falling through the cracks
When you are an adolescent, you are supposed
to feel as if you could live forever.
And, indeed, adolescents are less vulnerable
to disease and more resilient. Their survival
rates are as high as their youthful spirits.
But HIV changes everything. It is shocking
that more adolescents die every year
from AIDS-related illnesses than from any
other cause except road accidents. In 2013
alone, 120,000 adolescents died from AIDSrelated
causes: more than 300 every day.
It is even more shocking that the number
of adolescents dying of AIDS is not decreasing
when AIDS-related deaths have
dropped in every other age group. And it
is shameful that this is happening when
we have the knowledge and tools to keep
adolescents living with HIV alive and well
and to prevent new HIV infections.
What can we do to bring back the invincibility
of youth? We must begin at
the beginning and stay with adolescents
throughout their lives.
The vast majority of adolescents who died
of AIDS-related illnesses in 2013 acquired
HIV during pregnancy, delivery, or in the
first months of life because their mothers
were not receiving the antiretroviral medicines
that greatly reduce the possibility of
HIV transmission. Although we have made
great strides, far too many mothers and their
infants are still not getting the HIV services
they need to survive and thrive.
The remaining 20% of adolescents living
with HIV were infected as adolescents
an uncomfortable fact whose causes we
need to honestly confront.
Adolescent girls at risk
More than 250,000 15 to 19-year-olds
were newly infected with HIV in 2013
and they are overwhelmingly girls. In
that age group, girls account for two out
of three new HIV infections globally. In
sub-Saharan Africa, that number jumps to
nearly eight out of ten. 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 generally
to violence, including sexual violence,
forced marriage and trafficking. They are
far less likely than boys to have the information
they need to protect themselves,
but even if they have that information,
they may not be empowered to use it.
The remainder of young people who acquire
HIV during adolescence are often gay
and bisexual boys, and boys and girls engaged
in using drugs or selling sex. Many are never
diagnosed, let alone treated because they
fear repercussion if they seek information,
enter prevention programmes, or get tested.
Health systems failing adolescents
Many adolescents feel misunderstood, but
when it comes to HIV and adolescents, it
is not just a passing phase. National health
plans and health systems in the most affected
countries do not track or focus on
adolescents and there is precious little
data monitoring their health and development
over the age of five. Too old for
paediatrics and often deemed too young
for adult health services, many adolescents fall through the cracks at a time they most
need our attention.
We must do more to protect all adolescents
and empower them to protect themselves
and their health. In fact, we cannot
end the epidemic without a global movement
to end AIDS-related deaths and new
HIV infections among adolescents.
There are promising signs that such a
movement is gathering force. More programmes
are reaching out to adolescents,
many steered by young people themselves.
More countries are including adolescents
in national AIDS agendas.
The United States recently announced a
new investment of US$210 million to prevent
new HIV infections among adolescent
girls and young women. The Global Fund to
Fight AIDS, Tuberculosis and Malaria recently
announced $14 billion in grant money,
with a commitment to include a focus on
the adolescents at greatest risk.
A new platform for action
We need to build on this momentum. In late
February, leaders working to end the AIDS
epidemic came together in Kenya to call for
a new global target of reducing AIDS-related
deaths among adolescents by 65% and cutting
new HIV infections among adolescents
by 75% in the next five years.
This ambitious goal is the centrepiece of
All In, a new platform for action to end adolescent
AIDS. It concentrates on the areas
where we need to accelerate progress: from improving
data to identify the young people we
are missing and provide a sharper focus on adolescents
in national AIDS programmes
fostering innovation in developing new technologies
and approaches to engage adolescents
to advocating for more resources
to reach every adolescent living with,
or at risk of acquiring, HIV, before it is too late.
Most of all, young people themselves need
to be all in to end adolescent AIDS. Already,
they are helping steer this movement,
calling for positive change. The more we engage
them and support their leadership, the
more successful our common efforts will be
to end this epidemic together.
of upload: 20th March 2015