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 Aids-related 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.
Watch: Incredible 11-Year-Old living with HIV – Kenya | UNICEF
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 per cent of adolescents living with HIV were infected as adolescents – an uncomfortable fact whose causes we need to honestly confront.
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.
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 of America 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 US$ 14 billion in grant money, with a commitment to include a focus on the adolescents at greatest risk.
We need to build on this momentum. This week, leaders working to end the Aids epidemic are coming 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… to fostering innovation in developing new technologies and approaches to engage adolescents more effectively … 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. DM
Anthony Lake is the Executive Director of UNICEF. Michel Sidibé is the Executive Director of UNAids.
Photo: A South African health worker stands at a free HIV/Aids testing station during the World Aids Day concert in Khayelitsha township, Cape Town, South Africa, 01 December 2014. EPA/NIC BOTHMA
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