Report on the Global HIV/AIDS epidemic

AIDS in a new millennium: a grim picture with glimmers of hope
urveillance system, depicted in Figure 2, show that the percentage of
girls aged 15-19 infected with HIV in the capital, Lusaka, has on average
y almost half in the last six years.
ns between studies of sexual behaviour conducted in 1990, 1992, 1996
suggest that these falling HIV rates are due in part to a decrease in the
e of some types of risky sexual behaviour in urban areas. For example, far
ng women in Lusaka were having sex before marriage in 1996 than in 1990,
ercentage of unmarried women who were sexually active fell from 52% to
that period. Among young men, according to nationwide studies, the
ime later; in 1998 just over half of unmarried men said they had not had sex
t year, compared with just over a third two years earlier, and the proportion
porting two or more casual partners in the past year also fell. However,
no evidence at the national level that either girls or boys were postponing
)f their sex life.

Elsewhere in the region too, there are signs that young people are avoiding the patterns of behaviour which led their parents and older siblings to such high levels of
HIV infection. Condom use, for example, is increasing among young people (see
pages 59-64) and there are indications that, among the better-educated, sex with
casual partners may start later and be less frequent (see pages 43-44). But these
changes are taking place against a background of very high infection rates, especially in young African women.
Figure 3 shows frighteningly high prevalence rates of infection among teenagers and
women in their early 20s in various urban and rural areas in Africa. The rates among
teenage girls and especially among women under 25 defy belief: in 7 of the 11 studies, more than one woman in five in her early 20s was infected with the virus; a large
proportion of them will not live to see their 30th birthday. Close to 6 out of 10 women
in this age group in the South African town of Carletonville tested positive for HIV.
The infection rates in young African women are far higher than those in young men.
In the 11 population-based studies presented here, the average rates in teenage
girls were over five times higher than those in teenage boys. Among young people
in their early 20s, the rates were three times higher in women. In large measure, this
enormous discrepancy is due to age-mixing between young women and older men,
who have had much more sexual experience and are much more likely to be exposing the girls to HIV. It is also because girls are more easily infected during vaginal
intercourse with an infected partner than boys are.
The fact that, in Africa, women's peak infection rates occur at earlier ages than men's
helps explain why there are an estimated 12 women living with HIV for every 10 men
in this region of the world. Not only do the young age groups account for a bigger
proportion of the population, but individuals who are infected at a younger age tend
to survive longer and continue to be counted among those living with HIV.

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