Current HIV/AIDS Reports

, Volume 10, Issue 2, pp 159–168 | Cite as

Reducing HIV and AIDS in Adolescents: Opportunities and Challenges

  • Susan Kasedde
  • Chewe Luo
  • Craig McClure
  • Upjeet Chandan
The Global Epidemic (Q Abdool Karim, Section Editor)

Abstract

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.

Keywords

Adolescent 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 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    WHO: The second decade: improving adolescent health and development. Department of Child and Adolescent Health and Development. Geneva: WHO. 2001.Google Scholar
  2. 2.
    Patton G, McMorris BJ, Toumbourou JW, et al. Puberty and the onset of substance use. Pediatrics. 2004;114:300–6.CrossRefGoogle Scholar
  3. 3.
    WHO, UNFPA, and UNAIDS. Seen but not heard: very young adolescents aged 10–14 years. Geneva: UNAIDS. 2004.Google Scholar
  4. 4.
    Viner RM, Ozer EM, Denny S, et al. Adolescence and the social determinants of health. Lancet. 2012;379:1641–52.PubMedCrossRefGoogle Scholar
  5. 5.
    UNICEF. Opportunity in crisis: Preventing HIV from early adolescence to early adulthood. New York: UNICEF; 2011.Google Scholar
  6. 6.
    UNICEF. Progress for children: A report card on adolescents. New York: UNICEF; 2012.Google Scholar
  7. 7.
    WHO. Early marriages, adolescent, and young pregnancies, WHO Report to the 65th World Health Assembly. 2012.Google Scholar
  8. 8.
    WHO Fact Sheet No 364. Adolescent pregnancy. 2012.Google Scholar
  9. 9.
    UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2012. Geneva: UNAIDS; 2012.Google Scholar
  10. 10.
    UNAIDS. Unpublished 2011 Estimates. Geneva: UNAIDS. 2012.Google Scholar
  11. 11.
    UNICEF, Blame and Banishment. The underground HIV epidemic affecting children in Eastern Europe and Central Asia. Switzerland: UNICEF. 2010.Google Scholar
  12. 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. 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
  14. 14.
    Beyrer C, Baral S, van Griensven F, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380:367–77.PubMedCrossRefGoogle Scholar
  15. 15.
    Millett G, Jeffries IV WL, Peterson JL, et al. Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora. Lancet. 2012;380:411–23.PubMedCrossRefGoogle Scholar
  16. 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. 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. 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. 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. 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
  21. 21.
    Sweeney S, Obure CD, Maier CB, et al. Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience. Sex Transm Infect. 2012;88:85–99.PubMedCrossRefGoogle Scholar
  22. 22.
    Fortenberry JD, Martinez J, Rudy BJ, Monte D. Linkage to care for HIV-positive adolescents: a multi-site study of the Adolescent Medicine Trials Unit of the Adolescent Trials Network. J Adolesc Health. 2012;51:551–6.PubMedCrossRefGoogle Scholar
  23. 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
  24. 24.
    Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008;22 Suppl 4:S17–25.PubMedCrossRefGoogle Scholar
  25. 25.
    Underwood C, Skinner J, Osman N, Schwandt H. Structural determinants of adolescent girls’ vulnerability to HIV: views from community members in Botswana, Malawi, and Mozambique. Soc Sci Med. 2011;73:343–50.PubMedCrossRefGoogle Scholar
  26. 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
  27. 27.
    Andersson N, Paredes-Solís S, Milne D, et al. Prevalence and risk factors for forced or coerced sex among school-going youth: national cross-sectional studies in 10 southern African countries in 2003 and 2007. BMJ Open. 2012;2:e000754. doi:10.1136/bmjopen-2011-000754.PubMedCrossRefGoogle Scholar
  28. 28.
    Andersson N, Cockroft A. Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa. AIDS. 2008;22 Suppl 4:S73–86.PubMedCrossRefGoogle Scholar
  29. 29.
    Merkinaite S, Grund JP, Frimpong A. Young people and drugs: next generation of harm reduction. Int J Drug Policy. 2010;21:112–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Rhodes T, Simic M. Transition and the HIV risk environment. BMJ. 2005;331:220–3.PubMedCrossRefGoogle Scholar
  31. 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
  32. 32.
    Hillis SD, Zapata L, Robbins CL, et al. HIV seroprevalence among orphaned and homeless youth: no place like home. AIDS. 2012;26:105–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Robbins CL, Zapata L, Kissin DM, et al. Multicity HIV seroprevalence in street youth, Ukraine. Int J STD AIDS. 2010;21:489–96.PubMedCrossRefGoogle Scholar
  34. 34.
    Kissin DM, Zapata L, Yorick R, et al. HIV seroprevalence in street youth, St. Petersburg, Russia. AIDS. 2007;21:2333–40.PubMedCrossRefGoogle Scholar
  35. 35.
    Thorne C, Semenenko I, Malyuta R. Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000–10. Addiction. 2012;107:118–28.PubMedCrossRefGoogle Scholar
  36. 36.
    Silverman JG. Adolescent female sex workers: invisibility, violence, and HIV. Arch Dis Child. 2011;96:478–81.PubMedCrossRefGoogle Scholar
  37. 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. 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
  39. 39.
    Smyrnov P, Broadhead RS, Datsenko O, Matiyash O. Rejuvenating harm reduction projects for injection drug users: Ukraine's nationwide introduction of peer-driven interventions. Int J Drug Policy. 2012;23:141–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Nachega JB, Hislop M, Nguyen H, et al. Antiretroviral therapy adherence, virologic, and immunologic outcomes in adolescents compared with adults in southern Africa. J Acquir Immune Defic Syndr. 2009;51:65–71.PubMedCrossRefGoogle Scholar
  41. 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.
  42. 42.
    Birungi H, Mugisha JF, Obare F, Nyombi JK. Sexual behavior and desires among adolescents perinatally infected with human immunodeficiency virus in Uganda: implications for programming. J Adolesc Health. 2009;44:184–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Birungi H, Obare F, Mugisha JF, et al. Preventive service needs of young people perinatally infected with HIV in Uganda. AIDS Care. 2009;21:725–31.PubMedCrossRefGoogle Scholar
  44. 44.
    Hodgson I, Ross J, Haamujompa C, Gitau-Mburu D. Living as an adolescent with HIV in Zambia–lived experiences, sexual health, and reproductive needs. AIDS Care. 2012;24:1204–10.PubMedCrossRefGoogle Scholar
  45. 45.
    Ferrand RA, Bandason T, Musvaire P. Causes of acute hospitalization in adolescence: burden and spectrum of HIV-related morbidity in a country with an early-onset and severe HIV epidemic: a prospective survey. PLoS Med. 2010;7:e1000178. doi:10.1371/journal.pmed.1000178.PubMedCrossRefGoogle Scholar
  46. 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
  47. 47.
    Binagwaho A, Fuller A, Farmer P, et al. Adolescents and the right to health: eliminating age-related barriers to HIV/AIDS services in Rwanda. AIDS Care. 2012;24:936–42.PubMedCrossRefGoogle Scholar
  48. 48.
    Ferrand RA, Trigg C, Bandason T, et al. Perception of risk of vertically acquired HIV infection and acceptability of provider-initiated testing and counselling among adolescents in Zimbabwe. Am J Public Health. 2011;01:2325–32.CrossRefGoogle Scholar
  49. 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
  50. 50.
    Ramirez-Avila L, Nixon K, Noubary F, et al. Routine HIV testing in adolescents and young adults presenting to an outpatient clinic in Durban, South Africa. PLoS One. 2012;7:e45507.PubMedCrossRefGoogle Scholar
  51. 51.
    Li R, Jaspan H, O'Brien V, et al. Positive futures: a qualitative study on the needs of adolescents on antiretroviral therapy in South Africa. AIDS Care. 2010;22:751–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Dowshen N, D'Angelo L. Health care transition for youth living with HIV/AIDS. Pediatrics. 2011;128:762–71.PubMedCrossRefGoogle Scholar
  53. 53.
    Koenig LJ, Nesheim S, Abramowitz S. Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors. Curr Opin Obstet Gynecol. 2011;23:321–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Kim J, Pronyk J, Barnett T, Watts C. Exploring the role of economic empowerment in HIV prevention. AIDS. 2008;22 Suppl 4:S57–71.PubMedCrossRefGoogle Scholar
  55. 55.
    Chersich MF, Rees HV. Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. AIDS. 2008;22 Suppl 4:S27–40.PubMedCrossRefGoogle Scholar
  56. 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
  57. 57.
    Bailey C, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007;369:643–56.PubMedCrossRefGoogle Scholar
  58. 58.
    Gray H, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet. 2007;369:657–66.PubMedCrossRefGoogle Scholar
  59. 59.
    Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2:e298.PubMedCrossRefGoogle Scholar
  60. 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. 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. 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
  63. 63.
    Cohen MS, Gay CL. Treatment to prevent transmission of HIV-1. Clin Infect Dis. 2010;50 Suppl. 3:S85–95.PubMedCrossRefGoogle Scholar
  64. 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. 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
  66. 66.
    Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005;3:CD004775.PubMedGoogle Scholar
  67. 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
  68. 68.
    Celum C, Baeten JM. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence. Curr Opin Infect Dis. 2012;25:51–7.PubMedCrossRefGoogle Scholar
  69. 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. 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. 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. 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
  73. 73.
    Fay H, Baral SD, et al. Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana. AIDS Behav. 2011;15:1088–97.PubMedCrossRefGoogle Scholar
  74. 74.
    Baral S, Sifakis F, et al. Elevated risk for HIV infection among men who have sex with men in low- and middle income countries 2000–2006: a systematic review. PLoS Med. 2007;4:e339.PubMedCrossRefGoogle Scholar
  75. 75.
    Baral SD, Poteat T, et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:214–22.PubMedCrossRefGoogle Scholar
  76. 76.
    Sullivan PS, Carballo-Dieguez A, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012;380:388–99.PubMedCrossRefGoogle Scholar
  77. 77.
    Baggaley RF, White RG, et al. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39:1048–63.PubMedCrossRefGoogle Scholar
  78. 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

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Susan Kasedde
    • 1
  • Chewe Luo
    • 1
  • Craig McClure
    • 1
  • Upjeet Chandan
    • 1
  1. 1.UNICEFNew YorkUSA

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