Bank, 2006). An estimated 5 million people aged 15 to 24 years were living with HIV in 2009 (UNICEF, 2011). In 2011 an estimated 40 percent of HIV incidence in people aged 15 years and older was among those aged 15 to 24 years (UNAIDS, 2012b). Adolescents are vulnerable because of age-specific physical, psychological, and social changes (e.g., their relationships and roles, expectations, and economic security) (Call et al., 2002). These transitions affect the ways in which adolescents understand information, how they are influenced, their abilities to make decisions in the present and to plan for the future, and their perceptions of risk (FHI, 2010). The majority of the people in this age group living with HIV are in sub-Saharan Africa, where young women in particular are more vulnerable and at greater risk of HIV infection (Gouws et al., 2008; Napierala Mavedzenge et al., 2011; UNICEF, 2011). There are many socio-cultural factors that increase the vulnerability of young women to sexually transmitted HIV infection. These include deep-rooted gender roles, uneven power relations, sexual violence (including rape), intergenerational sex, and a lack of skills and information that would enable them to access services and better protect themselves (UNAIDS, 2009). Issues related to women and girls as well as gender norms are discussed in more depth in Chapter 8.
The United Nations Convention on the Rights of the Child guides the efforts of the international community to protect the rights of children to survival, healthy development, and access to health services. The convention’s guidelines stress the importance of reversing the HIV epidemic in children and using the Millennium Development Goals, the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS, and the UNGASS on Children as platforms through which to mitigate the negative effects of HIV on children’s health and well-being (UNICEF, 2007). The Committee on the Rights of the Child monitors the progress of countries in achieving standards and goals.5 Multilateral and bilateral stakeholders who support efforts and policies for OVC affected by HIV/AIDS have developed the Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. This framework includes five strategies for improving the well-being of children: “(1) Strengthen the capacity of families to protect and care for orphans and vulnerable children by pro-
5 The Convention on the Rights of the Child, which the United States has not ratified, is the first legally binding international instrument that addresses the complete range of civil, cultural, economic, political, and social rights of children. Through the convention, the United Nations Children’s Fund (UNICEF) assumes the responsibility of promoting the rights of children by supporting the Committee on the Rights of the Child. UNICEF provides governments with technical assistance on implementation of the Convention and the development of implementing reports, which must be submitted every 5 years (OHCHR, 2007; UN, 1990; United Nations Treaty Collection, 2010).