Young people are critical to success of the President’s Emergency Plan for AIDS Relief (PEPFAR). Yet PEPFAR has, so far, largely ignored the realities of young people’s lives and the state of the epidemic among youth. U.S. government policies severely limit PEPFAR’s use of effective, science-based, public health responses to reducing HIV transmission among youth. Such policies include the ideological funding mandate by Congress to spend 33 percent of prevention dollars on abstinence-until-marriage programs as well as various guidance directives from the Office of Global AIDS Coordinator (OGAC).

"Improving U.S. Global AIDS Policy for Young People: Assessing the President’s Emergency Plan for AIDS Relief” identifies some of the severe limitations of these policies as well as how the policies contradict public health science. This report discusses three major shortcomings of PEPFAR in addressing HIV/AIDS and young people:

* Ideology has trumped science in PEPFAR’s HIV prevention strategy for young people.
* PEPFAR resists linking HIV prevention with reproductive health care and services.
* PEPFAR does not pay adequate attention to HIV-positive adolescents as a vulnerable population.

Congress, OGAC, and country teams have the power to greatly improve the situation for young people and to reform PEPFAR’s response to one that is science-based and respectful of youth’s rights to comprehensive HIV prevention that is linked with reproductive health services. Some of the key recommendations in the report include:

* Repeal the abstinence-until-marriage funding mandate in the U.S. Leadership Act.
* Consider IOM’s recommendation to remove all PEPFAR funding mandates or, at least, make all earmarks non-binding to allow country teams flexibility to meet local needs.
* Revise OGAC’s ABC Guidance to reflect evidence-based best practices for HIV prevention among youth.
* Increase appropriations for family planning through USAID’s Office of Population and Reproductive Health.
* Require OGAC to improve monitoring and evaluation of programs using more precise age data.
* Convene a technical working group on HIV–positive adolescents. From the lessons learned at the consultation, issue new guidance on HIV-positive youth’s needs.

PEPFAR’s congressional authorization will expire in fiscal year 2008. Advocates for Youth urges members of Congress and staff as well as OGAC, the Administration, and colleague organizations to consider seriously the recommendations in this report and to ensure that youth are not, once again, ignored by PEPFAR. Without serious reflection and change, current policies will hinder PEPFAR from attaining its laudable goals and will leave a generation defenseless against HIV/AIDS.

I live and work in Africa. At no one time did my parents talked to me about sex openly or in public. This work was left to our teachers, who apparently saw me to be too innocent to be bombarded with sexual issues at an early age.

As i grew up, Tv was available with all its almost nude programs, magazines floated the streets and eventually AIDS was pronounced a National disaster in KEnya.

SOME INTERESTING FIGURES

It is estimated that 42 million people world wide have HIV / AIDS of which 2.5 million are children.

Predictions for AIDS deaths between the years 2000 to 2020 are around 68 million.

In 2003 those Africans who could benefit from treatment with ARV drugs, only 2% actually received the drugs.

However, there are problems in administering these drugs as they need to be taken at regular interval with clean water and the patient must also eat a healthy diet during treatment. This is often impossible when the patient doesn't have access to a clock and may only eat irregularly.

Cultural factors often make the situation especially difficult for women. In many countries women are not expected to talk about sexual matters and they may risk abuse if they refuse sex.
Some African men have many sexual partners and can unknowingly pass on HIV to them. It has become a myth that sex with a virgin can cure the man of AIDS.
The condom could prevent the spread of aids but even when they are made available, many African men won't use them.

Lets be wise. Keep the Promise. Speak about HIV/AIDS.

I have been thinking, why is that even as we fight about the problem of HIV/Aids infections, it is still spreading, and there is still some stigmatization tagged to it? It seems that there is something somewhere that we are missing. I have experienced the loss of a loved on to the infection and I understand how people feel when they lose a loved one from the infection. We need the way forward on how to help the youth embrace the concept of behavior change and this can be done by including them in the major bodies involved in the steering the campaigns to fight HIV/Aids.

Manières fonctionnantes pour la campagne de changement de comportement
Translated into French by: Erick Ochieng Otieno
J'avais pensé, pourquoi suis que même pendant que nous combattons au sujet du problème des infections de HIV/Aids, il écarte toujours, et est-ce que là toujours une certaine stigmatisation est étiquetée à elle ? Il semble que il y a quelque chose quelque part que nous sommes absents. J'ai éprouvé la perte d'a ai aimé dessus à l'infection et je comprends comment les gens jugent quand ils perdent a ont aimé un de l'infection. Nous avons besoin de la manière en avant sur la façon dont aider la jeunesse à embrasser le concept du changement de comportement et ceci peut être fait en les incluant dans les corps principaux impliqués dans la direction les campagnes pour combattre HIV/Aids.

Now that antiretroviral therapy is beginning to become available on a large scale, and across a wide range of populations in Africa and Asia, evidence is beginning to emerge about the variations in side-effects and tolerability between different populations.
In particular, side-effects associated with nucleoside analogue treatment, and stavudine (d4T, Zerit) especially, attracted a lot of attention at the Thirteenth Conference on Retroviruses and Opportunistic Infections.
Unfortunately these side-effects have been seized upon in a misleading way by AIDS denialists in South Africa as part of a shameless and highly misleading campaign to derail the roll-out of antiretroviral therapy in a country desperately in need of wider treatment access. AIDS denialists claim that side-effects experienced by people on treatment are a sign that antiretrovirals are `poisoning` South Africans.
"It is really shocking what damage [these] lunatics are doing to HIV care," said Dr Halima Dawood of King Edward's Hospital in Durban. "HIV is a disease that results in death and while the drugs have side effects, we are able to keep patients alive with the drugs."
Indeed, any rational, evidence-based approach to HIV treatment will reject such scare-mongering claims - unfortunately, these tactics do sometimes steer patients away from going on treatment. According to Chris Green, a treatment educator working with the Spiritia Foundation in Jakarta, Indonesia, "the word gets around. In our experience, a number of people who are probably inclined to avoid taking drugs when they feel well decide to delay starting ART because of these concerns."
It is also important to understand that drug toxicity is one of the major obstacles to good adherence, so careful observation of toxicity, education of patients and timely response to their concerns is a necessary part of HIV management.
Toxicities most commonly reported in cohort studies from resource-limited settings presented at the Thirteenth Conference on Retroviruses and Opportunistic Infections included:
 Peripheral neuropathy (damage to the nerves in the feet and legs, caused by d4T, universally reported as the most common serious toxicity)
 Lactic acidosis (a build-up of lactate in the body)
 Rash (caused by nevirapine)
 Anaemia (caused by zidovudine (AZT))
 Lipoatrophy (loss of fat from the limbs and face, chiefly caused by d4T, more prominently a problem in reports from Rwanda and India than from Uganda, South Africa or Kenya)

CD4 cell counts are still increasing after seven years of antiretroviral therapy in patients whose baseline CD4 cell count was below 500 cells/mm3 when they started HIV therapy, delegates to the recent Conference on Opportunistic Infections and Retroviruses (CROI) learnt earlier this month. Other research presented to the conference also showed that, to stand the best chances of achieving an increase in CD4 cell count to normal levels, it is necessary to start treatment with a CD4 cell count above 350 cells/mm3, and that patients with ongoing immune activation and a large thymus have smaller gains in CD4 cell count. A small study in the United Kingdom also suggested a possible role for recombinant human growth hormone to 'kick-start' HIV-specific immune responses.