AIDS is on a rapid increase among young people in Asia. And according to a new report by UNICEF, that’s at least in part because of the extreme popularity of dating apps among high risk groups.
The new UNICEF report brings to light an unexpected HIV/AIDS hotspot: adolescents in the Asia/Pacific region. It’s a sobering package of information. People from 10 to 19 years old are in a unique and difficult risk group when it comes to HIV. The biological realities of adolescence combine with social factors to drive up rates of HIV infection and reduce access to care and treatment.
These factors up to some very unpleasant numbers. In Asia and the Pacific, it appears that less than 33% of adolescents with HIV actually get treatment. And AIDS-related deaths of 10-19 year olds in the region increased by 110% between 2005 and 2014. That’s not the result of a general upward trend; AIDS-related adult deaths actually decreased by 28% over the same time period.
Stigma around HIV, homosexuality, and drug use is still powerful in the region, and adolescents are particularly susceptible to stigma and social pressure. Adolescents have a harder time accessing the tools they need to avoid infection – from drug treatment to clean needles to the condoms needed to have safer anal sex. In many countries, youths under 18 cannot be tested for HIV without parental consent.
But in recent years, there’s been one unexpected exacerbating factor: smart phones and gay dating apps. Extremely popular with gadget-loving teenagers, these dating apps allow easy access to casual sexual encounters with strangers. In combination with the adolescent propensity for risk-taking, the encounters rarely involve condoms. One young man is quoted in the report, “I was very vulnerable to HIV before I even turned 18…I was having unprotected penetrative sex with different boys who I barely knew and who I met through social media on the Internet.”
From the report:
Bangkok’s intensifying HIV epidemic among young MSM is largely a result of extensive sexual risk-taking, a higher number of partners, overall increased biological vulnerability through unprotected anal sex with an HIV positive partner, low uptake of HIV testing, and an earlier age of first sex – frequently in the low to mid-teens.7 All of these phenomena are common to other cities in and outside of Thailand. The explosion of smart phone gay dating apps has expanded the options for casual spontaneous sex as never before – mobile app users in the same vicinity (if not the same street) can locate each other and arrange an immediate sexual encounter with a few screen touches.
Younger adolescents are often still in school, which brings its own challenges. Schoolchildren with HIV face barriers just attempting to go to school. The report mentions China in particular, where over one third of children living with HIV experienced discrimination in the classroom, and 9 per cent of the children of people living with HIV were prevented from going to school in the last 12 months. At the same time, China has a national HIV curriculum which is supposed to be taught in all secondary schools, which implies that just attempting to improve awareness is not the solution.
In response, UNICEF proposes an increase in funding for services targeted directly to adolescents, calling it a “customized investment blueprint” with the overall title of “All In.” It focuses on four main approaches: 1) improving access to condoms and lubricant, 2) harm reduction services to reduce HIV transmission among people who inject drugs, 3) HIV testing and counselling, and 4) HIV treatment and care.
UNICEF also recommends working with the most popular dating apps to help spread messages about safe sex.
Popular smart phone dating apps in the region such as Jack’d, Blued and Grindr, while enabling a generation of MSM to meet sexual partners easily, could also be educative. Public health experts hope that such apps will become vital conduits promoting sexual health, including HIV messaging and testing.41 It is starting to happen in Asia. Thailand, for example, is using social media such as Facebook, Line and Camfrog to reach MSM with information on prevention and HIV testing.42 On World AIDS Day 2014, UNAIDS and UNICEF worked with Chinese gay dating app Blued to add a red ribbon next to every user’s profile picture. The ribbons linked to information about HIV and details of the user’s nearest voluntary testing centre.
In all, $748.6 million will be needed for the plan in 2016. By 2020, it will be $1 billion a year. It remains to be seen if UNICEF will be able to mobilize that funding. They argue, correctly, that underspending on HIV right now will be very costly in the future. However, that kind of math is rarely as convincing to policymakers as it should be. Asia-Pacific is also a difficult region to define when asking for support. Any region that includes China, Afghanistan, and Thailand is difficult to sell as a logical homogenous unit requiring a unified approach.
Finally, UNICEF’s adolescent-focused approach makes sense, but it is not universally accepted as best. Condoms, harm reduction, HIV testing, and ARVs are the cornerstones of any HIV response. While it is true that adolescents are an especially challenging population to reach with these interventions, many argue that improving services for everyone at risk for HIV is better value for money. For example, some challenges are unique to adolescence, like the need to attend school or get parental permission for HIV testing. Those need special solutions. More broadly, though, the challenge to working with young people is that adolescents are especially sensitive to anything that keeps them from getting access, such as fear of being identified as gay or HIV positive. Those are universal fears not specific to adolescents. If we can ensure than all HIV services address these kinds of common challenges, we can improve care for everybody. UNICEF’s focus on adolescents is an import approach, but it’s not the only option.