Striving for Better Results for Adolescents: Advancing HIV Prevention, Treatment, Care and Support

"Despite impressive overall results in the past decade's response to HIV, especially in terms of dramatically increased treatment coverage for people living with HIV and a 40% reduction in the number of children infected with HIV due to vertical transmission between 2001 and 2011 (UNAIDS, 2012), efforts to prevent HIV sexual transmission and transmission due to sharing of contaminated injecting equipment have achieved more limited success."

In this commentary accompanying the discussion: "Will There ever Be an AIDS-Free Generation?" (available in video format), the author, Craig McClure, discusses the epidemic's effect on adolescents and the underlying reasons for their vulnerability.

"...The 2011 HIV Investment Framework (Swartlander et al., 2011), published in the Lancet..., provides an analysis of the proven effectiveness of interventions targeted at reducing HIV risk, transmission and morbidity/mortality.
Six basic programmatic activities fall into this category:

• Male and female condom promotion and distribution
• Male circumcision of heterosexual males in high HIV prevalence settings
• The use of antiretroviral drugs to prevent mother to child transmission (PMTCT)
• Treatment with antiretroviral therapy
• Targeted approaches for those involved in the sex trade, males who have sex with other males, and people who inject drugs (including harm reduction interventions such as methadone substitution therapy and needle and syringe exchange)
• Behaviour change communication (including comprehensive sexuality education that begins in primary school and extends through secondary school)"

In addition to the "basic programmatic activities" the "Investment Framework grouped another set of activities to reduce HIV risk, transmission and morbidity/mortality under two categories:

1. Critical Social and Programmatic Enablers to enhance the effectiveness of the basic programmatic activities. For adolescents, these could include protective laws and policies, especially towards protecting adolescents living with HIV and sexual minorities from discrimination, policies which emphasize public health approaches over criminal justice to combat drug use, engagement of adolescents themselves in planning, delivery and monitoring of results;
2. Development Synergies. Broad development approaches for adolescents can contribute to reduced vulnerability, risk and impact of HIV, including programmes aimed at gender equality, extending secondary education to all girls and boys, and the strengthening of social protection, especially broad legal reform to protect adolescents from violence and other forms of exploitation, expansion of health insurance, and various approaches to income protection for families affected by AIDS, as an element of broader HIV-sensitive social protection programmes."

The document concludes that "...[a] tighter, more focused strategy to address HIV in adolescents, supporting countries to apply the analysis used in the HIV Investment Framework, matched against the unique epidemiological context of each country, can make a difference." McClure calls for further research, particularly operational research in the context of expanded programmes to close knowledge gaps and guide a more robust HIV response for adolescents.