Adolescents have been rightly highlighted as a priority population in ending HIV but the authors of this article explain that a gender lens is also needed. The authors’ analysis indicate that gender disaggregation illuminates the causes of transmission which must be brought into the light for prevention and appropriate intervention.
Using data provided by Avenir Health from country-produced Spectrum files, the authors analyzed the mode of transmission for older adolescents. Their findings indicate that among the roughly 1.2 million (uncertainty bounds 660 000–1·6 million) adolescents aged 15–19 years worldwide living with HIV, 43% of boys acquired HIV through horizontal transmission and 57% acquired it through vertical transmission. Conversely, they estimate that 65% of girls living with HIV acquired it horizontally, whereas 35% acquired it vertically.
For boys living with HIV, the percentage who acquired HIV through horizontal transmission ranges from 34% in sub-Saharan Africa to almost 100% in high-income countries, whereas for girls, it ranges from 70% in west and central Africa to 99% in high-income countries. In girls aged 15–19 years with HIV, it seems that there is no area of the world where vertical transmission of HIV is greater than horizontal transmission.
As this analysis illustrates, the HIV community must use a more nuanced understanding of gender, including how it contributes to the modes and underlying causes of HIV transmission, so that they can more effectively meet the diverse prevention, treatment, and care needs of both younger and older adolescent girls and boys.