Despite impressive progress towards achieving global targets aimed at halting and reversing the spread of HIV; it still remains a pressing public health challenge in Africa. Across the world, unprecedented investments into the HIV response have resulted in increased access to antiretroviral therapy, increased coverage of risk reduction programs and considerable success in prevention of mother to child transmission of HIV to the extent that ending the HIV epidemic by 2030 is a vision well within reach of global resources and efforts.
Africa has come a long way in the HIV response and has been both a trailblazer and host for various innovations aimed at controlling the HIV epidemic. For example, over the past 15 years, services for prevention of mother to child transmission of HIV expanded so rapidly across Africa that 85% of the 1.4 million children prevented from becoming infected with HIV were in Africa alone (WHO 2015). By 2014 however, Africa (which comprises only 11% of the world’s population) was home to 70% (25.8 million) of people living with HIV. A lot more therefore needs remains to be done before Africa can begin to realize the full benefits of HIV control measures within the continent’s unique context of rapid cultural, economic, political and population shifts.
A key emerging concern is the growing burden of HIV among adolescents aged 10 – 19 years. AIDS is now the leading cause of death among adolescents in Africa and the second most common cause of death among adolescents globally (WHO, 2014). According to UNAIDS, in 2013, an adolescent between the ages of 15 and 19 was newly infected with HIV every two minutes. Every year, 380,000 adolescent girls and young women are infected with HIV—that is 7,300 every week, over 1,000 every day. It should be noted that while this is by no means an African problem alone, the challenges of inadequate coverage and quality of HIV prevention and treatment services on the continent affects specific population groups like adolescents who traditionally have not been sufficiently targeted and / or reached by existing health systems. In addition in 2013, nearly half of all adolescents living with HIV globally were in six countries alone of which five are in Africa.
The drivers of this emerging crisis are varied and complex. Children who have acquired HIV from their mothers often present for treatment initially as adolescents; while on the other hand, adolescents are also acquiring HIV during unprotected sex or by using contaminated drug-injecting equipment. High mortality rates among adolescents living with HIV indicate challenges with access and adherence to treatment. In this region moreover, adolescent girls are disproportionately at high risk of acquiring HIV. Girls and young women account for 71 percent of new HIV infections among adolescents in sub Saharan Africa. 50% of these new infections are occurring in only 10 countries namely Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Adolescent girls are more vulnerable due to gender inequalities and gender violence. According to a UNICEF report released in 2015, adolescent girls are more likely to be married or in union by age 19 than their male counterparts, and less likely than boys to have comprehensive knowledge of HIV (UNICEF, State of the World’s Children report 2015).
The magnitude and importance of this emerging crisis has grabbed the attention of governments, NGOs and communities across Africa and the world. There is general consensus that ambitious and aggressive programs targeting adolescents need to be established. There are structural or non-health sector drivers of new HIV infections among adolescents such as social acceptance of child marriage, culturally-sanctioned gender violence, declining retention rates of girls in school and persistent stigma and discrimination. These structural drivers call for multisectoral approaches to reduce new infections among adolescents. In addition HIV services must be deliberately designed as youth friendly, meeting both confidentiality and quality expectations to ensure increased access to information, prevention and treatment for adolescents. The psychosocial support and counseling services needed by adolescents living with or at risk of acquiring HIV are obviously unique to an age group that is transitioning from childhood to adulthood. This calls for innovative approaches that include assuring adolescent participation in the design, management and evaluation of HIV programs and services. At all levels: individual, community and system; Africa and her partners must take action to engage, equip and empower adolescents as part of a dynamic and sustained HIV response movement across the continent.
Engage, Equip and Empower!
“AIDS is the leading cause of death among adolescents in Africa. Globally, two-thirds of all new infections among adolescents were among adolescent girls. This is a moral injustice. I am calling on young people to lead the All In movement, alongside the United Nations, public and private partners, and countries themselves, to end the adolescent AIDS epidemic.”
Michel Sidibé, Executive Director, UNAIDS
- Health for the world’s adolescents: a second chance in the second decade.2014 www.who.int/adolescent/second-decade
Global health sector response to HIV, 2000-2015: focus on innovations in Africa: progress report. WHO 2015
The State of the World’s Children 2015: Reimagine the Future: Innovation for Every Child http://sowc2015.unicef.org
UNAIDS All In: #EndAdolescentAIDS, 2015. http://allintoendadolescentaids.org
All In! to #EndAdolescentAIDS http://www.unaids.org/sites/default/files/media_asset/20150217_ALL_IN_brochure.pdf