Adolescents and HIV

Alison Jenkins, UNICEF TanzaniaCover photo: © Khanga Rue Media/2014/Olvera

THE GLOBAL SITUATIONADAPTED FROM PRESENTATIONS BY PRISCILLA IDELE, UNICEF HQ

Half of adolescents living with HIV are in six countries

Adolescent AIDS -related deaths: increasing

Bots

wan

a

Nam

ibia

Swaz

iland

Zam

bia

Zim

babw

e

Sout

h Af

rica

Keny

a

Mal

awi

Ugan

da

Untd

. Rep

. of T

a...

Ethi

opia

Buru

ndi

Ghan

a

Leso

tho

Côte

d'Iv

oire

Cam

eroo

n

Moz

ambi

que

Ango

la

Chad

Dem

. Rep

. of t

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ria

21 p

riorit

y co

unt..

.

0%

1000%

2000%

3000%

4000%

5000%

6000%

7000%

8000%

9000%

10000%

All ages

Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting.

ART GAP BETWEEN ADULTS AND CHILDREN BY COUNTRYPercentage of ART coverage among eligible adults (aged 15+), children (aged 0-14) and all ages in the 21 African Global Plan priority countries, 2012

Older adolescents have lowest retention rates in pre-ART care one year after enrollment

0%

10%

20%

30%

40%

50%

60%

11-14 years 15-19 years 20-24 years 25-29 years

pre-ART

ART

Based on 50,203 young people – 16% of all ICAP Patients in 4 countries

& 123 clinics

• 15-19 year olds have the worst pre-ART retention

• Those retained in programs had inadequate adherence

Source: 50,203 young people - 16% of all ICAP patients in 4 countries & 123 ART clinics, 2012

% lost to follow up in pre-ART care one year after enrollment (green bars)% lost to follow up one year after ART initiation (orange bars)

THE SITUATION IN TANZANIA

Adolescents in Tanzania

• 10.4 million adolescents (10-19 years) in Tanzania, representing 23% of the population

• Girls are more vulnerable:– Girls almost 3x more likely to be HIV positive than boys

(THMIS 2011/12). – 40% of girls pregnant or have a child by age 19 (DHS

2010). – 1 in 3 girls and 1 in 7 boys experienced unwanted sexual

experiences during childhood (VACS 2009)– Girls start dropping out of school at higher rates than

boys at age 13 (DHS 2010).

Higher Prevalence in Women: Transition to Adulthood

Age

Perc

ent H

IV p

ositi

ve

Comprehensive HIV knowledge is low, especially girls in rural areas, with

much regional variation

Source: THMIS 2011/12

Ta M Za U R Ka ir

0

20

40

60

80

100

42 42

28

4840

22

69

53 54

35

65

48

29

59

Males 15-19 years20-24 years

% of females and males with comprehensive HIV knowledge, by age

Tanz

ania

Mai

nlan

d

Zanz

ibar

Urb

an

Rura

l

Sim

uyu

Pwan

i

37 3728

51

32

13

69

44 44 4254

41

25

54

Females 15-19 years20-24 years

Testing in last 12 months, higher in girls, with regional variables

% of females and males who tested for HIV in the past 12 months and received results, by age

Ta Ma Za U R Ka N

0

20

40

60

80

100

15 156

1914

3

4037 3729

45

33

Males 15-19 years20-24 years

Tanz

ania

Mai

nlan

d

Zanz

ibar

Urb

an

Rura

l

Kuzi

ni ..

.

Aru

sha

24 2412

2822

6

3446 47

36

5443 39

54

Females 15-19 years20-24 years

Early sexual debut is common among adolescent girls and varies by region

Source: THMIS 2011/12

% of females aged 20-24 years who had sex before age 15 and age 18Ta

nzan

ia

Mai

nlan

d

Zanz

ibar

Urb

an

Rura

l

Mbe

ya

Tang

a

0

20

40

60

80

100

9 104 5

112

24

49 49

20

38

52

34

47

by age 15 by age 18

Condom use at last high risk sex remains low

Tan

Ma

Zan U

Rura

l0

20

40

60

80

100

45 45

39 39

49

34

41 40

53

36

Males15-19 years 20-24 years

15-24 years

Source: THMIS 2011/12

Tanz

ania

Mai

nlan

d

Zanz

ibar

Urb

an

Rura

l

38 38

31 31

34 34

Females15-19 years20-24 years15-24 years

% of females and males reporting multiple partners in the last 12 months who used a condom at last sex, by age

Adolescents in Tanzania

• 10.4 million adolescents (10-19 years) in Tanzania, representing 23% of the population

• Girls are more vulnerable:– Girls almost 3x more likely to be HIV+ than boys (THMIS

2011/12). – 40% of girls pregnant or have a child by age 19 (DHS

2010). – 1 in 3 girls and 1 in 7 boys experienced unwanted sexual

experiences during childhood (VACS 2009)– Girls start dropping out of school at higher rates than

boys at age 13 (DHS 2010).

ALHIV in Tanzania

• ~170,000 adolescents living with HIV (97,000 girls; 69,000 boys)

• How many ALHIV are accessing treatment?

• What are their treatment outcomes and retention in care?

Conclusions

• If HIV is to be reversed, we must give priority to reaching adolescents, particularly girls, with knowledge, skills, and services to reduce risk, vulnerability, morbidity and mortality

• HIV prevention among adolescents must take into account difference in age, sex, geographic, and key populations

• We need to determine the knowledge and behaviour data needs for young adolescents (10-14 years) from surveys – current surveys are not designed for them – no specific questions & very low sample sizes for 15-19 year olds

Conclusions

• Disaggregate routine health/HIV service data by age to track coverage and outcomes of treatment, care and support (10-14, 15-19 vs other age groups and for key populations)

• Insist on age-disaggregation of upcoming DHS/TIS

• Improve evidence base on the impact of other development sectors – e.g. social protection (TASAF), education, employment

Children and AIDS: Sixth Stocktaking Report, 2013 focusing on the first and second decades of life: • reviews the HIV burden among children and

adolescents and the progress being made • identifies key strategies to accelerate access

to HIV prevention, treatment, protection, care and support for children and adolescents

• summarizes opportunities arising from recent scientific advances, new technology and emerging practice innovations

• seeks to mobilize national and international efforts to keep children HIV-free and ensure that children living with HIV remain AIDS-free.

For supporting data and materials, please visit: www.childrenandaids.org

Email: childrenandaids@unicef.org

Ending HIV and AIDS in Adolescents, in JAIDS 2014 Supplement

To download the articles, please visit: http://journals.lww.com/jaids/toc/2014/07011