam Joglekar, Scientists
and Ms. Rajani Bagul, Research Assistant, National AIDS
Research Institute, Pune.
ICMR NEWS
The following meetings of various technical groups/
committees of the Council were held:
Meetings of the Task Forces (TFs)/Advisory Group/
Toxicology Review Panel held at New Delhi:
Meetings of the Scientific Advisory Committees (SACs)
of the ICMR Institutes/Centres:
TF on Clinical Trial on
Stainless Steel Band Material
Decembers, 1999
Toxicology Review Panel
December 6,1999
Advisory Group on
Pharmacology and Toxicology
December?, 1999
SAC of National Institute
of Epidemiology, Mumbai
December 15, 1999
SAC of the Institute of
Pathology, New Delhi
December 23, 1999
135
TF on Clinical Trial
with Vijayasar for Diabetes
Mellitus
December 13,1999
TF on RF/RHD
December 13,1999
TF on New Initiatives
in Genome Research
December 14, 1999
TF on Estimation of Cost of
Management of Smoking Related
Diseases (COLD and CHD)
December 22, 1999
Participation of 1CMR Scientists in Scientific Events:
Dr. Kamala Krishnaswamy, Director, National Insti
tute of Nutrition (NIN), Hyderabad, participated in the
International Seminar on Anaemia in South Asia at
Kathmandu (December 2-4, 1999).
Dr. Veena Shatrugna, Asstt. Director, NIN, Hyderabad,
participated in the seventh South Asian Workshop on
Gender and Sustainable Development at Dhaka (Decem
ber 3-4, 1999).
Population and Development: South to South Initiatives
at Dhaka (December 5-8, 1999).
Dr. C.N. Paramasivan, Dy. Director (Sr.Grade),
Tuberculosis Research Centre, Chennai, participated in
the WHO Intercountry Training on Laboratory Diagno
sis of HIV-Opportunistic Infections at Bangkok (December
13-17, 1999).
* Dr. V.M. Katoch, Dy. Director (Sr. Grade), Central
JALMA Institute for Leprosy, Agra, participated in the
International Colloquim on Tuberculosis in the New
Millennium at Antwerp (December 14-17, 1999).
Foundation Day Celebrations:
As part of the ICMR’s Foundation Day Celebrations,
the Council organised a lecture on “A Holistic Template
of Clinical Research in India: Shifting Paradigm of Syn
thesis and Symbiosis”, by Prof. J.S. Bajaj on December
13, 1999.
Dr. T. Ramamurthy, Asstt. Director, National Institute
of Cholera and Enteric Diseases, Calcutta, participated
in the thirty fifth US-Japan Cholera and related Diarrhoeal
Diseases Conference at Baltimore (December 3-5,1999).
Workshops:
Dr. C.P. Puri, Dy. Director (Sr. Grade), Institute for
Research in Reproduction, Mumbai, participated in the
Expert Group meeting on Reproductive Health Research
Capacity Development, organized by Partners in
An IEC Training Workshop on Biomedical Sciences
was organised at the National Institute of Nutrition,
Hyderabad during December 20-24, 1999.
An Indo-US Workshop on Prevention of Illness and
Injury Related to Industrial Accidents was organised on
December 17, 1999 at New Delhi.
ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
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International Congress on Frontiers in Pharmacology and
Therapeutics in 21 st Century
December 1-4,1999;
(at New Delhi)
Prof. S.K. Gupta, Secretary General of ICPT-21,
Department of Pharmacology, All India Institute
of Medical Sciences, New Delhi-110029.
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and (ii) Recent Advances in Statistical Methods and
Challenges for the New Millennium
December 2-4,1999;
(at Bangalore)
Dr. D.K. Subbakrishna, Organising Secretary of
the Annual Conference of ISMS, Department of
Biostatistics, National Institute of Mentalf Health
and Neurosciences, Bangalore-560029.
Workshop on the Role of Nitric Oxide Gas in the Treatment
of High Altitude Pulmonary Edema and Adult Respiration
Distress Syndrome
December 4,1999;
(at Pune)
Dr. W. Selvamurthy, Director, Defence Institute
of Physiology and Allied Sciences, Delhi-110054.
Neurosciences 2000 and Beyond : XVII Annual Conference
of Indian Academy of Neurosciences, Annual Meeting of
Neuroscience Society of India, and National Symposium on
Cellular and Molecular Basis of Brain Function
December 6-8,1999;
(at Gwalior)
Dr. I.K.. Patro, Organising Secretary of the
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December 6-9,1999;
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Dr. S.S. Agarwal, Head, Department of Medi
cal Genetics, Sanjay Gandhi Postgraduate Insti
tute of Medical Sciences, Lucknow-226014.
XXXI Annual Conference of the Society of Nuclear
Medicine
December 8-11,1999;
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Dr. Y.N.I. Anand, Organising Secretary of the
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Meenakshi Mission Hospital and Research
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, National Seminar on Newer Vistas in Bio-active Agents
December 9-10, 1999;
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Dr. N.S. Nagarajan, Coordinator of the Seminar,
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International Symposium on Cancer Control in Developing
Countries
December 10, 1999;
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Dr. Urmi Sen, Organising Secretary ofthe Sympo
sium, Chittaranjan National Cancer Institute,
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XV Asia Pacific Cancer Conference
December 12-15,1999;
(at Chennai)
Dr. T. Rajkumar, Secretary General, The XV
APCC Secretariat, Cancer Institute (WIA),
Chennai-600036.
II International Conference on Contaminants in the Soil
Environment in Australasia - Pacific Region
December 12-17,1999:
(at New Delhi)
Dr. Rajendra Prasad, Organising Secretary of the
Conference, Council of Scientific and Industrial
Research, Rafi Marg, New Delhi-110001.
International Conference on Medical Diagnostic Techniques
and Procedures
December 15-17, 1999;
(at Chennai)
Dr. Megha Singh, Organising Secretary,
ICMDTP, Department of Applied Mechanics,
Indian Institute of Technology, Chennai-600036.
III International Symposium on Cognition, Education and
Mental Health
December 16-19,1999;
(at Varanasi)
Dr. C.B. Dwivedi, Organising Secretary of the
Symposium, Department of Psychology, Banaras
Hindu University, Varanasi-221005.
LXVm Annual Meeting of Society of Biological Chemists
(India) and Symposium on Current Trends in Biology
December 27-29,1999;
(at Bangalore)
Dr. Sandhya S. Visweswariah, Organising Sec
retary, 68th SBC(I) Meeting, Indian Institute of
Science, Bangalore-560012.
XVIII National Symposium on Reproductive Biology
and Comparative Endocrinology
December 27-29, 1999;
(at Chennai)
Dr. R. Moses Inbaraj, Organising Secretary, 18th
SRBCE, Department of Zoology, Madras Christ
ian College, Chennai-600059.
XLIII All India Congress of Obstetrics and Gynaecology
December 27-30,1999;
(at Lucknow)
Dr. Vinita Das, Organising Secretary of the Con
gress, Department of Obstetrics and Gynaecology,
K.G. Medical College, Lucknow-226003.
LXXXVII Session of the Indian Science Congress
January 3-7,2000;
(at Pune)
Dr. Bhushan, Patwrdhan, Local Organising Sec
retary, Indian Science Congress-2000, University
of Pune, Pune-411007.
Workshop on Gene Amplification Techniques in Disease
Diagnosis and National Conference of Laboratory Medicine
January 21-25,2000;
(at New Delhi)
Dr. Sarman Singh, Organising Secretary of the
Conference, Department of Laboratory Medicine,
All India Institute of Medical Sciences, New
Delhi-110029.
V World Conference on Injury Prevention and Control
March 5-8,2000;
(at New Delhi)
Prof. Dinesh Mohan, Secretary General
(FIWOCO), Transportation Research and Injury
Prevention Programme, Indian Institute of
Technology, New Delhi-110016.
137
COUNCIL’S TRAINING PROGRAMMES
Reproductive Biology
Nutrition
At the Institutefor Research in Reproduction, Mumbai:
At the National Institute of Nutrition, Hyderabad:
•
Training Course on Cytological Detection of Reproductive Tract Infections (December 13-17,1999).
•
Postgraduate Certificate Course in Nutrition (December 1,1999-February 28, 2000).
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139
ICMR BULLETIN INDEX
Volume 29, 1999
Page No.
Month
Prospects of Using Bacillus sphaericus in the control of Culex
Mosquitoes in Relation to Resistance Development.
1
January
India’s Needs and Priorities in Fertility Regulation Research
17
February
Protein Turnover Studies Using Stable Isotopes
33
March
Alliums as Food for Healthy Life
43
April-May
Increased Male Responsibility and Participation : A Key to Improving
the Reproductive Health
59
June
Malariogenic Stratification of India Using Anopheles culicifacies
Sibling Species Prevalence
75
July
Risk of Aluminium Toxicity in the Indian Context
85
August
Silicosis - An Uncommonly Diagnosed Common Occupational Disease
95
September
Multi Drug Resistant Tuberculosis
105
OctoberNovember
Children and Young People in Context of HIV/AIDS:
Listen, Learn, Live! World AIDS Campaign with Children
and Young People
125
December
Main Feature
EDITORIAL BOARD
Chairman
Dr. N.K. Ganguly
Director-General
Members
Dr. Padam Singh
Dr. Lal it Kant
Dr. Bela Shah
Sh. N.C. Saxena
Dr. V. Muthuswamy
Editor
Dr. N. Medappa
Printed and Published by Shri J.N. Mathur for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110 029
R.N. 21813/71
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