better or much better than their parents’ lives (UNICEF, 2001a). Similarly, approximately three-quarters of 14-18-year-olds in 20 countries of Latin America and the Caribbean believed that they would have better lives than their parents (UNICEF, 2000).

With HIV/AIDS now the dominant cause of death among young people in sub-Saharan Africa and with other newly emerging infectious diseases, the concept of one common epidemiological transition, in which all societies evolve toward declining importance of infectious diseases and increasing importance of chronic conditions, may reflect too simple a view of long-term trends. Extensions of transition stages to accommodate further mortality declines, as well as critical exceptions to transition, notably in Africa, but also in Eastern Europe, have increasingly been noted (Caselli, Meslé, and Vallin, 2002). The health of young people in developing countries still contrasts strongly with the health of young people in developed countries, and even among developed countries, enough contrasts exist, for example, between Western and Eastern Europe, to illustrate that homogenization is far from being achieved.

HIV/AIDS and Other Sexually Transmitted Infections

Globally, almost 12 million people ages 15-24 were estimated to be living with HIV/AIDS in 2002. About three-quarters of these live in sub-Saharan Africa. The young age structure of countries hardest hit by the pandemic means that about half of all new infections are now occurring among this age group (Summers, Kates, and Murphy, 2002; Joint United Nations Programme on HIV/AIDS [UNAIDS], 2002). Since the vast majority of HIV infections are sexually transmitted, the vulnerability of young people is strongly influenced by their sexual behavior. Thus, early age at sexual initiation, early marriage, risky sexual practices, and commercial sex work are all contributing factors. In places where HIV is linked primarily to injecting drug use, young people, who tend to be the main users, are most affected. The injection of drugs among young people has apparently increased in some countries in recent years, most dramatically among young men in Eastern Europe and Central Asia (UNICEF, 2002; United Nations, 2000b).

Table 4-3 shows estimates by the Joint United Nations Programme on HIV/AIDS (UNAIDS) of the proportions of young people infected at the end of 2001. On average, prevalence is extremely high in countries of Eastern and Southern Africa. HIV prevalence in 2001 averaged 14 percent among females ages 15-24, 6 percent among males, and 12 percent among all adults ages 15-49. Prevalence is also very high in Western and Middle Africa. In a few countries in this region, such as the Central African Republic and Cameroon, levels resemble those in Eastern and Southern Africa.



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