Adolescents living with HIV

On this International Day Against Homophobia, Biphobia and Transphobia (IDAHOBIT) 2023, we unveil the UNICEF Spotlight Report on the Youth Aware initiative in Brazil. Youth Aware is a partnership with the Brazilian Ministry of Health, to transform the approach to HIV and STI prevention and treatment for LGBTQI+ youth through peer education and community mobilization. Young people in Brazil are disproportionately impacted by the HIV epidemic, and key populations face heightened vulnerability.

Supported by M·A·C VIVA GLAM, this flagship UNICEF programme redefines health services for adolescents, addressing their needs and the shifting landscape of gender and sexuality. The report showcases the stories of courageous individuals countering prejudice and sheds light on their aspirations and challenges. Together, we can challenge stigma, discrimination, and marginalization, advocating for a future where every young person can thrive. Join us as we celebrate IDAHOBIT and champion a healthier, more inclusive future.

HIV Service Delivery: Safeguarding the Future. This brief was developed to inform the global dialogue and accelerate action on giving priority to services and support for adolescent and young mothers living with HIV.

ALL In to #EndAdolescentAIDS

Around the world, an estimated 2.1 million adolescents between the ages of 10 and 19 years were living with HIV in 2016. Some 260,000 older adolescents (aged 15–19 years) were newly infected with HIV in 2016, or nearly  a new infection every two minutes. Nearly three out of four new infections occurred in sub-Saharan Africa. And adolescent girls continue to be disproportionately affected. Globally, nearly two thirds (65 per cent) of new HIV infections among adolescents aged 15–19 years were among girls.

Progress in preventing new infections among adolescents remains unacceptably slow, with new infections declining by only 14 per cent since 2010. Equally concerning, between 2000 and 2015, annual AIDS-related deaths declined for all age groups except adolescents (aged 10–19 years).

Demographic realities further undermine recent hopeful trends. In sub-Saharan Africa, the region most affected by HIV, the youth population has begun to explode in size and will continue to do so, with projections indicating that the number of people younger than 20 will double in 2030. That means redoubled efforts will be necessary to prevent an increase in new HIV infections among adolescents.

Building on research findings and effective interventions in low-and middle-income countries, this policy brief identifies key risks, including bullying and stigma, and facilitators, such as positive parenting and social support, that influence pathways between mental health and HIV outcomes for adolescents. It is part of a broader series that aims to support the translation of research into improved adolescent sexual reproductive health and HIV programming.

Good mental health and psychosocial wellbeing is especially important for adolescents during their transition to adulthood. It can support resilience and help initiate healthy behaviours that shape long-term positive health outcomes. Evidence shows that adolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. Poor mental health outcomes have been linked to low rates of adherence to life-saving antiretroviral treatment (ART) and retention in care.  Understanding risk factors and protective factors that influence mental health and ART adherence amongst adolescents is critical for effective programming. Within eastern and southern Africa, there is great momentum to identify and scale-up interventions that address mental health and improve treatment, care and support for adolescents living with HIV.

Adolescents in Eastern and Southern Africa (ESA) are key to achieving the global goal of ending the AIDS epidemic by 2030. ESA is home to 1.74 million adolescents living with HIV (ALHIV), representing 60 per cent of this population globally. In 12 ESA countries, AIDS is the leading cause of adolescent mortality. While there is an increasing focus on adolescents, the pace of progress remains slow, especially when compared with the growing needs of ALHIV.

It is time to deliver programmes at scale to address the needs of ALHIV, accelerating evidence of interventions producing results or showing significant promise for scale. This document examines and consolidates the current experiences of ALHIV programming in the region to support further implementation and scale-up of evidence-driven models. The findings serve as a call to action and the key considerations as a guide for governments and funding and implementing partners in scaling up service delivery to ALHIV.

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.