Currently, over 30% of all new HIV infections globally are estimated to occur among youth ages 15 to 25 years. Also, increasingly, children infected at birth grow into adolescents who have to deal with their HIV positive status. Combining the two, there are 5 million youth living with HIV globally.
Young people living with HIV (YPLHIV) are a diverse group and their experiences and challenges vary, particularly between those infected as adolescents and those who were infected as infants and have survived with the help of increasingly effective antiretroviral therapies (ART). Research suggests that young people may find it especially difficult to accept an HIV diagnosis, adhere to treatment, and use HIV prevention practices. Common challenges reported by YPLHIV include stigma, discrimination and disclosure.
Adolescent girls and young women are disproportionately affected by HIV in sub-Saharan Africa due to a range of social and structural factors. Previous research has identified several challenges facing adolescent girls living with HIV, including ART adherence, stigma, lack of emotional support and harmful gender norms, which may impact their medical and psychosocial outcomes.
Programmatic strategies to address these concerns are expanding. Referral services and advocacy networks are developing, as well as programs that integrate youth-friendly HIV care into other services, such as family-centered care or life-skills training. However, more research is needed to better understand how to meet the medical, social, and psychological needs of YPLHIV.
Through collaboration with the private sector, PEPFAR is leading the ambitious DREAMS partnership to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women. The goal of DREAMS is to reduce new HIV infections among adolescent girls and young women in the highest HIV burdened geographic areas of 15 countries. The multi-sectoral DREAMS core package of interventions goes beyond the health sector to address the structural drivers that directly and indirectly increase girls’ HIV risk, including poverty, gender inequality, sexual violence, and a lack of education. (2018).
Technical and Programmatic Considerations for Index Testing and Partner Notification for Adolescent Girls and Young Women
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, the potential risks to AGYW in low- and middle- income countries (LMICs) of HIV PN among this vulnerable population were synthesized (2019).
Despite growing interest in undertaking research in adolescent HIV, the current pace of interventional research in particular remains very low compared with the needs of adolescents living with HIV(ALHIV). More robust evidence is needed to inform innovative and targeted interventions that bridge research gaps, inform policy, and improve outcomes for adolescents. Armstrong et al. document a global research prioritization exercise that was undertaken by WHO and CIPHER to focus efforts on priority research in the context of diminishing resources (2018).
The US Health Services and Resources Administration (HRSA), HIV/AIDS Bureau (HAB) developed a toolkit containing 10 topic areas, ranging from YLWH support groups to data-driven programming. Each section includes strategies to address the specific topic, and resources are provided to support implementation. Providers can use some or all of the information in the toolkit to enhance their programs in an effort to better meet the needs of YLWH (2018).
Despite a growing population of youth living with HIV, few interventions have been developed to address their unique mental health needs and to promote resilience. Dow et al. developed and piloted a mental health intervention, Sauti ya Vijana ( The Voice of Youth), to address identified mental health needs and promote resilience. SYV successfully promoted youth resilience as measured by youth-reported utilization of new coping skills, improved peer and caregiver relationships, reduced stigma, and improved confidence to live positively according to their personal values (2019).
Improving Retention in HIV Care among Adolescents and Adults in Low- and Middle-Income Countries: A Systematic Review of the Literature
Adolescents living with HIV are an underserved population, with poor retention in HIV health care services and high mortality, who are in need of targeted effective interventions. Murray et al. conducted a literature review to identify strategies that could be adapted to meet the needs of adolescents living with HIV. Of the 23 studies identified, only two specifically focused on youth, highlighting a critical gap in knowledge that needs to be addressed (2017).
Interventions to Improve Antiretroviral Therapy Adherence among Adolescents in Low- and Middle-Income Countries: A Systematic Review of the Literature
Globally, an estimated 30% of new HIV infections occur among adolescents (15–24 years), most of whom reside in sub-Saharan Africa. HIV-related mortality increased by 50% between 2005 and 2012 for adolescents 10–19 years while it decreased by 30% for all other age groups. Efforts to achieve and maintain optimal adherence to antiretroviral therapy are essential to ensuring viral suppression, good long-term health outcomes, and survival for young people. This review by Ridgeway et al. found sparse evidence and concluded that there is a pressing need to develop and test targeted intervention strategies to improve adherence among this high-priority population (2018).
The purpose of this strategy is to help PEPFAR country teams and implementing partners (a) develop country and regional operational plans (COPs and ROPs), (b) design programs that integrate gender issues and (c) work to advance gender equality throughout the HIV continuum of prevention, care, treatment, and support. All HIV programs should identify gender-related issues and take concrete steps to address them throughout the program cycle (2013).
Fast-tracking the end of the AIDS epidemic by 2030 requires strong political leadership and commitment to stop new infections and deaths among young women and adolescent girls and eliminate mother to child transmission of HIV. This requires building on and extending Africa’s commitments on reproductive health and rights, expanding ministerial commitments on comprehensive sexuality education and stopping early marriage, adolescent pregnancy and expanding treatment service coverage (2015).
Transitioning to a Healthy Adulthood: Lessons Learned from Adolescent Girls Living with HIV in Urban Zambia
Nearly six percent of Zambian girls aged 15-19 are living with HIV. Many were infected at birth when antiretroviral therapy (ART) was not widely available for pregnant women. Others have acquired HIV through sexual relationships or abuse. Adolescent girls continue to be at high risk for acquiring HIV due to social factors, like harmful gender norms, and structural factors, such as a lack of youth-friendly health services. Previous research in Zambia found that adolescents living with HIV of- ten had difficulty adhering to treatment, disclosing their HIV status to family and friends and coping with stigma. They also had limited access to information about sexual and reproductive health. Despite these challenges having been identified, very few community-based or clinic-based programs are de- signed to support healthy transitions to adulthood for adolescent girls living with HIV (2015).
This brief from UNFPA aims to inform discussions about how best to provide health services, programs, and support for young transgender people. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young transgender people; the barriers and constraints they face to appropriate services; examples of programs that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies, and capacities of these young people (2015).