Adolescent girls and young women: key populations for HIV epidemic control

Abstract

IntroductionAt the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers. This age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control.DiscussionAdolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations.ConclusionsThere is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative.

Understanding and responding to HIV risk in young South African women: Clinical perspectives

“…Factors associated with HIV risk in young people from southern Africa have previously been reviewed [2] and include: living in a high HIV-prevalence area with low ART coverage; being from a household with poor socioeconomic indicators, including food insecurity and adult death; not being in school or having few years of schooling; a relatively early sexual debut; more than the average number of lifetime sexual partners; sex with an older partner, potentially in a transactional relationship (sex for gifts or favours); inconsistent condom use; a history of sexually transmitted infections; and a history of pregnancy.…”

“…Given the current lack of availability of effective biomedical HIV prevention technologies [2,12] and the importance of structural factors in driving HIV in young SA women, it might seem that there is not much healthcare workers can do to support the former in reducing their odds of acquiring HIV, except advocate for broader economic and scientific development (Box 3). However, a closer look at the case studies in Box 2 reveals a number of ways in which healthcare workers might intervene to break young women out of the cycles of amplifying risk they face.…”

HIV diagnosis increasing in older adults in Europe

“…While the focus on younger age groups reflects a very valid concern with rates of infection in younger people in parts of the world [7][8][9] , the focus on data collection on those aged under 50 or 50 years reflects a belief that HIV is an infection acquired by younger people and is an infection people grow older with, rather than acquire HIV in older age. Therefore, the paper by Tavoschi and colleagues is timely in highlighting that increasing numbers of older people are acquiring HIV-infection in Europe each year.…”

Health Coaches: An Innovative and Effective Approach for Identifying and Addressing the Health Needs of Justice Involved Youth

“…The CDC [27] observed a 40% prevalence of STDs among girls admitting to having sex. Young African American women, particularly those in the 15-24 age range, are disproportionately affected by HIV, accounting for 46% of all U.S. females with this disease [28,29]. Although African American adolescents are at heightened risk for HIV/AIDS, less than one-third report having an HIV test [30].…”