Compiled by E. Mohamed Rafique, Resource Person and Rituu B. Nanda, Research Associate 14 September 2008: Under the influence of substances like alcohol and drugs, the risk of unsafe sexual activity is high especially among youth. Responding to the query, members shared interventions and documents addressing sexual health, developed, managed and implemented together with those addressing substance use.
A significant number of young people engage in sexual intercourse as well as drug and alcohol use at an early stage in their lives. In our country, respondents observed, it is easier for youth to obtain prescription drugs than getting beer or other drugs. Reduced inhibitions lower the likelihood of safe sexual intercourse. Members quoted a study which says that youth are three times as likely to have sex that is unprotected when they are drunk, than when sober.
Members identified gaps in knowledge and beliefs about alcohol and drug abuse and HIV among youth. Adolescents are either ill informed or not well informed about their health, sexuality or physical well-being. Youth often engage in unsafe sex as they consider condom mainly for birth control, respondents mentioned.
Among the several socio-economic groups in a community, members noted that there are two main groups vulnerable to substance abuse and unsafe sexual behaviour. One is from the elite class and another is of the deprived class or less educated, unemployed or under-employed groups. Reports depict that urban middle class households in which both parents are working, provide enough space for their children to indulge in unguided behaviour. Sex with multiple partners in the workplace among young staff has emerged as a new HIV threat in the country, members reported.
The need to educate teens is enormous as they are more likely to experiment and risk, members stated. It is easier to prevent changing behaviour pattern than to modify conduct once it becomes a habit. So, HIV prevention programmes for youth must focus on alcohol abuse as well as other drug abuse and sexual risk behaviour. Accordingly, members quoted The HIV and Alcohol Prevention in Schools project in South Africa , which seeks to reduce and prevent alcohol use and risky sexual behaviour among adolescents.
It is important to conduct a multi-centric research study with analysis of data including the public health sector. In addition, we need to look at these issues in context of demographic and typical geo-social conditions. Suggesting a resource, members said, Child line India Foundation gives statistics of the drug abuse among children, as well as, details of the interventions to address the issues.
The socio-economic determinants have an impact over HIV prevention and control. As, in the transition phase or conflict between traditional and modern values, members observed, media can play a vital role. Therefore, while designing interventions, we must specify the socio-economic groups we are addressing, respondents emphasised.
Attitudinal change is not easy to achieve, members stated. In Papua New Guinea , The Constellation for AIDS Competence experienced that when youth discuss the issue, reflect on their concerns and vulnerabilities, they change their behaviour. When they understand that they have the capacity to stop the spread of HIV, they start taking action. A continuous effort to train and create awareness would be one of the strategies to consider, besides strengthening law enforcement and policy as well as setting up and implementing institutional mechanisms. Similarly, UNODC in India targets young people, taking to them information on drugs and the related risks of HIV.
Parents and teachers face deep-rooted cultural constraints in discussing these issues with children. Systematic training of teachers and parents on developing communication skills to discuss culturally sensitive topics with adolescents is required. Open interaction with children within the parameters of cultural norms can instil strong values and develop social skills, which in turn can minimize their risk of abusing drugs or contracting HIV. UNODC in an Asian country adopted a two-pronged approach, training and creating peer network and IEC or BCC campaigns. It distributed CDs to those parents who were working or had little time to spend with their young children.
Members provided other suggestions to deal with issues of substance abuse and HIV in youth:
· Inculcating healthy behaviour in youth through importance of fitness, sports, nature loving helps them live most productively like People’s Health Organisation (India)
· Using innovative cultural and artistic input in peer-education is cost-effective.
· Avoidance of words and terms which are not in accordance with a sensitive approach towards people, especially when the ‘community’ is a primary stakeholder of the proposed intervention
· Studies and research on these issues from NACO and SACS to be put on forums like Solution Exchange
· Inputs from IEC division of NACO and SACS on the subject
Finally, members recognized that the potential for HIV spread among the youth is considerable given the evidence of overlapping drug use and sexual risk behaviours. Applauding the awareness campaigns for youth around sex, drugs and alcohol, they said that these are not enough in isolation. Discussants called for an integrated prevention programme addressing alcohol, drugs, and sexuality.