Youth Livelihoods and HIV/AIDS
Young and poor. Two decades into the epidemic, this is increasing the face of the victims of HIV/AIDS in the developing world. Those working to prevent its spread and mitigate its impact increasingly recognize the links between HIV/AIDS, youth, and poverty. They struggle, however, with how best to address the economic factors driving the epidemic. This edition of In Focus examines the potential of efforts to improve the economic circumstances of youth group of activities known as the youth livelihoods approach to help stem the spread of HIV/AIDS.
What is the youth livelihoods approach?
A livelihood is everything people know, have, and do to make a living. The livelihoods approach builds on earlier poverty reduction models, including participatory and integrated rural development. Applied to youth, the livelihoods approach comprises a broad and interrelated set of programs and policies that include:
• Giving youth salaried jobs and other opportunities to earn income, Providing credit, savings and other financial services and related training in job and business skills;
• Developing institutions, alliances and networks for youth to advance their economic interests; and Promoting policy and social changes that improve young people’s livelihood prospects.
The conceptual link between youth livelihoods and HIV/AIDS
A consensus is now emerging that poverty reduction is an important component in the fight against HIV/AIDS
Poverty compounds the vulnerability of young people to HIV infection. Early in the epidemic, wealthier people were more likely to be infected. The opposite now appears to be true. Youth who are poor have an increased risk of infection because they are more likely to:
• Be in poor general health to begin with and to leave sexually transmitted diseases untreated;
• Yield to pressure to exchange money or goods for sex;
• Migrate to find work, and thus increase their chances of risky sex and lack hope for the future.
Youth already infected with HIV face heightened economic concerns. One-third of the 36 million people living with HIV/AIDS are youth ages 15 to 24; youth account for half of new HIV/AIDS infections. As they fall sick, their ability to provide for themselves and for others who depend on them declines.
• Their symptoms often reduce their capacity to work.
• In many countries, discrimination against infected youth makes it harder for them to find and keep a job and to work productively.
• In the hardest-hit countries, poor youth with HIV face an even bleaker economic future as AIDS increases overall poverty and income inequality.
The disease creates severe economic problems for young people from poor, AIDS-affected families. The current number of AIDS orphans, 13 million, is projected to triple in a decade. In the worst-affected countries, AIDS may orphan as many as 40 percent of all children.
• For poor youth, the onset of HIV-related illness in a parent, brings immediate economic problems.
• Traditional family and community support networks for surviving children are heavily burdened where the epidemic is already widespread.
• Youth from affected homes often forgo schooling and other opportunities, thus threatening their livelihoods prospects and increasing their own chances of contracting HIV.
Girls are particularly vulnerable to the economic factors that contribute to the spread of HIV/AIDS. Two of every three young persons infected with HIV/AIDS is a girl or young woman.
• Girls generally have fewer economic and educational opportunities than boys. As a result, girls are more likely to engage in formal or informal sex work or practice involuntary or risky sexual behaviour.
What is known about youth livelihoods efforts and their contribution to HIV/AIDS prevention, care and support?
Recent reviews of adolescent livelihoods programs, have found that:
• A wide range of institutions have program or policy efforts to improve youth livelihoods;
• Most efforts are small-scale and focus on boys;
• Relatively few efforts explicitly link youth livelihoods activities and HIV/AIDS prevention, care and support; and
• Few programs have been well-documented or rigorously evaluated.
Examples of programs and policy efforts that have been put in place include the following:
• Programs that provide jobs, work experience, and income generation.Such programs increase economic opportunities and improve life prospects. Although circumstances force many youths into exploitative and dangerous jobs, legitimate, non-harmful work may be the best option for youth whose educational opportunities are extremely limited. A largeproportion of adolescent’s 32 percent in Africa are already employed. AIDS is forcing more youth into the job market.
The chance to earn income is also extremely important to an infected youth facing economic problems, or to a youth supporting a family when parents have fallen sick or died from HIV/AIDS.
As more adolescents enter the formal work force, their place of employment can also become a setting for prevention and care and support activities.
Training youth in job and business skills and providing financial services. These programs provide financial relief to AIDS-affected youth and their families.
Vocational education and job training: Prepare young people for specific careers and are most effective if they make strong labour market links and develop job placement components. Programs linking job training and improved sexual and reproductive health include the following:
Training in enterprise skills for example, planning, risk management, and decision making has emerged as an important, yet relatively unexamined, component of many livelihoods’ programs. Many such skills are valuable to youth in situations where they are attempting to avoid risky sexual behaviours.
• Partnering with non-governmental organization and other service providers specializing in business training to provide poor rural/urban youths with reproductive health services and business training. This contributes on the increased knowledge about reproductive health and improved attitudes towards responsible sexual behaviour.
Financial services, including high-quality microfinance (credit and savings) efforts, are among the most promising approaches to mitigating the economic impact of HIV/AIDS. Many microfinance organizations in the hardest-hit countries in sub-Saharan Africa should offer products specifically for AIDS-affected clients and households, although some of these products may have limited applicability.
Innovative financial products geared to AIDS-affected youth include the establishment of education trusts for minors and allowing youth from AIDS-affected households to use microfinance services. These programs have potential if organisation collaborate design and implement them well.
• There is need to link youth to microfinance with sexual and reproductive health outcomes. Loan repayment rates should be lowered to an affordable price according the setting of communities where the household income is too low.
Developing institutions that bring together youth for economic advancement also help prevention, care and support efforts. When youth belong to an organization that helps them and provides opportunities, they better avoid risky behaviours, including those that might lead to HIV/AIDS.
• Several countries are putting together networks of young people living with HIV/AIDS. Most of these groups help youth find and keep jobs.
Policies support prevention efforts by shaping the context in which jobs, training, services, and institutions operate. Many of the policies to address the HIV/AIDS-related problems of youth are livelihoods-related, and include:
• Antipoverty policies with broad social benefits that help individuals, families, and communities cope with AIDS;
• Policies that improve the job, credit, and schooling opportunities of adolescent girls and reduce their vulnerability to sexual exploitation.
• Formulation and enforcement of national policies that protect and support youth in especially difficult circumstances, such as street kids, refugees and war victims;
• National legislation to protect the property rights of AIDS orphans and to address the needs of young people affected or infected by HIV/AIDS. One program for AIDS orphans in Uganda helps HIV-infected parents prepare for their children’s economic future. Parents receive help choosing a guardian, writing a will, and getting legal advice on property inheritance, and also participate in income-generating activities.
Lessons that have been identified from programmatic efforts
Recognize diversity. Youth are an incredibly diverse group, in terms of both their economic circumstances and sexual attitudes and behaviour. Younger youth are more economically disadvantaged than older youth. Girls are usually more economically disadvantaged than boys, but boys are often more subject to peer and societal pressure to engage in risky sex. Programmatic and policy responses must take this diversity into account.
Focus on the poor. Those youth for whom livelihoods programs work best poor and marginalized youth are at highest risk of contracting and transmitting HIV/AIDS. To have maximum impact on the epidemic, programs need to maintain the focus of livelihoods programs on these disadvantaged groups.
Livelihoods is one piece of the puzzle. Livelihoods strategies are one component of the range of strategies needed to prevent HIV/AIDS and mitigate its impact on children and youth. HIV/AIDS programs must continue to focus on the immediate needs of youth for reproductive health information and services, while incorporating a livelihoods perspective to their activities.
Linking is widespread, but little understood. Organizations are increasingly linking livelihoods programs with other HIV/AIDS prevention and mitigation activities, but relatively few of these arrangements have been documented.
• Linking can take place in different ways. Health organizations can: inform livelihoods groups on HIV/AIDS and its impacts on affected youth; serve as a referral point for AIDS-affected livelihoods clients; learn from livelihoods specialists how to help affected youth; and educate youth involved in livelihoods programs on HIV/AIDS prevention and mitigation.
Peer education has been a particularly effective means of transmitting such information.
• Evidence from the United States strongly suggests that combining HIV education and information programs with livelihoods efforts can produce a greater positive impact together than in isolation.
Livelihoods programs require specialized expertise. Health organizations should either team up with livelihoods-focused groups or, if they choose to conduct such programs by themselves, ensure they have qualified staff and an in-depth understanding of programmatic issues.
Programs should do more to link prevention with care and support. Greater linking of HIV/AIDS prevention with care and support for youth infected with HIV or from AIDS-affected families could improve the effectiveness and cost-effectiveness of both types of programs, particularly since youth tend to be more receptive to prevention messages.
Better evaluation is needed. Relatively little is known about the effectiveness, cost-effectiveness, sustainability, and potential for scaling up of livelihoods programs. Furthermore, their impact on adolescent reproductive health has not been systematically evaluated, although efforts are under way to improve the state of knowledge.
• Measuring the success of livelihoods programs remains a challenge, because their impact is long term and measurement of livelihoods skills is inherently difficult. Furthermore, the interaction among the economic influences on health behaviors is complex, making it difficult to determine the impact of livelihoods programs on HIV/AIDS prevention, care and support.
Program sustainability and scaling up. Decisions on scaling up of programs are critically important given the enormous magnitude of the HIV/AIDS problem and the limited resources available to address it. Working through existing organizations is one way to ensure that programs continue to provide services at a reasonable cost. Focusing on the most vulnerable children is another way to have the largest impact both on livelihoods outcomes and on HIV/AIDS prevention, care and support.
A collaborated effort is needed, there are so many service providers with high level of experience in the livelihood program, and therefore working together will ensure a coordinated and suitable programming to support our beneficiaries living with HIV. The local government has to take a pivot role in bringing up these entities on board and ensuring synergy among them for a successful service delivery to the beneficiaries.
Youth link networks