HIV Prevention and Treatment Strategies for Africa's Growing Teen and Young Adults Are Central to Future World Progress

Young people continue to be left behind by the HIV response. With just 12 years left to end AIDS by 2030, we need to act now to uproot the barriers, bigotry, and exclusion that keep us at risk!

-- A call to action from The PACT, a global coalition of youth organizations working on HIV and sexual and reproductive health and rights.

The world is making headway against HIV. Yet, tens of millions of people still need HIV-related services. And for the world's HIV epidemics to be controlled, effective community-based prevention programs reaching adolescents and young people, especially in sub-Saharan Africa, need to be developed, funded, and scaled up.

There is an urgent need to build and scale up these community-based HIV programs for young people in Africa, in part because the world's largest-ever generation of adolescents is now coming of age on the African continent. Africa is the world's youngest continent; in some countries, most people are younger than 20, and the youth population under 25 years old is predicted to almost double from 230 million today to 450 million by 2050. Without a significant increase in HIV information, prevention, testing, and treatment aimed at young adults and adolescents, there is a significant threat of a new wave of HIV transmissions among this generation.

Those were key messages across multiple presentations at the recent 2018 International AIDS Conference and related satellite meetings organized by the International Association of Providers in AIDS Care (IAPAC), the Joep Lange Institute (JLI), and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

According to UNAIDS, 1.8 million people became newly infected with HIV in 2017, bringing the total global number of people living with HIV to 36.9 million. Approximately one in five of all new HIV infections in the world were among women under the age of 25 -- with approximately 340,000 young women becoming HIV-positive in just one year. Thus, most new HIV diagnoses were among young women, and most of the world's young people living with HIV are in sub-Saharan Africa.

New data at AIDS 2018 showed that adolescent girls, young women, and their male partners in Africa are not being reached with HIV prevention, testing, or treatment programs in the numbers needed to sustain progress against HIV epidemics.

The U.S. global AIDS coordinator, Ambassador Deborah Birx, presented data (including from here) on 10 African countries showing that, although all 10 are making progress in reducing HIV infections and HIV deaths, in eight of these 10 countries, the majority of young people ages 15-24 still don't know their HIV status, and fewer than one in three young HIV-positive people in several of these countries are virally suppressed.

Progress Towards Epidemic Control
Slide presented by U.S. global AIDS coordinator, Ambassador Deborah Birx, at the IAPAC 2018 90-90-90 Targets Workshop, July 2018

Ambassador Birx and others also highlighted evidence showing that young African men are more likely than young African women to be living with undiagnosed and untreated HIV. The result is that men are more likely to be sicker when they do learn of their HIV status and more likely to die from HIV. Moreover, because they are unaware of their HIV status, they are more likely to transmit HIV to their sexual partners.

Evidence shows that comprehensive programming works to prevent HIV and AIDS. Presentations about the U.S.-funded DREAMS Initiative and other programs working with young people throughout Africa show that programs combining HIV services with access to sexual and reproductive health services and intensive social support and community support can reduce HIV infection rates among young women by 25-40% or more.

However, as a focus only on young women is not enough and to address HIV among young men in Africa, PEPFAR announced a new $800 million initiative called MenStar, which is aimed at reaching an additional one million men during the coming years with HIV self-testing campaigns, dedicated men's services at health clinics, and community outreach programs, with the goals of increasing the number of young men who learn their HIV status and of having 90% of men who are HIV-positive achieve viral suppression.

An evident gap is the involvement of young people in the health programs that are meant to serve them. Testimony by young activists at AIDS 2018 showed that adolescents and young adults are not accessing or using HIV-related testing or services because they perceive these services as irrelevant to them, not friendly or accessible, or of poor quality.

A large number of presentations at AIDS 2018 and at a youth-focused AIDS 2018 preconference also showed that health systems are still not centered on the needs of young people and that youth face a range of barriers to health care, including informal fees and other costs, limited hours and locations of operation, medicine stockouts, and unwelcoming or unprofessional clinic staff behavior. A range of young community advocates at the youth-focused AIDS 2018 pre-conference called for funding and support for involving young people in the design, implementation, and oversight of services.

Ultimately, the answer is what has been true since the beginning of the HIV epidemic: Community-based, community-centered, and community-involved responses are key to effective HIV prevention, treatment, care, and support.