Op-ed by Jennifer Slyker
This World AIDS Day, we applaud gains against the world HIV/AIDS epidemic and optimistically embark upon a new vaccine trial. But we also recognize our work is far from done especially when it comes to young people. Without a significant global transformation in priorities and resources towards adolescents, we leave them at risk of dying from a preventable and treatable disease.
Globally, 2 million adolescents aged 10-19 years old are infected with HIV/AIDS, the second leading cause of death for this age group. HIV/AIDS-related deaths are decreasing in children, youth (age 20-24) and adults but increasing in adolescents. In the United States., adolescents accounted for more than a quarter of new infections in 2010. Compared to adults, adolescents are less likely to know their HIV status, less likely to start treatment and are at higher risk of dying from AIDS. Half may stop treatment within a year of diagnosis.
Why are adolescents falling behind? The reasons are many. Adolescents are often an afterthought, grouped with children in some health programs and adults in others. They are often excluded from medical research because they are a difficult group to work with ethically and practically. Teenagers have unique needs for age-appropriate behavioral and medical interventions, and our systems don't always serve them well. Adolescence is a transition toward independence physically, mentally and socially, and no two people are the same. How adolescents behave, what is expected from them and how they are treated is determined largely by family and cultural context.
Gender inequality and economic instability put young girls at high risk for sexual violence, substance abuse and HIV. They may not able to delay sex or insist on protection. Adolescent boys are also at high risk. In the United States, 80 percent of adolescent HIV diagnoses occur among gay and bisexual males, and the number of new infections increased for this population between 2010-2013. Stigma, discriminatory laws and divestment of public funds have limited adolescent access to critical sexual and reproductive health services.
So what needs to be done? The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), World Health Organization, UNAIDS, and UNICEF have recognized the increasing inequity facing adolescents and called for the strategic development of youth-friendly HIV services. In 2015, PEPFAR launched ALL IN (#EndAdolescentAIDS) to advocate for critical changes in programs and policy, aiming to reduce adolescent AIDS deaths by 65 percent and new HIV infections by 75 percent before 2020. In addition to mobilizing political will, we must invest in interventions, technologies and approaches tailored to adolescents.
Working toward an AIDS-free generation:
- Strengthen education: Strengthen school-based health curricula, and leverage social media platforms to spread accurate and essential information on HIV.
- Facilitate communication: Promote parent-child communication regarding sex, HIV and healthy relationships.
- Increase access: Support adolescent access to HIV testing and counseling services, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP is the provision of antiretrovirals (ARVs) to high-risk individuals to prevent HIV acquisition. PEP is using ARVs following an exposure to reduce the risk of infection.
- Support non-discriminatory legislation and policies: Advocate for legal protections against discrimination based on race, ethnicity, gender and sexual orientation. Discrimination and stigma contribute to HIV by promoting violence, increasing depression and substance abuse and decreasing access to preventative care.
- Support innovation: Involve adolescents in research and vaccine studies. New technologies can simplify HIV prevention and treatment for adolescents, including long-lasting injectable formulations of ARVs and dual protection products that prevent both HIV infection and unintended pregnancy.
Our youth are our future. I encourage you to celebrate this 2016 World AIDS Day by talking with your kids about HIV. Tell them what the 1980s and early 1990s were like when we had no effective treatment and AIDS truly was a death sentence. Celebrate by teaching them how to protect themselves, and encourage them to continue the conversation with their teachers, peers and partners. Then next year on World AIDS Day, we can celebrate their progress toward becoming an AIDS-free generation.
Dr. Slyker is an assistant professor of global health at the University of Washington in Seattle where she leads a research program devoted to improving HIV testing services for older children and adolescents at risk for HIV infection. She also leads the HIV/AIDS core at the UW Global Center for Integrated Health of Women, Adolescents and Children (Global WACh).