The global impact of HIV/AIDS on young people.

This article provides an overview of the impact of HIV/AIDS on young people around the world, generally defined as those between the ages of 10 and 24. It uses a variety of sources and studies. Readers are cautioned that global data sets and studies specific to young people are in short supply; therefore, country- or community-specific information is often used to illustrate key points.

Because of its focus on young people, this article does not discuss mother-to-child transmission (MTCT); however, MTCT remains a major route of transmission in some parts of the world and contributes to the number of young people living with HIV or at increased risk of infection.

CURRENT IMPACT

HIV/AIDS prevalence among young people is already high in many hard-hit countries around the world, and young people continue to make up a significant proportion of new infections.

Prevalence and incidence. There are an estimated 40 million people living with HIV/AIDS worldwide, more than a third of whom (38 percent) are under the age of 25. (1) They account for 33 percent of adults ages 15 to 49 estimated to be living with HIV/AIDS.

Of the five million people newly infected with HIV in 2001, almost six in 10 (58 percent) were under the age of 25. Those 15 to 24 years of age represented four in 10 of these new infections. Young people ages 15 to 24 account for half of all new infections among individuals 15 to 49. This amounts to almost 6,000 infections per day among 15 to 24-year-olds, or approximately one every 15 seconds. When infections among children under the age of 15 are factored in, an estimated 8,000 young people become infected with HIV every day worldwide. (2)

In regions where the epidemic is mostly related to heterosexual transmission, new HIV infections occur disproportionately among girls and young women. In regions where injection drug use and male-to-male sexual contact are primary modes of transmission, rates of new infections among young men exceed or are equal to those among young women. (3)

Overall, most people newly infected with HIV or already living with HIV/AIDS are in sub-Saharan Africa. Among young people, approximately three quarters (76 percent) of those already infected live in this region, (4) as do over 90 percent of the world's AIDS orphans (some 12.1 million children). Children orphaned by AIDS are more likely to become or remain impoverished and to become infected themselves. (5)

In sub-Saharan Africa, as many as 11 percent of young women and six percent of young men age 15 to 24 are estimated to already be living with HIV/AIDS. Within the region, Botswana and Lesotho have the highest proportions of infected youth. In Botswana, for example, up to 45 percent of young women and 19 percent of young men age 15 to 24 are estimated to be living with HIV. (6) In Lesotho, up to 51 percent of young women and 23 percent of young men are estimated to be living with HIV. (6)

Countries in other regions of the world also have high HIV/AIDS prevalence rates among youth. Approximately 15 percent of young people living with HIV/AIDS are in the East/South Asia and Pacific region of the world. (7) In Cambodia, as many as three percent of young women are estimated to be infected, as are one percent of young men. In Haiti, HIV prevalence is as high as seven percent for young women and five percent for young men. (8)

Even in developed countries that have had important successes in prevention and treatment leading to reductions in new infections, morbidity, and mortality, such as the United States, recent data indicate a rise in incidence among some young populations. Young people under the age of 25 continue to represent as many as half of new infections. (9)

Nations with young populations hard hit. High rates of HIV infection among young people are, for the most part, occurring in countries with very young populations. Sub-Saharan Africa is one of the youngest regions of the world. Over half of its population is estimated to be under the age of 18 (with one in four people between the ages of 10 and 19). (10) In Zambia, Malawi, Kenya, and Mozambique, over half of the population is below the age of 18. In South Africa, more than 40 percent of the population is below the age of 18.

Hard-hit countries in other regions of the world also have young populations. Almost half of Haiti's population is below 18. By comparison, about a third of the world's population is below the age of 18, and slightly more than one quarter of the U.S. population is below 18. (11) The confluence of high HIV/AIDS prevalence and disproportionately young populations results in a concentration of infections among young people that has vast and long-term consequences for the course of the epidemic and for the future of many highly-affected countries.

The National Intelligence Council, part of the Central Intelligence Agency, has identified a number of countries with "youth bulges" (defined as those in which the ratio of 15- to 29-year-olds to 30- to 54-year-olds exceeds 1.27.) (12) Most of these are in sub-Saharan Africa and correspond to those countries with already-high prevalence of HIV among young people. Of the 25 sub-Saharan countries with youth bulges, over half have prevalence rates of HIV among young males and/or females higher than 10 percent. (13)

Analysis of data from the U.S. Census Bureau (14) indicate that the youth bulges will increase in many highly affected countries, including Botswana, Burundi, Lesotho, and Mozambique, due in part to the effects of the epidemic (as those in slightly older cohorts die prematurely).

PROJECTED IMPACT

The HIV/AIDS epidemic is expected to have far-reaching demographic impacts on many nations, affecting the population structures of hard-hit countries. (15) Teens and young adults will be increasingly affected.

Prevalence among young people. The U.S. Census Bureau estimates that HIV/AIDS prevalence rates among adults age 15 to 49 will continue to rise at least through 2010 in many hard-hit countries in Africa, Asia, and Latin America. (16)

The number of young people living with HIV/AIDS is also expected to grow over the next decade. Analysis of U.S. Census Bureau data indicates that if current trends persist, the global total of young people living with HIV/AIDS could rise from the current estimate of 12.4 million to 21.5 million in 2010, an increase of more than 70 percent. (17) This estimate is based on analysis of data from 49 highly affected countries in Africa, Asia, and Latin America, which represent approximately 75 percent (or 9.3 million) of the global estimate of young people currently living with HIV/AIDS.

AIDS-related deaths. One of the most direct measures of the epidemic's impact is mortality. In countries where 15 percent or more of all adults are estimated to be infected with HIV--nine countries as of the end of 2001--it has been projected that at least one-third of boys now aged 15 will die of AIDS unless treatment improvements or a vaccine is introduced. (18) In Botswana, where prevalence is particularly high, a 15 year-old now has about an 80 percent chance of dying of AIDS. (19)

Deaths due to HIV/AIDS are premature deaths, and many who die from AIDS-related causes were infected as teens and young adults. (20) UNAIDS estimated that the survival time from HIV infection to death in sub-Saharan Africa is approximately eight to nine years. (21) As such, most of those who die from AIDS-related causes between the ages of 20 and 34 were infected an average of eight to nine years earlier, as teens or younger adults. U.S. Census Bureau data from 50 highly affected countries were analyzed to assess this impact. (22)

In these 50 countries, it is projected that, between 1990 and 2010, a total of 26.7 million people age 20 to 34 will have died from AIDS-related causes. The majority (59 percent) of these deaths will be among young women. In addition, most of these deaths will occur in the current decade (78 percent or 20.7 million between 2000 and 2010).

Population growth rates. In addition to the direct measures of HIV/AIDS prevalence and HIV-related mortality, the epidemic will also have broader population affects. Growth rates for populations in many countries have already been reduced. The U.S. Census Bureau estimates that AIDS will result in negative population growth in several countries before the year 2010, including Botswana, Lesotho, Mozambique, South Africa, and Swaziland. Several other countries are estimated to experience flat growth rates by the year 2010, including Namibia and Zimbabwe. Population growth rates are also expected to be affected in Latin America, the Caribbean, and Asia. (23)

Life expectancy. HIV/AIDS has also affected life expectancy, the average age to which a person born today can be expected to live. Due to HIV/AIDS, life expectancy in many hard-hit countries has already been reduced and could drop below age 30 in some countries by the year 2010, reversing steady gains over the last century. (24)

Life expectancy in Botswana, for example, is projected to decrease to 27 years by 2010, a net decrease of 47 years due to AIDS. In Zimbabwe, life expectancy is projected to be 35 years in 2010, a net decrease of 36 years. (25)

ADOLESCENT VULNERABILITY

Several factors make youth particularly vulnerable to HIV infection, including their biological and emotional development and their financial dependence. In many parts of the world, young people have limited access to health care services and reliable information about sexual activity and its implications. They are often unlikely or unable to protect themselves appropriately as they demonstrate an inclination to sexual experimentation, often with multiple partners. (26)

These sexual behaviors, and sex in conjunction with drug and/or alcohol use, may increase the likelihood of becoming infected with HIV. In addition, young people's sense of invulnerability ("it can't happen to me"), combined with lack of experience, may leave them unaware of the consequences of their actions and therefore less likely to take precautions against risk of infection. (27)

Awareness and knowledge. Surveys indicate that although many young people across the world have now heard about the HIV/AIDS epidemic, awareness is not universal. UNICEF reports that in more than a dozen countries, over half of young people had never heard of AIDS. (28)

In addition, awareness does not necessarily translate into practical knowledge: a significant percentage of at-risk young people may still be unaware of how to protect themselves or harbor misconceptions about HIV transmission. Surveys in 17 countries found that one in two adolescents could not name a single method of protecting themselves from HIV infection (with girls knowing less than boys in all instances). (29) Researchers working in Mozambique found that 74 percent of young women and 62 percent of young men (age 15 to 19) were unaware of any way to protect themselves from HIV. (30) A recent survey of young South Africans found high levels of concern about HIV/AIDS, but many still did not know important facts about the disease or how to prevent or treat HIV infection. (31)

Awareness of HIV/AIDS among young people may also not translate into a perception of personal risk, even among those in countries with very high prevalence. (32) This may be in part due to a lack of visibility of HIV-positive youth, with most young people living with HIV not even knowing they are infected. (33)

Health experts note that the availability of appropriate youth-targeted information varies across regions and within nations and communities. Social, religious, and economic influences lead to widely-varying opinions on how and what to provide to young people concerning HIV prevention. (34) In some places, therefore, young people may be more vulnerable because they are less likely to know enough about HIV to protect themselves. (35)

Lack of information, particularly when it relates to sexual behavior, can bring unintended and potentially dangerous results. For example, some heterosexual youth, to avoid pregnancy and maintain virginity, may engage in alternatives to vaginal intercourse such as anal or oral sex, believing these practices are not "having sex" (and therefore carry no risk, even though anal sex is one of the most efficient ways to transmit HIV, and oral sex, not as risky, is not entirely safe). (36)

Other sexually transmitted diseases. Being infected with another sexually transmitted disease (STD) also increases the likelihood of both acquiring and transmitting HIV. (37) The prevalence of STDs other than HIV among youth is high. (38) A broad, cross-national survey of STD data among developed countries (North American, European, and Scandinavian countries plus Russia and Romania) found that syphilis, gonorrhea, and chlamydia disproportionately affect adolescents and young adults, with generally higher incidence among females than males. (39)

In the United States, it is estimated that two-thirds of the 12 million cases of STDs diagnosed annually are among people under the age of 25. (40) In England and Wales, cases of gonorrhea and syphilis-again documented disproportionately among young people-have hit their highest levels in more than a decade. (41)

Data from developing countries are more limited. The World Health Organization (WHO) reports that age-specific data from developing countries show peak incidence of STDs among those 15 to 29. Studies of gonorrhea in several African and Middle Eastern nations found the highest levels of infection among those in this same age group, with the highest among those aged 15 to 19. (42)

Socioeconomic factors. Most young people at risk for HIV infection or already living with HIV/AIDS reside in the world's poorest regions. Their vulnerability to HIV operates within a broader context of poverty, which may include lack of access to education, economic opportunities, and health-related services.

Formal educational systems can contribute directly and indirectly to the impact of HLV on young people. Teachers and schools can improve awareness of risk and teach strategies for protection through good-quality sexual health education programs, which help delay initiation of sexual behavior and protect sexually active youth from HIV, STDs, and pregnancy. (43)

However, educational systems in many countries, already struggling before the spread of AIDS, have been significantly affected by the epidemic. About one million African children and young people are estimated to have lost their teachers to AIDS in 2001. (44) Prior gains in school enrollment, resulting from increased investments by many developing countries, have been adversely affected as teachers succumb to AIDS or leave to seek health care. (45) Students who are infected may be stigmatized and/or pressured to leave. (46) Students orphaned by AIDS are often unable to pay educational fees and, if forced to leave school, face increased risk of poverty and HIV infection. (47) Girls may be particularly affected by this phenomenon because they are often the first to be taken from school when sick parents need help or their families need income. (48)

Lack of economic opportunity is also an important contributor to HIV-related vulnerability This is particularly true of girls and young women, who have less access to and control over income, property, land, and credit. (49) Though the extent of gender disparities in economic opportunity vary from country to country, they are ubiquitous. (50)

Without options, young women may exchange sex for money, shelter, or safety-often under threat of violence. (51) Studies of unmarried adolescents in several sub-Saharan countries have found that 13 to 38 percent of girls have received or been given money or gifts in exchange for sex. (52)

Alternatively, because they have nowhere else to go, they may be forced to remain in relationships with partners who are violent or are believed or known to be infected with HIV. (53) Young women often lack the power to insist on the use of condoms. (54)

Lack of economic opportunity is not just a problem for women. Gay and bisexual (and sometimes heterosexual) boys and young men in many countries trade sex for money, drugs, or shelter with wealthier men--both for survival and to enhance income. (55)

HEALTH CARE ACCESS

Systemic disparities in access to health care for young people can heighten vulnerability to HIV. Many of the countries hardest hit by HIV/AIDS lack sufficient infrastructure and resources to deliver needed HIV-related services, including prevention and treatment services, HIV counseling and testing, and mental health care. (56) In addition, there are some persistent barriers to these health services for youth in developing and developed nations alike--lack of privacy and confidentiality, staff insensitivity to young people's special needs and perspectives, lack of affordable services, and lack of services geared toward adolescents ("teen friendly"). (57) Health care access may worsen as the burden of caring for so many millions of people suffering from AIDS-related illnesses takes an increasing toll on health infrastructures. (58)

Stigma may also play a role in young people's willingness to seek services. (59) Young women and girls, for example, may avoid health care services, including HIV testing and treatment for STDs, because of fear of stigmatization or even of violence--particularly if it becomes known that they're sexually active (before or outside of marriage) or infected with HIV. (60)

THE MOST VULNERABLE

Certain subpopulations of youth have been identified as bearing a disproportionate share of HIV's proliferation and/or are at increasing risk: young women and girls, young men who have sex with men, injecting drug users, sex workers, and children who have been orphaned by AIDS. (61)

Young women and girls. Women comprise an increasing proportion of adults living with HIV/AIDS, rising from 41 percent in 1997 to 50 percent in 2001. (62) In sub-Saharan Africa, women represent more than half of all people living with HIV/AIDS. (63)

Prevalence of HIV is typically higher among young women in sub-Saharan Africa, (64) who represent the majority of young people living with HIV/AIDS in that region and in Asia. (65) Among women, peak HIV prevalence is around age 25, while in men it occurs 10 to 15 years later and generally at lower levels. (66) Infections among South African girls, for example, peak at age 15 to 19; among boys they peak at age 20 to 24. (67)

In some of the most affected countries, the rates of new HIV infections among girls are as much as five to six times higher than those among boys. (68) In Botswana, for example, up to 45 percent of women age 15 to 24 are estimated to be HIV positive, about twice the proportion of HIV-positive men in the same age group. (69)

Although it is most pronounced there, this trend is not unique to the developing world. In the United States, women now represent 30 percent of new HIV infections and an increasing proportion of new AIDS cases as well (rising from seven percent in 1985 to 25 percent in 2001). (70)

Biologically, the risk of becoming infected with HIV during unprotected vaginal intercourse is greater for women than men. (71) The immaturity of young women's reproductive organs makes them even more vulnerable than mature women to HIV infection by providing enhanced opportunity for exposure and infection. (72)

Cultural and economic factors also contribute to increased vulnerability of young women and girls. For example, lack of economic autonomy may induce young women to partner with older men for protection and support. (73) Growing evidence suggests that sexual relationships between older men and younger women are responsible for much of the gender disparity between young women's and men's infection rates and for the increasing numbers of infections among younger girls. (74)

Young women who have sex with older partners are at greater risk for infection because these older partners are more likely to be infected than age-equivalent partners would be. (75) In some countries, younger and younger girls are put at risk because some men are seeking partners who are not infected, fueled in part by an expectation that younger girls are less likely to be infected or by a misguided belief that having intercourse with a virgin will cure or prevent AIDS. (76)

Condoms, though effective in reducing the risk of HIV transmission, require that the male partner agree to their use. Insisting that a partner (or husband) wear a condom might be interpreted as a challenge to long-accepted rules, and could raise questions about loyalty, fidelity, and trust. (77)

As mentioned previously, sexual violence and coercion put women at risk of infection and may keep those already HIV-positive from seeking available care. UNAIDS reports that some new cases of HIV infection among women are caused by gender-based violence in their homes, schools, work places, and social spheres. (78) In South Africa, for example, a woman who made her HIV infection public was stoned to death by neighbors who felt she had brought shame upon their community. (79)

Young gay and bisexual men. Because of the efficiency of anal intercourse as a mode of transmitting HIV, men who have unprotected sex with men are at a relatively high risk for HIV Worldwide, approximately five to 10 percent of all HIV infections are due to sexual transmission between men. (80) UNAIDS estimates that male-to-male sexual transmission is a predominant risk factor for HIV in several countries, including the United States, Brazil, Costa Rica, and Mexico, and may be playing an increasing role in Eastern Europe. (81) The U.S. Centers for Disease Control and Prevention (CDC) estimates that half of new AIDS cases reported in the United States in 2000 among males age 13 to 24 were among men who have sex with men (MSMs). (82)

Stigma, social exclusion, and lack of information can result in increased risk-taking among MSMs. (83) These factors make it difficult to obtain accurate data on the extent of MSM behaviors and related risks. (84) Many societies outlaw homosexual behavior or in some way officially condemn or ignore its existence. In Vietnam, for example, AIDS cases among MSMs are simply not reported. (85)

Many young MSMs may also be sexually involved with women, acting as "viral bridges" by introducing HIV into the larger population. A UNAIDS survey in Cambodia found that 40 percent of self-identifying MSMs also reported having sex with women in the month before being surveyed. (86) Research in Budapest found that the percentage of men who identified themselves as gay or bisexual but who had sex with a female at least once was high (77 percent), with 26 percent reporting sex with a female within the last year. (87) This same group reported a low rate of condom use for vaginal intercourse (23 percent). (88) Similar rates of bisexual behavior were found in Russian (89) and Brazilian (90) studies.

Despite encouraging reductions in unsafe sex practices in the early 1990s, risky behaviors and HIV infection rates among young MSMs may be on the rise again in the developed world. A recent survey of 23- to 29-year-old MSMs in six U.S. cities found high HIV prevalence rates among Whites (seven percent), Hispanics (14 percent), and particularly Blacks (32 percent). (91) An earlier sample of younger MSMs (15 to 22) in seven U.S. cities found a seven percent overall HIV prevalence rate, with higher rates among Black (14 percent) and Hispanic (seven percent) youth than among Whites (thee percent). (92) Public health experts have expressed concern that recently-noted outbreaks of STDs among MSMs may signal a resurgence of risk-taking among older MSMs and a lack of awareness or concern among younger MSMs. (93)

Young injection drug users. Intravenous injection is the quickest and most efficient route of HIV transmission because infected blood is delivered directly into a user's blood stream. Approximately 10 percent of HIV infections globally are due to injection drug use. (94) Eastern Europe and Central Asia are experiencing a rapid spread of HIV due largely to high numbers of youth injecting drugs. (95)

In the Russian Federation, where HIV is predominantly transmitted through injection drug use, HIV is concentrated largely among 18 to 30 year-olds; the average HIV-infected drug user is 24. A 1999 survey of 15 to 16 year-olds in Moscow found that six percent admitted to having used heroin at least once in their lives; also in 1999, 40 percent of clients of a St. Petersburg drug treatment program were young people, up from 13 percent two years earlier. (96)

In Central Asia, 70 percent of injection drug users are under age 25. (97) Canada, China, Latvia, Malaysia, Moldova, Russia, Ukraine, and Vietnam reported that more than half of all new HIV infections in 1998 to 1999 occurred among injection drug users, an increasing percentage of whom are young people. (98)

Children and youth orphaned by AIDS. Children orphaned by AIDS present a significant challenge. Since the epidemic began, an estimated 13.2 million children--most of whom live in the developing world--have lost their mothers or both parents to AIDS. (99)

Prior to the onset of the AIDS epidemic, approximately two percent of children in developing countries were orphans. By 1999 in some African countries the rate was more than 10 percent. In 2000, one child every 14 seconds became an orphan because of AIDS. (100) This impact is expected to worsen. The United States Agency for International Development (USAID) has estimated that as many as 44 million children will be orphaned by AIDS by 2010. (101)

The impact of HIV/AIDS on children begins well before the death of their parents. Children living in households headed by HIV-positive parents face increased risk of hunger, malnutrition, material deprivation, reduced access to school and health care, and increased emotional distress. (102)

After parents die, in much of the world the burden for caring for orphans falls on families and communities--and particularly on young women. However, these care networks are being overwhelmed by the magnitude of the needs put upon them, leaving many children vulnerable to malnutrition, exploitation, and abandonment. (103) UNAIDS reports that orphans living with extended families or in foster care are more prone to discrimination, including limited access to health, education, and social services. (104) As alternatives, some children maintain their own households or assume other adult burdens; others take to the streets. (105) Without support systems and resources, they are at substantially increased risk of malnutrition, abuse, illness, and HIV infection. (106)

Communities and societies are impacted as well. The U.S. National Intelligence Council notes that the large number of children orphaned by AIDS, located largely in countries that are already disproportionately young, will strain family systems and contribute to crime and political instability. (107)

Sexually exploited children. The sexual exploitation of children also contributes to increased incidence of HIV transmission. Prostitution, trafficking, child pornography, and forced marriages all heighten risk of HIV infection for children and communities within which such practices occur. (108)

Approximately one million children enter the world's sex trade every year, (109) placing them at greater risk for HIV infection. (110) Rates of HIV infection among young sex workers can be high. For example, studies have found HIV prevalence of 17 percent among sex workers in urban Nepal, 72 percent for sex workers under 18 in Mumbai, India, and 30 percent for sex workers age 13 to 19 in Cambodia. (111) Younger sex workers may be particularly vulnerable because of their inexperience in negotiating condom use and, as previously mentioned, because their clients may assume that sex with a child or virgin decreases their risk of infection or may even have preventive or curative powers against HIV. (112)

Sexual exploitation of children is exacerbated by the large number of children orphaned by AIDS. These children, parentless and in poverty, increase the pool of those young people vulnerable to exploitation or, in some cases, dependent upon trading sex for survival. (113)

Trafficking in children may also serve to increase the spread of HIV. Reports of children trafficked across continents and oceans to meet "demand" suggest the consistency with which the practice occurs and the potential it brings of increasing the spread of HIV In one case, over 1,000 children were sent from China, Laos, Malaysia, Thailand, and Vietnam to Atlanta, GA, to work as prostitutes. (114)

HIV/AIDS PREVENTION

Several recent prevention reviews demonstrate effectiveness in reducing risky behaviors and HIV transmission. (l15) Few large-scale prevention efforts, however, have been geared toward youth, and youth may need different prevention strategies than older adults. Where they do exist, such efforts have been shown to lead to increased knowledge about HIV/AIDS, delays in sexual activity, and increased condom use among those having sex for the first time. Prevention efforts have also led to reductions in HIV transmission among some populations. (116)

The impact of the epidemic on young people is expected to grow, particularly in hard-hit countries that already have very young populations. Therefore, the level of available resources and how those resources are used will continue to challenge global and national leaders. (117)

Projections of demographic shifting over the next decade and beyond show that-absent significantly enhanced prevention and treatment efforts, and perhaps the introduction of new technologies including microbicides and vaccines-the combination of young populations and the spread of HIV will result in the continued growth of the HIV/AIDS pandemic.

Prevention interventions directed at youth will therefore be critical to altering the future course of the pandemic. (118) In fact, where national prevention efforts have been most successful-in Uganda and Thailand-young people are often the first to respond to prevention interventions and to show positive results. (119) In Uganda, for example, HIV prevalence declined significantly among pregnant women, with the greatest decline among those in the youngest age group (15 to 19 years old). In Thailand, HIV prevalence rates declined among young military recruits (a proxy of national success for Thailand's HIV prevention campaign).

A new analysis of the potential impact of different prevention interventions, including increased condom use and a reduction in the number of sexual partners, among young people 15 to 19 years old in South Africa projects significant reductions in HIV incidence and prevalence over time. (120) In addition, projection models demonstrate that even modest changes in behavior-such as increased condom use and STD treatment-can significantly reduce HIV/AIDS prevalence. (121)

This article was excerpted and adapted for the SIECUS Report with permission of The Henry J. Kaiser Family Foundation from a report on tile status of the HIV/AIDS epidemic titled Tip of the Iceberg: The Global Impact of HIV/AIDS on Youth. The foundation is an independent national health philanthropy dedicated to providing information and analysis on health issues to policymakers, the media, and the general public. Go to the Kaiser web site at www.kff.org for tile complete report.

REFERENCES

(1.) UNAIDS, AIDS Epidemic Update, December 2001.

(2.) UNAIDS, "UNAIDS Executive Director Calls for Action to Protect Youth from HIV/AIDS," Press Release, May 10, 2002. Available at: www.unaids.org/whatsnew/press/eng/pressarc02/SSyouth100502.html; UNAIDS, AIDS Epidemic Update, December 2001; P. Piot, "Testimony to a Hearing on 'Halting the Global Spread of HIV/AIDS: The Future of U.S. Bilateral and Multilateral Responses," Committee on Foreign Relations of the United States Senate, 2002.

(3.) UNAIDS, AIDS Epidemic Update, December 2001; UNICEF, Progress of Nations, 2000.

(4.) UNICEF, Progress of Nations, 2000; Population Reference Bureau, Youth in Sub-Saharan Africa: A Chartbook on Sexual Experience and Reproductive Health, April 2000. Available at: www.prb.org/Template.cfm?Section=PRB&template=/Content Management/ContentDisplay.cfm?&ContentID=2821

(5.) UNAIDS. Children and Young People in a World of AIDS, August 2001; S. Hunter and J. Williamson, "Children on the Brink" USAID. 2000. Available at: http://www.dec.org/pdf_docs/PNACJ284.pdf

(6.) UNAIDS (Unpublished data; 2002).

(7.) UNICEF, Progress of Nations, 2000.

(8.) UNAIDS (Unpublished data; 2002).

(9.) CDC. Young People at Risk: HIV/AIDS Among America's Youth, March 11, 2002.

(10.) UNICEF, Progress of Nations, 2000; Population Reference Bureau, Youth in Sub-Saharan Africa: A Chartbook on Sexual Experience and Reproductive Health, April 2000. Available at: www.prb.org/Template.cfm?Section=PRB&template/ContentManagement/Conte ntDisplay.cfm&ContentID=282l

(11.) UNICEF, Progress of Nations, 2000.

(12.) National Intelligence Council (Central Intelligence Agency), "Global Trends 2015: A Dialogue About the Future with Nongovernmental Experts," December 2000. Available at: www.cia.gov/nic/pubs/index.htm.

(13.) UNAIDS (Unpublished data; 2002).

(14.) U. S. Census Bureau. Unpublished data, 2002.

(15.) K. A. Stanecki, U. S. Census Bureau, "The AIDS Pandemic in the 21st Century: The Demographic Impact in Developing Countries." (Paper presented at the 13th International AIDS Conference, July, 2000, Durban, South Africa.); U. S. Census Bureau. Unpublished data, 2002; U. S. Census Bureau. Unpublished data, 2002.

(16.) U. S. Census Bureau. Unpublished data, 2002.

(17.) This projection is based on U.S. Census Bureau estimates of HIV/AIDS prevalence and population size in 49 countries among those ages 15 through 49 through 2010. These data were used to calculate the number of people ages 15 through 49 estimated to be living with HIV/AIDS in each year between 1990 and 2010. The proportion of young people ages 15 through 24 living with HIV/AIDS of those ages 15 through 49, currently estimated at one third, was used to derive an estimate of the number of young people living with HIV/AIDS in these 49 countries in 2010. UNAIDS estimates that there were 12.4 million young people ages 15 through 24 living with HIV/AIDS at of the end of 2001. These 49 countries represented 75 percent of this global estimate (or 9.3 million) in 2001. This proportion was used to extrapolate a global estimate of the number of young people living with HIV/AIDS currently and through 2010. Several factors make this global estimate of youth prevalence in 2010 uncertain, but also suggest that it may be conservative. First, this analysis assumes that young people, ages 15 through 24, will continue to make up one third of HIV/AIDS prevalence among those ages 15 through 49 through 2010, and that this proportion is representative of the epidemic in the 49 countries analyzed. Many of these highly affected countries, however, already have very large proportions of young people, proportions that are expected to increase due in part to the effects of AIDS, as those in slightly older cohorts die at disproportionately higher rates. Therefore, teens and young adults may comprise an increasingly greater proportion of those living with HIV/AIDS over time--a number which itself is projected to grow. In addition, this analysis assumes that these 49 countries will continue to represent 75 percent of the global total of youth living with HIV/AIDS in 2010, as they are estimated to represent today Not included in the 49 countries are India, China, and other countries that are projected to have substantial numbers of affected individuals over time. Therefore, this subset of 49 countries may well represent less than 75 percent of global youth with HIV/AIDS prevalence over time, which would result in a higher 2010 projection.

(18.) UNAIDS (Unpublished data; 2002); UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000; UNAIDS. AIDS and Population, (fact sheet), 2002. Available at: www.unaids.org/fact_sheets/files/Demographic_Eng.html

(19.) P. Piot, "Testimony to a Hearing on 'Halting the Global Spread of HIV/AIDS"; Henry J. Kaiser Family Foundation. The Impending Catastrophe: A Resource Book on the Emerging HIV/AIDS Epidemic in South Africa, May 2000. Available at: www.kff.org/content/2000/20000515a/; UNAIDS, Report on the Global HINT/AIDS Epidemic, June 2000.

(20.) UNAIDS. AIDS and Population, (fact sheet), 2002. Available at: www.unaida.org/fact_sheets/files/Demographic_Eng.html

(21.) UNAIDS. (Personal communication, 2002.)

(22.) U. S. Census Bureau. Unpublished data, 2002.

(23.) K. A. Stanecki, U. S. Census Bureau, "The AIDS Pandemic in the 21st Century"; U. S. Census Bureau. Unpublished data, 2002.

(24.) Ibid.

(25.) U. S. Census Bureau. Unpublished data, 2002.

(26.) K. Kiragu, "Can We Avoid Catastrophe?," Population Reports, vol. 12, 2001.

(27.) Population Reference Bureau, Youth in Sub-Saharan Africa. Available at: www.prb.org/Template.cfm?Section=PRB&template=/ContentManagement/Cont entDisplay.cfm&ContentID=2821

(28.) UNICEF, Progress of Nations, 2000.

(29.) UNAIDS, Together We Can: Leadership in a World of AIDS, June 2001.

(30.) UNAIDS. Children and Young People in a World of AIDS, August 2001.

(31.) Henry J. Kaiser Family Foundation, Hot Prospects, Cold Facts: National Survey of South African Youth, March, 2001. Available at: www.kff.org/content/2001/20010314/

(32.) Population Reference Bureau, Youth in Sub-Saharan Africa. Available at: www.prb.org/Template.cfm?Section=PRB&template=/ContentManagement/Cont entDisplay.cfm&ContentID=282l

(33.) UNAIDS, AIDS Epidemic Update, December 2001.

(34.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000; Henry J. Kaiser Family Foundation, Hot Prospects, Cold Facts: National Survey of South African Youth, March, 2001. Available at: www.kff.org/content/2001/20010314/; H. BlaMe, "My Voice Counts Too," Progress of Nations 2000 (UNICEF, New York, 2000) pp. 2-3.

(35.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(36.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS: The What, the Why, and the How," International Center for Research on Women. (Plenary address, International AIDS Conference, Durban, South Africa, July, 2000.) Available at: www.icrw.org/docs/Durban Speech.pdf; U.S. Centers for Disease Control and Prevention, Preventing the Sexual Transmission of HIV, the Virus that Causes AIDS: What You Should Know about Oral Sex, December 2000. Available at: ftp://ftp.cdcnpin.org/Updates/oralsex.pdf

(37.) UNAIDS, WHO, Sexually Transmitted Diseases: Policies and Principles for Prevention and Care.

(38.) Institute of Medicine, Committee on Prevention and Control of Sexually Transmitted Diseases, T. R. Eng and W. T. Butler, The Hidden Epidemic: Confronting Sexually Transmitted Diseases (Washington, DC: National Academy Press, 1997).

(39.) C. Panchaud, S. Singh, D. Feivelson, and J. E. Darroch, "Sexually Transmitted Diseases Among Adolescents in Developed Countries, Family Planning Perspectives, January-February 2000, vol. 32, no. 1, pp. 24-32, 45.

(40.) Henry J. Kaiser Family Foundation, Sexually Transmitted Diseases in the United States (Fact Sheet), February 11, 2000. Available at: www.kff.org/content/2000/3003/STD%20fact%20Sheet.PDF.12

(41.) UNAIDS, AIDS Epidemic Update, December 2001.

(42.) UNAIDS, WHO, Sexually Transmitted Diseases: Policies and Principles for Prevention and Care.

(43.) UNAIDS, Global Crisis--Global Action, June 2001.

(44.) P. Piot, "Testimony to a Hearing on 'Halting the Global Spread of HIV/AIDS"; National Intelligence Council (Central Intelligence Agency), "Global Trends 2015: A Dialogue About the Future with Nongovernmental Experts," December 2000. Available at: www.cia.gov/nic/pubs/index.htm

(45.) UNICEF, Progress of Nations, 2000.

(46.) Ibid.

(47.) Ibid.

(48.) UNAIDS. Children and Young People in a World of AIDS, August 2001.

(49.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS: The What, the Why, and the How," International Center for Research on Women (Plenary address, International AIDS Conference, Durban, South Africa, July, 2000.) Available at: www.icrw.org/docs/DurbanSpeech.pdf; UNAIDS, Gender and HIV/AIDS (Fact Sheet), June 2001. Available at: www.unaids.org/fact_sheets/ungass/pdf/Fsgender_en.pdf

(50.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS." Available at: www.icrw.org/docs/DurbanSpeech.pdf

(51.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS." Available at: www.icrw.org/docs/DurbanSpeech.pdf; Gender and HIV/AIDS. Available at: www.unaids.org/fact_sheets/ungass/pdf/Fsgender_sn.pdf

(52.) Population Reference Bureau, Youth in Sub-Saharan Africa. Available at: www.prb.org/Template.cfm?Section=PRB&template=/ConrentManagement/Cont entDisplay.cfm&ContentID=2821

(53.) S. Gregson, C. A. Nyamukapa, G. P. Garnett, et al., "Sexual Mixing Patterns and Sex-differentials in Teenage Exposure to HIV Infection in Rural Zimbabwe," Lancet, June 1, 2002, pp. 1896-1903.

(54.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(55.) Y.A. Amirkhanian, J.A. Kelly, A.A. Kukharsky, et al., "Predictors of HIV Risk Behavior Among Russian Men Who Have Sex with Men: An Emerging Epidemic," AIDS, February 16 2001, vol. 15, no. 3, pp. 407-12; J. A. Kelly, Y.A. Amirkhanian, T. L. McAuliffe, et al, "HIV Risk Behavior and Risk-related Characteristics of Young Russian Men Who Exchange Sex for Money or Valuables from Other Men, AIDS Education Prevention, April 2001, vol. 13, no. 2, pp. 175-88; UNAIDS. AIDS and Men Who Have Sex with Men: UNAIDS Point of View, July 1998; UNAIDS. AIDS and Men Who Have Sex with Men [UNAIDS technical update]. May, 2000. Available at: www.unaids.org/publications/documents/specific/ men/men tue2000.pdf.

(56.) UNAIDS, Report on the Global HIV//AIDS Epidemic, June 2000.

(57.) S. Hunter and J. Williamson, "Children on the Brink," USAID. 2000. Available at: http://www.dec.org/pdf_docs/PNACJ284.pdf; Henry J. Kaiser Family Foundation, Hearing Their Voices: A Qualitative Research Study on HIT/Testing and Higher-risk Teens, June 1999.

(58.) National Intelligence Council (Central Intelligence Agency), "Global Trends 2015." Available at: www.cia.gov/nic/pubs/index.htm; P. Wehrwein, "AIDS Leaves Africa's Economic Future in Doubt," CNN. March 26, 2002. Available at: www.cnn.com/specials/2000/aids/stories/economic.impact

(59.) UNAIDS, Together We Can: Leadership in a World of AIDS, June 2001; U.S. Centers for Disease Control and Prevention, "HIV-related Knowledge and Stigma-United States, 2000," Morbidity and Mortality Weekly Report, December 1, 2000, vol. 49, no. 47, pp. 1062-64; R. O. Valdiserri, "HIV/AIDS Stigma: An Impediment to Public Health," American Journal of Public Health, March 2002, vol. 92, no. 3, pp. 341-42.

(60.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS." Available at: www.icrw.org/docs/DurbanSpeech.pdf

(61.) UNAIDS, AIDS Epidemic Update, December 2001.

(62.) UNAIDS, Children and Young People in a World of AIDS, August 2001; UNAIDS, Global Crisis-Global Action, June 2001; UNAIDS, Gender and HIV/AIDS. Available at: www.unaids.org/fact_sheets/ungass/pdf/Fsgender_en.pdf.

(63.) UNAIDS (Unpublished data; 2002).

(64.) S. Gregson, C. A. Nyamukapa, G. P. Garnett, et al., "Sexual Mixing Patterns and Sex-differentials in Teenage Exposure to HIV Infection in Rural Zimbabwe," Lancet, June 1, 2002, pp. 1896-1903.

(65.) UNICEF, Progress of Nations, 2000.

(66.) K. A. Stanecki, U. S. Census Bureau, "The AIDS Pandemic in the 21st Century."

(67.) Henry J. Kaiser Family Foundation. The Impending Catastrophe. Available at: www.kff.org/content/2000/20000515a/

(68.) P. Piot, "Testimony to a Hearing on 'Halting the Global Spread of HIV/AIDS"; UNAIDS, Global Crisis--Global Action, June 2001; UNAIDS, Gender and HIV/AIDS (Fact Sheet), June 2001. Available at: www.unaids.org/fact_sheets/ungass/pdf/FSgender_en.pdf

(69.) UNAIDS (Unpublished data; 2002).

(70.) U.S. Centers for Disease Control and Prevention, "HIV/AIDS Update: A Glance at the HIV Epidemic," 2002. Available at: www.cdc.gov/nchstp/od/news/At-a-Glance.pdf. Accessed June 28, 2002; U.S. Centers for Disease Control and Prevention, "HIV/AIDS Surveillance Reports," Available at: www.cdc.gov/hiv/stats/hasrlink.htm

(71.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000; K. Kiragu, "Can We Avoid Catastrophe?," Population Reports, vol. 12, 2001;T.A. Peterman, R. L. Stoneburner, J.R. Allen, H.W. Jaffe, and J. W. Curran, "Risk of Human Immunodeficiency Virus Transmission from Heterosexual Adults with Transfusion Associated Infections, Journal of the American Medical Association, January 1, 1988, vol. 259, no. 1, pp. 55-58.

(72.) K. Kiragu, "Can We Avoid Catastrophe?," Population Reports, vol. 12,2001.

(73.) S. Gregson, et al., "Sexual Mixing Patterns and Sex-differentials in Teenage Exposure to HIV Infection in Rural Zimbabwe."

(74.) UNAIDS. Children and Young People in a World of AIDS; UNAIDS, Global Crisis--Global Action; S. Gregson, et al., "Sexual Mixing Patterns and Sex-differentials in Teenage Exposure to HIV Infection in Rural Zimbabwe."

(75.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(76.) Human Rights Watch, "Scared at School: Sexual Violence Against Girls in South African Schools, March 2001. Available at: www.polity.org.za/govdocs/reports/nongov/sexviolence; "Here's How We Can Fight AIDS," The Sunday Times, Johannesburg, South Africa, November 25, 2001.

(77.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS. Available at: www.icrw.org/docs/DurbanSpeech.pdf

(78.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000; UNAIDS, Global Crisis--Global Action, June 2001.

(79.) Associated Press, "HIV Positive South African Women Murdered," December 19, 1998.

(80.) UNAIDS. AIDS and Men Who 1-lave Sex with Men [UNAIDS technical update]. May, 2000. Available at: www.unaids.org/publications/documents/specific/men/men tue2000.pdf

(81.) UNAIDS, AIDS Epidemic Update, December 2001; UNAIDS, Global Crisis--Global Action, June 2001.

(82.) U.S. Centers for Disease Control and Prevention, HIV/AIDS Surveillance Reports: U.S. HIV and AIDS Cases Reported through December 2000, Year- End Edition, 2001, vol. 12, no. 2.

(83.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000; UNAIDS. AIDS and Men Who Have Sex with Men [UNAIDS technical update]. May, 2000. Available at: www.unaids.org/publications/documents/specific/men/men tue2000.pdf; U.S. Centers for Disease Control and Prevention, "HIV-related Knowledge and Stigma--United States, 2000$' Morbidity and Mortality Weekly Report, December 1, 2000, vol. 49, no. 47, pp. 1062-64.

(84.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(85.) UNAIDS, WHO, Vietnam. Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: 2000 Update (revised), 2000.

(86.) UNAIDS, AIDS Epidemic Update, December 2001.

(87.) P. Csepe, Y.A. Amirkhanian, J.A. Kelly, T. L. McAuliffe, and L. Mocsonoki, "HIV Risk Behaviour Among Gay and Bisexual Men in Budapest, Hungary, International Journal of STD/AIDS, March 2002, vol. 13, no. 3, pp. 192-200.

(88.) Ibid.

(89.) Y. A. Amirkhanian, J.A. Kelly, A.A. Kukharsky, et al., "Predictors of HIV Risk Behavior Among Russian Men Who Have Sex with Men: An Emerging Epidemic," AIDS, February 16 2001, vol. 15, no. 3, pp. 407-12.

(90.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(91.) U.S. Centers for Disease Control and Prevention, "HIV Incidence Among Young Men Who Have Sex with Men-Seven U.S. Cities, 1994-2000," Morbidity and Mortality Weekly Report, June 1, 2001, vol. 50, no. 21, pp. 440-44.

(92.) U.S. Centers for Disease Control and Prevention, "HIV Incidence Among Young Men Who Have Sex with Men"; U.S. Centers for Disease Control and Prevention, "Need for Sustained HIV Prevention Among Men Who Have Sex with Men," March 11, 2002. Available at: www.cdc.gov/hiv/pubs/facts/msm.htm

(93.) U.S. Centers for Disease Control and Prevention, "Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex with Men--King County, Washington, 1997-1999," Morbidity and Mortality Weekly Report, September 10 1999, vol. 48, no. 35, pp. 773-77; U.S. Centers for Disease Control and Prevention, "Outbreak of Syphilis Among Men Who Have Sex with Men--Southern California, 2000," Morbidity and Mortality Weekly Report, February 23 2001, vol. 50, no. 7, pp. 117-20.

(94.) UNAIDS, "Drug Use and HIV/AIDS (Fact sheet),June 2001. Available at: www.unaids.org/fact_sheets/ungass/pdf/Fsdruguse_en.pdf

(95.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000; D. Burrows, D. Holmes, and N. Schwalbe, "Drug Use Injects HIV/AIDS into Former Soviet Union," Global AIDS Link (Global Health Council), vol. 72, 2002, pp. 12-13.

(96.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(97.) D. Burrows, et al., "Drug Use Injects HIV/AIDS into Former Soviet Union."

(98.) K. Kiragu, "Can We Avoid Catastrophe?," Population Reports, vol. 12, 2001; UNAIDS, USAID, MAP [Monitoring the AIDS Pandemic] Report 2000: The Status and Trends of the HIV/AIDS Epidemics in the World, July 2000.

(99.) S. Hunter and J. Williamson, "Children on the Brink," USAID. 2000. Available at: http://www.dec.org/pdf_docs/PNACJ284.pdf

(100.) UNAIDS. Children and Young People in a World of AIDS, August 2001.

(101.) S. Hunter and J. Williamson, "Children on the Brink," USAID. 2000. Available at: http://www.dec.org/pdf_docs/PNACJ284.pdf

(102.) J. Rosen, (Synergy Project, USAID), Responding to the Education Needs of Children and Adolescents Affected by AIDS in saharan Africa: Report on Town Hall Meeting, October 23, 2001. Available at: www.synergyaids.org/resources.php?id=3502.

(103.) National Intelligence Council (Central Intelligence Agency), "Global Trends 2015:A Dialogue About the Future."

(104.) UNAIDS. Children and Young People in a World of AIDS, August 2001.

(105.) S. Hunter and J. Williamson, "Children on the Brink," USA ID. 2000, Available at: http://www.dec.org/pdf_docs/PNACJ284.pdf

(106.) UNAIDS, Report on the Global HIV/AIDS Epidemic, June 2000.

(107.) National Intelligence Council (Central Intelligence Agency), "Global Trends 2015:A Dialogue About the Future."

(108.) UNICEF, Profiting from Abuse: An Investigation into the Sexual Exploitation of Children, 2001.

(109.) UNICEF, Profiting from Abuse: An Investigation into the Sexual Exploitation of Children, 2001.

(110.) Population Council, Asia Foundation, Prevention of Trafficking and the Care and Support of Trafficked Persons (in the Context of an Emerging HIV/AIDS Epidemic in Nepal), February 2000. Available at: www.popcouncil.org/pdfs/horizons/trafficking1.pdf

(111.) UNAIDS. Children and Young People in a World of AIDS, August 2001; Population Council, Asia Foundation, Prevention of Trafficking and the Care and Support of Trafficked Persons. Available at: www.popcouncil.org/pdfs/horizons/trafficking1.pdf

(112.) G. Rao Gupta, "Gender, Sexuality, and HIV/AIDS." Available at: www.icrw.org/docs/DurbanSpeech.pdf; C. Panchaud, et al., "Sexually Transmitted Diseases Among Adolescents in Developed Countries, Family Planning Perspectives, January-February 2000; Human Rights Watch, "Scared at School: Sexual Violence Against Girls in South African Schools, March 2001. Available at: www.polity.org.za/govdocs/reports/nongov/sexviolence

(113.) UNICEF, Profiting from Abuse: An Investigation into the Sexual Exploitation of Children, 2001.

(114.) Ibid.

(115.) A. Rosenfeld, L. Myer, and M. Merson, (Henry J. Kaiser Family Foundation), The HIV/AIDS Pandemic: The Case for Prevention, June 2001. Available at: www.kff.org/content/ 2001/20010627a/pandemic.pdf; D. Low-Beer and R. Stoneburger (Henry J. Kaiser Family Foundation), In Search of the Magic Bullet: Evaluating and Replicating Prevention Programs, June 2001; E. Marseille, S. Morin, C. Collins, T. Summers, and T. Coates (Henry J. Kaiser Family Foundation), The Cost-Effectiveness of HIV Prevention in Developing Countries, June 2001; Center for AIDS Prevention Studies (University of California at San Francisco), Can Cost-effectiveness Analysis Help in HIV Prevention?

(116.) A. Rosenfeld, et al. (Henry J. Kaiser Family Foundation), The HIV/AIDS Pandemic: The Case for Prevention, June 2001. Available at: www.kff.org/content/2001/20010627a/pandemic.pdf; D. Low-Beer and R. Stoneburger (Henry J. Kaiser Family Foundation), In Search of the Magic Bullet, June 2001.

(117.) P. Piot, "Testimony to a Hearing on 'Halting the Global Spread of HIV/AIDS"; P. Alagiri, C. Collins, T. Summers, S. Morin, and T. Coates (Henry J. Kaiser Family Foundation), Global Spending on HIV/AIDS: Tracking Public and Private Investments in AIDS Prevention, rare, and Research, July 2001.

(118.) K. Kiragu, "Can We Avoid Catastrophe?," Population Reports, vol. 12,2001.

(119.) W. Sittitrai (UNAIDS), HIV Prevention Needs and Successes: A Tale of Three Countries; An Update on HIV Prevention Success in Senegal, Thailand and Uganda. (Paper presented at the Office of AIDS Research Advisory Council, National Institutes of Health, Bethesda, MD, April 28, 1999.)

(120.) M. Steinberg and S. Kramer (Henry J. Kaiser Family Foundation), Modeling HIV Prevention for Youth, June 2002.

(121.) Henry J. Kaiser Family Foundation. The Impending Catastrophe. Available at: www.kff.org/content/2000/20000515a/