Adolescents: The Forgotten Key

Written by: Sisasenkosi Mandi
​Edited by: Alyscia Batista

HIV infection rates in young people are expected to rise in the next coming years, even if the current rate of HIV prevention progress is maintained [1]. This is because of the projected increase in the number of young people worldwide, and barriers to access particular to this group. This presents adolescents and young people (AYP) as a group requiring special attention for the global goal to end AIDS by 2030 to remain attainable. To achieve this, adolescents must be named and recognized as a key population.

Key populations are groups that receive additional resources and directed programming, in recognition of unique barriers in their ability to access care [2]  Other recognized key populations include sex workers, men who have sex with men (MSM) and those who inject drugs. While young people may be part of one or more of these vulnerable groups, interventions that don't specifically target young people have little effect on outcomes for them [3]. Further, studies and interventions for key populations seldom disaggregate their data, making it difficult to track outcomes specific to young people. As a result there is a dearth of data on young people and HIV, resulting in sluggish responses to gaps in care. Consequently, there is very little research to inform scale up of interventions targeting adolescents and youth.

In Sub-Saharan Africa, girls now make up 80 % of all new adolescent HIV infections [4]. This means the population most in need of care due to higher rates of poverty and gender inequality, has limited access to resources such as medical care, contraception, and comprehensive knowledge of sex and HIV [5]. This has been reflected not only in the high HIV infection and prevalence rates but in the increased risk for girls, who are more than twice as likely to contract the virus as boys in the same age group [6]. Focus on adolescents will allow care to reach these girls and elevate their access. 

Much progress has been obtained from focus on other key populations, and there has been a surge in programs tailored to populations that are hard to reach through mainstream channels. Adolescents fall into this category because they too require specialized, multifaceted programming, adapted to their needs and stage of development. Studies have shown, for example, that health care settings need to provide adolescent friendly spaces, staff that treat young people with respect and uphold their confidentiality [7]. Resources directed specifically at this group are needed for these targeted interventions to be possible at a large scale. Being a young person or adolescent needs to be recognized as bringing specific challenges that cannot be addressed by the mainstream interventions for adults or children.  

Focusing attention on a particular group is effective because better coordinated care and further resource allocation occur by increasing stakeholder investment. When we reach out to key populations early, we increase their likelihood to be captured in the system, to be protected more effectively, and to remain in interventions longer. It also allows for specific training for health care staff and others on how to interact successfully with the group. Research has shown that stigma from health care workers and others dissuades key populations from seeking care [4]. Since the recognition of MSM as a key population there have been more interventions directed specifically to them to increase access to medical care and treatment. This has included myriad trainings delivered to sensitize health workers on how to interact positively with MSM. There has been widespread success and awareness raised, including reduction in health care provider stigma after stigma reduction training, especially in countries where stigma is high[8].

Adolescents now comprise more than half of all new HIV infections, and are the only group to have an increase in AIDS related deaths over the last few years [6]. This is a clear indication that adult oriented interventions are failing. There is a desperate need for radical action. It is important to highlight and acknowledge AYP's unique challenges in accessing and remaining in care and the dire need for coordinated efforts that produce real results. To unlock all this, it is time to name adolescents and young people as a key population to encourage research, funnel resources, and increase awareness, before it is too late. 

Works Cited: 

[1] Avert. Young People, HIV and AIDS. [Internet]. Last updated: 2019 October 10. Cited 2020 February 23. Available from: 
https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/young-people#footnote10_ooj7da1

[2] USAID. KEY POPULATIONS: TARGETED APPROACHES TOWARD AN AIDS-FREE GENERATION [Internet]. Last updated 2019 September 18. Cited 2020 February 23. Available from: https://www.usaid.gov/global-health/health-areas/hiv-and-aids/technical-areas/key-populations

[3] Pettifor A. Adolescent lives matter: preventing HIV in adolescents. Current Opinion in HIV and AIDS [Internet] 2018 April 4. 
Cited 2020 February 22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902132/#__ffn_sectitle

[4] UNAIDS. Ending the AIDS epidemic for adolescents, with adolescents [Internet]. 2016. Cited 2020 February 23. Available from: 
https://www.unaids.org › filesPDF
Web results
Ending the AIDS epidemic for adolescents, with adolescents - unaids

[5] Fatusia A. O. Adolescents and youth in developing countries: Health and development issues in context. Journal of adolescence [Internet]. 2010 July 2. Cited 2020 February 23. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0140197110000837

[6] UNICEF. Adolescent deaths from AIDS tripled since 2000 [Internet]. 2015 November 27. Cited 2020 February 23. Available from: https://www.unicef.org/media/media_86384.html

[7] UNICEF. Lost in Transitions: Current issues faced by adolescents living with HIV in Asia Pacific [Internet]. 2013 November. Cited 2020 February 23. Available from: https://www.unicef.org/eapro/Lost_in_Transitions.pdf
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[8] Geibel S, Hossain M.I.S, Pulerwitz J, Sultana N, Hossain T, Roy S, et. al. Stigma Reduction Training Improves Healthcare ProviderAttitudes Toward, and Experiences of, Young Marginalized People in Bangladesh. Journal of Adolescent Health [Internet]. 2016 September. Cited 2020 February 23. Available from: https://www.jahonline.org › pdf 
Stigma Reduction Training Improves Healthcare Provider ... - Journal of Adolescent Health

Image Source: https://upload.wikimedia.org/wikipedia/commons/e/ee/Italian_teenagers_Venice_2007.jpg