Adolescents and young people represent an increasing share of people living with HIV globally. According to UNICEF, 590,000 young people between the ages of 15 to 24 were newly infected with HIV in 2017, yet recent data indicate that HIV testing rates among adolescents are low. In Eastern and Southern Africa, the region most affected by HIV, only 17 percent of adolescent boys aged 15-19 and 23 percent of adolescent girls of the same age have been tested for HIV in the past 12 months and received their results. Testing rates in South Asia and West and Central Africa and are even lower.
HIV disproportionately affects adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs) due to a range of social and structural factors AGYW are vulnerable to HIV due to social and cultural factors, including early sexual debut, early and forced marriage and childbirth, sexual relationships with older men, economic pressure for transactional sex, and restricted ability to negotiate condom use. Structural factors, such as a lack of youth-friendly health services and less access to education, also contribute to girls’ vulnerability to HIV.
AGYW are a priority population that would benefit from HIV index testing to ensure early linkage to care and treatment services. Recently, partner notification (PN) linked with HIV index testing has also been recommended for AGYW in LMICs to support global efforts to reach 95-95-95 goals and achieve epidemic control. HIV PN for AGYW is also seen as an entry point for engaging adolescent boys and young men, populations that are harder to reach, in HIV services through PN. However, little is known about the potential social harms that AGYW may experience due to HIV PN.
While HIV index testing and partner notification (PN) services have the potential to reach adolescent girls and young women (AGYW) aged 15-24 and their sexual partners in need of HIV testing services (HTS), the implementation of PN requires careful consideration to minimize potential social harms for AGYW who may be experiencing violence or stigma, fear violence or stigma, or who may have acquired HIV as a result of violence. Paramount among considerations regarding the roll-out of HIV PN for AGYW is ensuring voluntarism, with informed consent and the explicit right to decline.
YouthPower Learning reviewed the evidence on social harms linked with HIV index testing and PN, including intimate partner violence (IPV) and stigma. Using the lens that a holistic positive youth development approach can help to address the barriers and challenges associated with HIV PN among AGYW, we synthesized the potential risks to AGYW in low- and middle- income countries (LMICs) of HIV PN among this vulnerable population.
Forthcoming in February 2019