Martha was born with HIV in 1996 in Malawi. Now 19 and a mother herself
Popular opinion would have us believe that HIV is over and, while the latest data tells us we’ve made huge progress in preventing infections and saving lives, it also reveals that some groups have been left behind. Adolescents are among them. This age group is at the greatest risk and there needs to be a far deeper awareness of how things must change and how to help.
Adolescents are dying from HIV-related illnesses far more than any other cause. What is even more shocking is the fact that HIV-related deaths have dropped in every other age group. One of the causes of this situation is that the vast majority of teens who are dying of HIV-related illnesses acquired HIV as infants due to the fact that, 10 to 15 years ago, most pregnant women and mothers living with HIV were not receiving the antiretroviral medicines that prevent HIV transmission.
At the turn of the century, as the world embarked on the Millennium Development Goals (MDGs), an HIV diagnosis was a death sentence for most children and their parents in low- and middle-income countries. Over the last 15 years, however, prevention, treatment, care and support have made a huge difference: an estimated 30 million HIV infections were averted, and nearly eight million people who would have died, survived.
In 2014, 15 million people living with HIV were receiving treatment. Progress in the response to HIV is one of the great success stories of the MDGs.
The strides made in the prevention of mother-to-child transmission of HIV over the same period have also been remarkable.
Efforts to eliminate this transmission will help to change the course of the epidemic for the next generation of adolescents. In the meantime, however, immediate investments must be made to get life-saving treatment to those adolescents who acquired HIV as children but were never diagnosed or who fell out of treatment programmes, and to provide them with the support and healthcare they require.
At the same time, we need to urgently address new infections among adolescents. There were 26 every hour of 2014, across the world. An alarming two out of three infections are in girls. In sub-Saharan Africa that number jumps to nearly eight out of 10, and in South Africa, more than 800 girls in this age group are infected with HIV every week.
Girls are more vulnerable to HIV because they are more vulnerable to sexual violence, forced marriage and trafficking, and the persistent effects of gender inequality that denies them equal status in many communities. Existing programmes are not doing enough to help them acquire the skills and behaviours they need to protect themselves.
In sub-Saharan Africa, among 15 to 19-year-old girls, only 26% had comprehensive HIV-related knowledge, only 13% were tested for HIV, and almost 70% who slept with multiple partners did not use a condom last time they had sex. These figures need to change and efforts have been made to transform the plight of these young girls.
Adolescents are falling through the cracks at a time they most need our attention. To address this, All In to #EndAdolescentAIDS, co-led by Unicef and Unaids, along with UNFPA, WHO, Pepfar, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the MTV Staying Alive Foundation and young people represented through Y+ and the PACT, was launched in early 2015.
The All In platform for action focuses on HIV prevention and comprehensive care and treatment for adolescents by encouraging strategic changes in policy and engaging more young people in the effort. It has four key action areas. The first is in engaging, mobilising, and empowering adolescents as agents of social change; the second is in improving data collection to better inform programming and the third is in encouraging innovative approaches to reach adolescents with essential HIV services adapted to their needs. The fourth step is in placing the HIV epidemic among adolescents firmly on the global political agenda to spur concrete action and the mobilisation of resources.
Since the launch of All In to#EndAdolescentAIDS, we have seen a much overdue shift in attention to this population group with more programmes reaching out to adolescents, many steered by young people themselves, and more countries including specific plans for adolescents in their national HIV agendas. An important initiative is Dreams, a $-210 million partnership between the US government through the US President’s Emergency Plan for AIDS Relief (Pepfar) with the Bill & Melinda Gates Foundation and the Nike Foundation. Dreams seek to reduce new HIV infections in adolescent girls and young women in 10 sub-Saharan African countries: Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The ultimate goal of the partnership is to help girls develop into Dreams —Determined, Resilient, Empowered, Aids-free, Mentored, and Safe — women.
We need to build on this momentum and keep young people at the centre of the response and be bold in insisting that the respect for human rights remains at the heart of any change, and that evidence must guide our programming.
Children and adolescents need not become infected with HIV; but if they do, they need not die. Ending HIV by 2030 is a real possibility, more so than at any time since the epidemic started. We have the tools and experience to put a stop to new HIV infections and keep children and adolescents who are living with HIV alive and healthy. It is within our power to achieve an HIV-free generation. Now is the time to step up and keep on going, to continue with the work done to date and to constantly develop and invest in initiatives that can help transform people’s lives.
Leila Gharagozloo-Pakkala is the Regional Director for Eastern and Southern Africa at UNICEF.
Manuel Fontaine is the Regional Director Western and Central Africa at UNICEF