While new HIV infections have
declined among children, adolescents and adults since 2000, HIV-related deaths have
risen sharply among adolescents, especially 15- to 19-year-old males, Tyler Porth
of UNICEF told delegates at the 20th International AIDS
Conference (AIDS 2014) in Melbourne on Monday.
Analysis of UNAIDS 2012 HIV
and AIDS Spectrum estimates showed a 32% decrease in AIDS-related deaths
between 2005 and 2012 among non-adolescents (aged 0-9 and aged 20 and above) compared
to a 50% increase among adolescents (aged 10-19).
In spite of the significant
reductions in new infections among children and adolescents, large and
increasing numbers of children who acquired HIV perinatally are surviving into
adolescence, often with lower CD4 cell counts and poorer survival.
Among 15- to 19-year-old
adolescents, boys were almost twice as likely to die of AIDS complications
compared to their female counterparts in sub-Saharan Africa. In South Africa,
adolescent boys in this age group were around three times more likely to die of
AIDS than girls of the same age in 2012.
The disparity is due to a
greater proportion of adolescent boys living with HIV acquired perinatally,
Tyler Porth told delegates. These disparities are often exacerbated in some
settings because of adolescents’ poorer access to health services including
testing and treatment, he added.
These findings highlight the considerable
difficulties of transitioning from paediatric to adult care facilities with
important implications for HIV and AIDS programmes and the urgent need to
prioritise adolescents. A tailored and adolescent-sensitive approach is
critical if the unique needs of adolescents are to be adequately addressed.
In 2012, approximately 2.1
million adolescents were living with HIV, of whom over 80% were in sub-Saharan
Africa. One third (an estimated 780,000) of new infections in 2012 were among
young people aged 15 to 24. Close to half of these (approximately 300,000) were
among 15 to 19 year olds.
Scale-up of services aiming to prevention perinatal transmission (transmission which occurs during pregnancy, birth or breastfeeding)
over the past decade has resulted in new vertical infections (from mother to baby) declining by over
half between 2001 and 2013. During this time, efforts have also been made to
improve access to antiretroviral therapy (ART) for children. However, as of 2013, only 24% of children
living with HIV were on ART. Declines in AIDS-related death among children
mean more children are surviving into adolescence.
The difficulties of reaching
and retaining adolescents in care are recognised. A dearth of
adolescent-friendly services and absence of incentives to attract adolescents
to care contribute to the problem. Compounding the problem further is the fact that, frequently, adolescents
are overlooked in national and global AIDS strategies.
By analysing estimated annual
AIDS mortality risk among adolescents living with HIV, Tyler Porth and
colleagues sought to highlight adverse trends and quantify differences between
males and females.
Analysis of UNAIDS 2012 HIV
and AIDS Spectrum estimates determined trends, quantified annual AIDS mortality
risk (AMR) among people living with HIV and male-to-female annual AIDS
mortality risk ratio (AMRR). The latter shows sex disparities in AIDS mortality
rates. Estimates of UNAIDS data from 1990 to 2012 were analysed and supplemented
with country reported programme data and published literature.
Tyler Porth noted the paucity
of treatment data available for adolescents.
Among most age groups the AMR
began decreasing globally around 2005 when ART was scaled up, but not among
Having a better understanding
of the factors affecting these trends and how the adolescent epidemic was
maturing so differently from that seen in younger children and adults would
provide information to more precisely target HIV and AIDS programming for
The impact of progress in preventing mother-to-child transmission (PMTCT)
on the number of adolescents acquiring HIV perinatally can take one to two decades.
Many of those who acquired HIV perinatally during the period 2000 to 2005, when over half a million
children were infected annually, are only now entering adolescence.
Increased ART access for
children means more children are surviving into adolescence. Even without ART,
an estimated third of infants are slow progressors. In sub-Saharan Africa, an
estimated 20 to 30% of these children have a ten-year survival rate.
The annual AMR, while similar
among males and females of all ages, differed significantly between adolescent
boys and girls aged 15 to 19. In this age range, AMR decreased significantly
among girls while remaining constant among boys; a disparity that has been
increasing since 1996. Each year since 2006 adolescent boys living with HIV,
aged between 15 and 19, have been 80% more likely to die compared to girls living
with HIV of the same age.
The increase in AMR among
boys aged 15 to 19, relative to girls of the same age, may be because 65% of
global adolescent HIV infections are in girls. A greater proportion of
adolescent girls living with HIV have acquired HIV more recently, so have a
lower risk of mortality, he noted.
Tyler Porth concluded that
the adolescent HIV epidemic is unique and presents a unique set of
epidemiological, social and programmatic challenges.
Prioritising and meeting the
needs of adolescents living with HIV in HIV and AIDS programming is critical to
facilitate a healthy transition into adulthood in which they will survive and