Adolescents living with HIV

This publication primarily seeks to define and clarify the key elements of adolescent-friendly health services to help ensure that adolescents living with HIV receive appropriate and effective treatment, summarize existing guidance on adolescent-friendly health services and differentiated service delivery for adolescents living with HIV while showcasing best-practice case studies based on country experience in implementing these services.

This document is the result of collaborative work between the Department of HIV and Global Hepatitis Programme, WHO and the HIV/AIDS section, UNICEF.

WHO recommends peer support, including peer counseling, for adolescents and young people living with HIV age 10-24 years (AYPLHIV). Peer support enables providers, programs and services to be more responsive, acceptable, sustainable and relevant, encouraging AYPLHIV to seek and remain engaged in care.

Peer support activities range from support groups to peer-to-peer counseling and treatment buddy programs. Generally, AYPLHIV are formally or informally engaged as peer supporters at health facilities or in communities to provide care for and promote the health and well-being of their peers. A peer supporter can be a peer, or a near-peer (someone a few years older who understands the needs of AYPLHIV). In all cases, the aim is to ensure a source of empathic support and share positive coping strategies.

Studies show that peer support can improve AYPLHIV linkage, adherence, viral suppression, retention and psychosocial well-being. Peer support models can also provide young peer supporters with opportunities for leadership development, capacity-building and youth-led advocacy, helping to combat the negative effects of self-stigma and peer pressure.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.

Tuberculosis (TB) is a major contributor to morbidity and mortality in children living with HIV (CLHIV), particularly in TB endemic settings. TB in CLHIV is a
preventable and treatable disease. WHO recommends a cascade of TB services for all CLHIV that begins with routine screening for TB symptoms and/or recent contact with an infectious TB case. It would end with either; 1) diagnosis of active TB disease and prompt initiation of TB treatment, or 2) exclusion of active TB disease and prompt initiation of TB preventive therapy (TPT). Prompt, appropriate treatment for active TB disease is effective in CLHIV.

Similarly, TPT (such as isoniazid preventive therapy) is effective in preventing TB disease and reducing mortality in CLHIV. Effectiveness of both TPT and TB treatment is maximized when CLHIV receive early antiretroviral therapy (ART) to manage HIV infection. However, implementation of these evidence-based interventions to treat and prevent TB in CLHIV remains poor.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.

Urgent and ambitious 2020 global targets are on the horizon, yet there has been insufficient progress in paediatric and adolescent HIV to date. Scaling up HIV services for all children and adolescents is needed, in alignment with the UNAIDS super-fast-track framework. It’s time to make sure that nobody is left behind.

This series of 12 policy briefs by the Child Survival Working Group (CSWG) looks at scaling up key interventions for children and adolescents living with HIV. They present evidence, policy and monitoring considerations, implementation guidance and tools necessary to scale up 12 key interventions which have proven successful in identifying, linking and supporting children and adolescents to access and remain in quality care and treatment.

They are designed for program managers in government and civil society programs, particularly at country-level, and provide practical information and direction.

Learn more in the Foreword and download the briefs below. 

• Addressing the service delivery needs of children of key populations

• Strategies to improve retention of mother-baby pairs in PMTCT programs

• A child-centred approach for HIV programs

• Providing differentiated service delivery to children and adolescents

• Point-of-care testing as a solution for timely early infant diagnosis

• Complementary and connected: Engaging community and faith-based organizations to deliver PMTCT and pediatric HIV services

• Sensitizing health workers to providing responsive care for adolescents and young people living with HIV

• Family-based index case testing to identify children with HIV

• Meaningful engagement of adolescents and young people in national and local HIV programming

• Scaling up optimal antiretroviral treatment for children: A long overdue intervention

• Preventing and treating tuberculosis among children living with HIV

• Providing peer support for adolescents and young people living with HIV

The 95-95-95 targets will only be achieved with zero discrimination, including within healthcare settings. Health worker attitudes, including those of professional and lay providers, are essential in establishing the culture of a health service. Protecting confidentiality and treating adolescents and young people living with HIV (AYPLHIV) with respect are key elements of adolescent and youth-friendly health services (AYFHS). However, AYPLHIV report stigmatizing and unsupportive health worker practices, including imposed moral values, discrimination, shame and scolding and violations of confidentiality. To ensure health workers are equipped to deliver appropriate services, training and sensitization are required. While the importance of sensitization is increasingly acknowledged, a gap remains in documented interventions and models.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more. 

The starting point for this guideline is the point at which a woman has learnt that she is living with HIV, and it therefore covers key issues for providing comprehensive sexual and reproductive health and rights-related services and support for women living with HIV. As women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities, as well as from the health-care institutions where they seek care, particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes.

This guideline is meant to help countries to more effectively and efficiently plan, develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV, taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address to achieve gender equality and support human rights.

Caring for people living with HIV during the ebola outbreak in Sierra Leone. The outbreak of Ebola Virus Disease (EVD) that hit Sierra Leone in May 2014 ravaged communities, severely disrupting general health services and reducing access to those services. The epidemic rapidly spread to all districts in the country, with varying levels of intensity.