World AIDS Day and Adolescents

Dec 01, 2025 Letters

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Dear Editor,

Globally, this is a very new World AIDS Day, different from any in the last 22 years.

For many, HIV no longer carries the threat of a life-ending disease.  Sadly, that is not the case for millions of others whose lives were protected by funding through USAID. What was once a proud US President’s Emergency Plan for AIDS Relief (PEPFAR) was cruelly and arbitrarily dismantled by the current occupant of that office.

Bill Gates, a very rich man himself, put it best: “The world’s richest man is killing the world’s poorest children.” He was describing Elon Musk. The world’s richest and most powerful country is killing hundreds of thousands of people in the world’s poorest and most fragile countries.

The USAID funding of about US$ 20 billion was less than 1% of the US budget.  In 2024, it was a mere 0.3%. Yet most Americans believe USAID is about 25% of the federal budget.

Atul Gawande, a distinguished physician, estimates that USAID saved 92 million lives in two decades.  Now, Brooke Nichols, an epidemiologist at Boston University, estimates that the closure of the programme has already resulted in more than six hundred thousand deaths, two-thirds of them children, at a rate of almost 90 per hour.

So, on this World AIDS Day we face a new challenge.

We have no right to USAID funding.  We must find ways to take care of our own citizens.

Arguably, in the Caribbean, Guyana has created the widest legal space for adolescent access to sexual and reproductive healthcare.  Its Medical Practitioners Regulations 2008 allows service to 16-year-olds; its National Sexual and Reproductive Health Policy permits the use of the Gillick competency test for adolescents younger than 16 years.  There is no minimum age for access to HIV testing without parental consent.

Yet Guyana’s adolescent fertility rate is 63.1, far above the regional average of 35.4.  This is not a matter of law; our challenge is culture and education. We must find inexpensive ways of reaching adolescents in a sustained programme. One of the most effective and proven mechanisms is schools.  That can be our big platform for prevention.  We must teach our children about hygiene, interpersonal relations, inclusion, abstinence, sexuality, and, yes, about responsible sex.

Health and Family Life Education (HFLE) is not an examinable subject.  It is therefore largely ignored. Yet, as we all know, failure in that subject has vastly greater life-long consequences for adolescents than failure in any other ‘examinable’ academic subject. We are profoundly ignorant of the catastrophic state of adolescent sexual relations in our tiny region. We are the second worst, or the worst region in the world by almost any metric – age of sexual debut, incest rate, rate rape, adolescent fertility rate, unintended pregnancy rate, abortion rate, and rate of gender violence.  We are in crisis.

And yet we remain oblivious.  We do not speak to our children about sex – only 5% of parents do, almost always mothers.  Teachers are reluctant to address ‘sensitive’ areas of the HFLE curriculum.  They are often untrained.  The responsibility for HFLE is typically passed on to the youngest, newest, and most unprepared staff member.  And for the most part, religious leaders stigmatise and horrify sexuality.

If we truly understood the life-saving importance of HFLE, we would set about making it a top priority.  It would be examinable.  We would assign the subject to our best teachers.  We would hold all schools strictly accountable for delivery. As a matter of urgency, we would convene sessions with parents, urge them to speak with their children, and provide them with material, hard copy or digital, to make those conversations easier.

A recent assessment of the Comprehensive Sexuality component within HFLE showed that no country in the region had met the minimum international standards.  Not even one. https://caribbean.unfpa.org/en/publications/formative-assessment-comprehensive-sexuality-education-within-health-and-family-life.  Indeed, none was even close.

We should not depend on any country to care for our children. That is our responsibility as parents, teachers, social workers, healthcare workers, and neighbours.

To begin with, we must acknowledge that we have failed miserably in our duty as parents.  We must get beyond our cultural inhibitions to speak about sex.  If we truly care about our adolescents, we must speak with them early and often about sex.

In every Caribbean Island, there are more churches, mosques, and temples than schools.  We cannot accomplish our goal of moral and prudent sexual behaviour, without the engagement of religious leaders.  They must climb above their denial and stigmatisation of sexuality to face reality and join actively in becoming trustworthy sources of moral guidance and information.

Sincerely,
Fred Nunes

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• adolescents, AIDS, Fred Nunes, World AIDS Day

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