in 55 countries, only 40 percent on average are aware that mosquitoes cannot transmit HIV (UNICEF, 2002).
Knowledge of ways to prevent the transmission of infection is also low among young people in many countries. In 17 national surveys conducted between 1994 and 1999, 40 percent of females ages 15-19 on average could not identify any preventive measure—abstaining from sex, being faithful to one partner, avoiding multiple partners, or condom use. Males of the same age were somewhat more knowledgeable, with 27 percent not knowing how to protect themselves. Across countries, however, the level of knowledge is quite variable but nonetheless consistent with the prevailing level of risk. For example, the percentage not knowing any preventive measures was 96 percent for females and 88 percent for males in Bangladesh, where HIV represents a relatively modest risk for young people, compared with 11 and 16 percent, respectively, in Uganda, where the risks are very high (Kiragu, 2001). It is also worth noting that only a small percentage of young people who are infected report in surveys being aware that they are HIV positive (UNICEF, 2002).
The extent to which young people are able to judge accurately the risks associated with health behavior is still poorly understood overall (Blum, McNeely, and Nonnemaker, 2002), but there is some evidence that they underestimate their own risk of becoming infected with HIV/AIDS. In part this underestimation is due to a lack of accurate information, such as misconceptions about modes of transmission as well as a sense that “this cannot happen to me.” But (as is true among adults generally) it is also related to a desire to be accepted, to trust one’s partner, and to believe that he or she is “clean” (Brown et al., 2001). Moreover, since infection with HIV does not have immediately apparent effects, young people may find it difficult to make choices with consequences that seem very removed from their immediate situation (Weiss, Whelan, and Gupta, 1996).
Nevertheless, trends in the use of condoms by young people suggest that behavior is changing in sub-Saharan Africa and Latin America, where data on condom use have been collected for young people (see also the section below on sexual initiation). Condom use among sexually active young women is still relatively low, but increases are evident when Demographic and Health Surveys (DHS) from the late 1980s are compared with surveys about 10 years later (Table 4-4). Among young women who presumably are most likely to have high-risk sex—never married, sexually active females—the (unweighted) average increases among 15-19-year-olds from 0.3 to 8.0 percent and among 20-24-year-olds from 0.2 to 5.5 percent. The often-cited case of Uganda and its success in promoting behavior change is evident here; virtually no women ages 15-24 were recorded as using condoms in 1988-1989, whereas about 10 years later the proportions among never married, sexually active women exceed one in three and are