Reducing HIV and AIDS in Adolescents: Opportunities and Challenges
- 957 Downloads
Adolescents are critical to efforts to end the AIDS epidemic. Few national AIDS strategies explicitly program for children in their second decade of life. Adolescents (aged 10–19 years) are therefore largely invisible in global, regional, and country HIV and AIDS reports making it difficult to assess progress in this population. We have unprecedented knowledge to guide investment towards greater impact on HIV prevention, treatment, and care in adolescents, but it has not been applied to reach those most vulnerable and optimize efficiency and scale. The cost of this is increasing AIDS-related deaths and largely unchanged levels of new HIV infections in adolescents. An AIDS-free generation will remain out of reach if the global community does not prioritize adolescents. National AIDS responses must be accountable to adolescents, invest in strengthening and monitoring protective and supportive laws and policies and access for adolescents to high impact HIV interventions.
KeywordsAdolescent Adolescents Adolescence HIV/AIDS Girls Gender Living with HIV Injecting drug use Key affected populations Males who have sex with males Sexual exploitation Effectiveness Investment
Conflict of Interest
Susan Kasedde declares that she has no conflict of interest.
Chewe Luo declares that she has no conflict of interest.
Craig McClure declares that he has no conflict of interest.
Upjeet Chandan declares that she has no conflict of interest.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.WHO: The second decade: improving adolescent health and development. Department of Child and Adolescent Health and Development. Geneva: WHO. 2001.Google Scholar
- 3.WHO, UNFPA, and UNAIDS. Seen but not heard: very young adolescents aged 10–14 years. Geneva: UNAIDS. 2004.Google Scholar
- 5.UNICEF. Opportunity in crisis: Preventing HIV from early adolescence to early adulthood. New York: UNICEF; 2011.Google Scholar
- 6.UNICEF. Progress for children: A report card on adolescents. New York: UNICEF; 2012.Google Scholar
- 7.WHO. Early marriages, adolescent, and young pregnancies, WHO Report to the 65th World Health Assembly. 2012.Google Scholar
- 8.WHO Fact Sheet No 364. Adolescent pregnancy. 2012.Google Scholar
- 9.UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2012. Geneva: UNAIDS; 2012.Google Scholar
- 10.UNAIDS. Unpublished 2011 Estimates. Geneva: UNAIDS. 2012.Google Scholar
- 11.UNICEF, Blame and Banishment. The underground HIV epidemic affecting children in Eastern Europe and Central Asia. Switzerland: UNICEF. 2010.Google Scholar
- 12.National Center for AIDS and STD Control (NCASC) Integrated Biological and Behavioral Surveillance (IBBS) 2011 Round V, Injecting Drug Users. Kathmandu and Pokhara Valleys Fact Sheet. Accessed February 21, 2013 http://www.ncasc.gov.np/uploaded/facts_n_figure/IBBS_2011/2011_IBBS_IDUs_Factsheet.pdf.
- 13.US Centers for Disease Control and Prevention. HIV and young men who have sex with men, May 2012 Accessed Feb 21, 2012. http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hiv_factsheet_ymsm.pdf
- 16.US Centers for Disease Control and Prevention, HIV Among Youth in the US: protecting a generation, in CDC vital signs. November 2012.Google Scholar
- 17.Birdthistle I, Dringus S, Knight L, et al. Investing in young people: a review of national-level spending on HIV prevention for young people aged 10–24 in 16 high-prevalence countries. Presented at the XIX International AIDS Conference. Washington DC, United States of America. 2012.Google Scholar
- 18.• Deogan C, Ferguson J, Stenberg K. Resource needs for adolescent friendly health services: estimates for 74 low- and middle-income countries. PLoS One. 2012;7:e51420. Estimates additional resource needs for scaling up health service delivery to adolescents to achieve MDG 4, 5, and 6 by 2015, indicating a substantial investment gap in the adolescent HIV and health response in low and middle income countries.PubMedCrossRefGoogle Scholar
- 19.•• Schwartlander B, Stover J, Hallett T, et al. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet. 2011;377:2031–41. Makes a strong, evidence-based argument for a more targeted and strategic investment approach to reduce HIV risk, transmission, morbidity, and mortality, with broad-based population impacts.PubMedCrossRefGoogle Scholar
- 20.Guttmacher Institute and IPPF. In brief: Facts on the sexual and reproductive health of adolescent women in the developing world. New York: Guttmacher Institute; 2010.Google Scholar
- 23.Kenny J, Mulenga V, Hoskins S, et al. The needs for HIV treatment and care of children, adolescents, pregnant women, and older people in low-income and middle-income countries. AIDS 2012;(Suppl 2):S105–16.Google Scholar
- 26.•• Baird S, Garfein R, Mcintosh C, Ozler B. Effect of a cash transfer program for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomized trial. Lancet. 2012;379:1320–9. Demonstrates how cash transfer programs (structural intervention) that do not directly target sexual behavior can reduce HIV and HSV-2 infections in adolescent schoolgirls in low income settings.PubMedCrossRefGoogle Scholar
- 31.European Bank for Reconstruction and Development, Transition report. Energy in transition - economic transition in central and eastern Europe, the Baltic states, and the CIS. EBRD: London; 2001.Google Scholar
- 37.Zhang XD, Temmerman M, Li Y, et al. Vulnerabilities, health needs, and predictors of high-risk sexual behavior among female adolescent sex workers in Kunming, China. Sex Transm Infect. 2012;1–8.Google Scholar
- 38.FHI, Young People Most at Risk of HIV. A meeting report and discussion paper from the Interagency Working Group, U.S. Agency for International Development, the Joint United Nations Programme on HIV/AIDS (UNAIDS) Inter-Agency Task Team on HIV, and Young People, and FHI. FHI: Research Triangle Park. 2010.Google Scholar
- 41.Mbori-Ngacha D. Follow-up and adherence management for children and adolescents living with HIV, in from the ground up: establishing a framework for success. Elizabeth Glazier Pediatric AIDS Foundation. 2004;885–6. http://ftguonline.org/ftgu-232/index.php/ftgu/index. Accessed 9 Jan 2013.
- 46.•• Ferrand RA, Munaiwa L, Matsekete J, et al. Undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe. Clin Infect Dis. 2010;51:844–51. Reports high rates of undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe, emphasizing the importance of routine HIV testing and counselling at the primary care level to identify vertically-infected adolescents (‘slow progressors’ ) and link them to treatment and care.PubMedCrossRefGoogle Scholar
- 49.van Rooyen H, McGrath N, Chirowodza A, et al. Mobile VCT. Reaching men and young people in urban and rural South African pilot studies (NIMH Project Accept, HPTN 043). AIDS Behav. 2012;[epub ahead of print].Google Scholar
- 56.Interagency Task Team on HIV and Young People Guidance Brief. HIV Interventions for Most-at-Risk Young People. New York: UNFPA. 2009.Google Scholar
- 60.World Health Organization. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: WHO; 2004.Google Scholar
- 61.•• Grant RL, Grant RM, Lama JR, Anderson PL, et al. Pre-exposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99. Article presents findings from the first successful trial testing the proof of concept of use of oral daily combination pre-exposure prophylaxis in 2 high risk populations (MSM and transgender women).PubMedCrossRefGoogle Scholar
- 62.WHO. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Recommendations for a public health approach. Geneva: WHO; 2010.Google Scholar
- 64.•• Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opin HIV AIDS. 2012;7:99–105. Article describes the seminal randomized controlled trial proving 96 % reduction in sexual transmission of HIV in sero-discordant heterosexual couples through the use of antiretroviral therapy.PubMedCrossRefGoogle Scholar
- 65.Shepherd J, Kavanagh J, Picot, J, et al. The effectiveness and cost-effectiveness of behavioral interventions for the prevention of sexually transmitted infections in young people aged 13–19: a systematic review and economic evaluation, Health Technology Assessment. 2010:14.Google Scholar
- 67.•• Karim QA, Karim SSA, et al. Effectiveness and safety of Tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168–74. Article presents the findings of the first successful trial showing that the use of Tenofovir based vaginal microbicide gel reduced the risk of HIV acquisition by 39 % including some as young as 18. The gel had a higher effectiveness (54 %) in women who adhered to the guidelines provided.CrossRefGoogle Scholar
- 69.US Centers for Disease Control and Prevention: HIV surveillance in adolescents and adults. Accessed March 7, 2013. http://www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/index.htm.
- 70.WHO (2006) Global estimates of health consequences due to violence against children. Background paper to the UN Secretary-General’s Study on Violence against Children. Geneva, World Health Organization, based on estimates by Andrews G, et al. (2004). Child Sexual Abuse. Ch. 23 in Ezzati M, et al. (2004). Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, Vol 2. Geneva, World Health Organization, pp. 1851–940, and using UN Population Division data for the population under 18 years.Google Scholar
- 71.Strode A, Grant K. Children and HIV: using an evidence-based approach to identifying legal strategies that protect and promote the right of children infected and affected by HIV and AIDS, Working paper prepared for the Third Meeting of the Technical Advisory Group of the Global Commission on HIV and the Law. 2011.Google Scholar
- 72.Ferrand R, Lowe S, et al. Survey of children accessing HIV services in a high HIV prevalence setting: time for HIV-infected adolescents to count? Bull WHO 2010;6:428–34.Google Scholar
- 78.WHO. Guidelines: Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people: Recommendations for a public health approach. 2011.Google Scholar