Adolescents and young people represent a growing share of people living with HIV worldwide. In 2016 alone, 610,000 young people between the ages of 15 to 24 were newly infected with HIV, of whom 260,000 were adolescents between the ages of 15 and 19. To compound this, most recent data indicate that only 15 per cent of adolescent girls and 10 per cent of adolescent boys aged 15-19 in sub-Saharan Africa – the region most affected by HIV – have been tested for HIV in the past 12 months and received the result of the last test. If current trends continue, hundreds of thousands more will become HIV-positive in the coming years. Additionally, AIDS-related deaths among adolescents have increased over the past decade while decreasing among all other age groups, which can be largely attributed to a generation of children infected with HIV perinatally who are growing into adolescence.
In 2015, UNICEF and UNAIDS, in partnership with other international health and development partners, launched ALL IN! to End Adolescent AIDS. This global initiative established 2020 targets towards ending the AIDS epidemic among adolescents by 2030. To achieve this, it is critical to accelerate efforts to address the epidemic among adolescents.
HIV IN ADOLESCENTS
In 2016, about 2.1 million adolescents between the ages of 10 and 19 were living with HIV worldwide. Adolescents account for about 6 per cent of all people living with HIV and about 15 per cent of new adult HIV infections. The regions with the highest numbers of HIV-positive adolescents are sub-Saharan Africa and South Asia. Of the 2.1 million adolescents living with HIV, about 1.7 million (84 per cent) live in sub-Saharan Africa.
Adolescents aged 15 to 19 account for an estimated 15 per cent of new adult HIV infections worldwide. Globally, in 2016, adolescent girls accounted for two thirds of all new HIV infections among adolescents. In sub-Saharan Africa that year, nearly three times as many adolescent girls were newly infected with HIV than adolescent boys. In North America, East Asia and the Pacific, Latin America and the Caribbean and Western Europe, more boys are newly infected with HIV each year than girls in adolescence. This reflects differences in risk behaviour in these regions, which means that interventions must be tailored to the specific nature and dynamic of the epidemic.
In some sub-Saharan countries, adolescent girls are two to three times more likely to be infected than boys of the same age group. However, HIV does not only affect sub-Saharan Africa, and in 2016 more than one fourth of adolescents newly infected with HIV lived outside of the region.
WHAT IS NEEDED TO TURN THE TIDE
In order to reverse the epidemic amongst adolescents, an agenda for action is needed to accelerate HIV results with and for adolescents particularly excluded groups. ALL IN! to #EndAdolescentAIDS encourages action and collaboration to inspire a social movement to drive better results with and for adolescents (aged 10-19 years) through critical changes in programmes and policy. It aims to unite actors across sectors to accelerate reductions in AIDS-related deaths by 65% and new HIV infections among adolescents by 75% by 2020, and thus set the global AIDS movement on track to end the AIDS epidemic among adolescents by 2030.
All-IN! serves as a platform to strengthen partnership across sectors and foster meaningful involvement of adolescents in all aspects of programming and advocacy for adolescents, while providing an opportunity to support countries to improve data collection, analysis and utilization for programme planning, and monitoring and evaluation.
According to UNAIDS estimates, HIV incidence has fallen in many of the most severely affected countries because adolescents and young people are adopting safer sexual practices. In several countries, risk behaviour is on the decline, including the initiation of sex before age 15, sex with multiple partners and sex without condoms.
In countries with generalized epidemics, schools can be a critical venue for reaching adolescents with the information and skills they need to avoid infection. Evidence shows that school-based sex education can be effective in changing the knowledge, attitudes and practices that lead to risk behaviour.
Preventing HIV in countries with low prevalence or where the epidemic is concentrated in specific populations is especially challenging since the spread of the virus is fuelled by high-risk, often stigmatized behaviour. People who engage in such behaviour tend to be young and include sex workers, people who inject drugs and men who have sex with men.
For more information on UNICEF’s programme and policy work on HIV and AIDS, click here.
Though progress has been made in preventing HIV infection in children, a UNICEF analysis of UNAIDS data suggests that without accelerated action, the 2020 super-fast-track targets for eliminating HIV transmission in children, reducing new infections in adolescent girls and young women, and for increasing HIV treatment in children and adolescents living with HIV will not be met.
Children are still dying of AIDS-related causes. Children living with HIV (aged 0–4) face the highest risk of AIDS-related death compared to all other age groups. The AIDS-response must focus on solutions for this extremely vulnerable population. Preventing new infections, but also testing and starting treatment early are the best ways to end AIDS among the youngest children. In an age when the tools and knowledge are at hand to prevent and treat HIV in children, new infections and deaths among this age group reflect a collective failure to prioritise children.
This document guides countries through the process of collecting and reporting sub-national data on adolescents to inform programme planning and implementation efforts. It has been developed with the specific aim of identifying data gaps for adolescents and informing immediate programme planning needs at the sub-national level.
Guidance Document: Strengthening the Adolescent Component of National HIV Programmes through Country Assessments
This guidance document and its accompanying tool, the Adolescent Assessment and Decision-Makers Tool (AADM), were devised to facilitate country assessments aimed at strengthening the adolescent component of national HIV programmes. The purpose of the country assessments is to: (1) support country teams in the identification of equity and performance gaps affecting adolescent HIV programming; and (2) define priority actions to improve the effectiveness of the national adolescent HIV response.
At the turn of the century, and the beginning of the Millennium Development Goals, an HIV diagnosis was equivalent to a death sentence for most children and their families in low-income countries. But now, an early diagnosis paired with treatment and care can ensure long healthy lives, regardless of location, and can help prevent transmission of HIV to others. Since 2000, 30 million new infections were prevented, nearly 8 million deaths averted, and 15 million people living with HIV are now receiving treatment.
The JAIDS Supplement is a key source of evidence that will inform collective efforts towards ending the adolescent AIDS epidemic. The series presents a collection of reviews on adolescents analyzing current evidence and experience from programmes to highlight how to improve HIV-specific outcomes.
In the foreword to this State of the World’s Children 2011 edition, Anthony Lake, Executive Director of UNICEF writes: “Adolescence is not only a time of vulnerability, it is also an age of opportunity. This is especially true when it comes to adolescent girls. We know that the more education a girl receives, the more likely she is to postpone marriage and motherhood – and the more likely it is that her children will be healthier and better educated. By giving all young people the tools they need to improve their own lives, and by engaging them in efforts to improve their communities, we are investing in the strength of their societies.”
GLOBAL AIDS RESPONSE PROGRESS REPORTING/UNIVERSAL ACCESS
In an effort to harmonize data collection and minimize the reporting burden on countries, UNAIDS, WHO and UNICEF have developed a joint reporting tool. The tool, which has been translated into several UN languages, combines the Global AIDS Response Progress Reporting and Universal Access reporting on the health sector response to HIV/AIDS. Countries that have not yet begun using the tool are advised to download the latest version. Accompanying guidelines support countries in using the tool and provide detailed descriptions of the indicators used.
- For more information, click here.
- For Global AIDS Response Progress Reporting/Universal Access reporting guidelines, click here.
- To view the latest version of the reporting tool, click here.
- To view a list of indicators, click here.
SPECTRUM/EPP ESTIMATE MODELLING
UNAIDS, WHO and UNICEF are using Futures Institute’s modelling software, Spectrum/EPP, to generate estimates, which support policy decisions concerning public health. Spectrum includes modules for HIV estimates and projectors.
NATIONALLY REPRESENTATIVE SURVEYS
Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), AIDS Indicator Surveys (AIS), reproductive health surveys, sexual behaviour surveys and other nationally representative surveys are currently used to collect data on HIV and AIDS.