April 19, 2016

Approximately 2.2 million adolescents– 60 percent of them girls–are living with HIV. (1) In sub-Saharan Africa, adolescent girls and young women aged 15 – 24 account for almost 70% of all young people living with HIV. (2) Compared to boys, adolescent girls have up to 8 times higher rates of new HIV infections, affected by early (and often forced) sexual activity, multiple sex partners, and high rates of sex with older partners. Gender-based violence (GBV) perpetuates the spread of HIV/AIDS by limiting girls’ and boys’ ability to negotiate safe sexual practices, contributing to increases in sexual risk behavior, and reducing access to essential health and social services. (4) Addressing gender norms and inequities is essential to reducing HIV risk and to increasing access to care and treatment services for adolescent girls and boys. (5)

Despite expanded eligibility for treatment, multiple factors including lack of knowledge, inaccessible services, need for parental consent, poverty, gender, stigma and discrimination, and lack of confidentiality may affect adolescents’ willingness to seek services or to continue accessing care and treatment. (6) Though few health systems offer adolescent-focused services, adolescents living with HIV need a range of integrated care and treatment services that are youth-friendly and targeted to their particular developmental needs. (7) Information and services for sexual and reproductive health (SRH), family planning, prevention for HIV-positive adolescents, HIV care and treatment, and disclosure and adherence support are key pieces to helping adolescents live positively and make a healthy transition to adult care and treatment. (8)

Adolescents in transition

Advances in antiretroviral therapy (ART) and access to treatment are extending children’s lives into adolescence and eventually adulthood.  Detailed recommendations for treating adolescents can be found in the 2013 WHO guidelines.  Physical, mental and developmental changes are all part of transitions that can be particularly challenging for adolescents living with HIV (ALHIV).  Adolescents need “comprehensive, nondiscriminatory, and confidential sexual and reproductive health services…at every possible point of care so that they can remain healthy during their transition into adulthood.” (9) Programs need to support these transitions by strengthening systems’ to provide adolescent-friendly information, social protection, services and referrals on a range of topics including safer sex, prevention, and healthier behaviors, psychosocial and peer support groups and adult mentors.  Primary and secondary education, economic strengthening for income opportunities, life skills and vocational training are also critical adolescent needs.  Importantly, all of these programs must provide environments that engage and retain adolescents in care, support their continuing treatment and adherence, and work towards a successful transition into adult care. (10)

Key messages and activities for supporting adolescents living with HIV

  1. Promote healthy adolescent development by strengthening family-centered care and support and facilitating peer networks, mentorship programs and support groups in elementary and secondary schools. Include out-of-school-youth – particularly girls. (11)
  2. Link adolescents living with HIV to psychosocial and mental health services that promote well-being, increase coping skills to deal with a positive diagnosis, and support safe disclosure and treatment adherence.
  3. Address specific needs of most-at-risk adolescents (e.g. injection drug users, transactional sex workers, men who have sex with men and transgender adolescents) living in general and concentrated epidemics.
  4. Ensure adolescents, especially girls, have access to life skills programs, job-training, economic strengthening and both primary and secondary education.
  5. Provide adolescents living with HIV with risk reduction and positive prevention information and strategies, including condoms.
  6. Train service providers in adolescent-friendly service provision that is age-appropriate, confidential, non-discriminatory and meets adolescents’ specific needs. Strengthen outreach activities in communities and schools to increase adolescents’ knowledge and uptake of HIV testing and counseling (HTC), care, and treatment services.
  7. Strengthen HTC programs to effectively link HIV-positive adolescents to youth-friendly sexual and reproductive health (SRH) services, and HIV care and treatment programs.  Increase gender equity in programs and services, particularly for adolescent girls.
  8. Strengthen capacity of governments, civil society, communities and households to provide long-term physical, emotional and social support to children and adolescents living with HIV. Provide child and social protection services for adolescents to grow up in nurturing, empowering environments and to make healthy transitions to adulthood.
  9. Work with governments, civil society organizations and communities to address harmful social and gender norms and to reduce systemic barriers to adolescent care and treatment. (12)

Recognize adolescents as potential agents of change.  Actively include them in design of strategies and services, implementation and evaluation.  Utilize social media and new technologies to support adolescents to lead and develop specific strategy recommendations, such as the “CrowdOutAIDS” project that will inform UNAIDS New Generation Leadership Strategy.