AIDS 2014 – Ending the adolescent AIDS epidemic

Ungdom og hiv

29.10.2014Anne May Andersen, Norad

2

Unacceptable inequality: AIDS deaths rising among adolescents

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

50,000

100,000

150,000

200,000

250,000

Children aged 0–4 Children aged 5–9 Adolescents aged 10-19 Young people aged 20–24

Deaths in adolescents aged 10 - 19

Deaths in children aged 0 – 4 years

Deaths in children aged 5 – 9 years

Deaths in young people aged 20 - 24

Source: UNAIDS 2012 HIV and AIDS estimates

3

HIV and AIDS Among Adolescents

1. One in five people are aged between 10 and 19

2. 2.1 million adolescents live with HIV - 1.7 million (82%) in Sub-Saharan Africa

3. In all other regions: HIV concentrated in key populations

4. HIV is now the second leading cause of death among adolescents, 300 deaths every day

South Africa

Mozambique

Kenya DRC

Tanzania

Cameroon

Cote dIvoire

Swaziland

Uganda

Malawi

Nigeria

Zimbabwe

Leso

tho

Zambia

Indonesia

Russian Federation

IndiaChina

Brazil USA0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

8273 73 72 72 70 70 70 70 69 69 69 69

62 6050 49

3829 29

1827 27 28 28 30 30 30 30 31 31 31 31

38 4050 51

6271 71

% female % male

Per c

ent (

%)

Source: UNAIDS 2012 HIV and AIDS estimates

A Tale of Two Epidemics

New HIV Infections in Adolescents in 20 Countries with Highest Number of New HIV Infections, 2012

Results: M:F Annual AIDS Mortality Risk Ratio

Source: UNICEF analysis of UNAIDS, 2012 HIV and AIDS estimates

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120.8

0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

Male-to-female AIDS mortality risk ratio among all low- and middle-income countries, 1990-

2012, by age groupAges 0-4 Ages 5-9 Ages 10-14 Ages 15-19 Ages 20-24 Ages 25+

Mal

e-to

-fem

ale

annu

al A

IDS

mor

talit

y ri

sk r

atio

Results: Annual AIDS Mortality Risk

Source: UNICEF analysis of UNAIDS, 2012 HIV and AIDS estimates

Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19 Ages 20-240%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

9.1%

3.9%

6.8%

5.3%

1.5%

2.9%

Annual AIDS mortality risk among people living with HIV in all low- and middle-income coun-

tries, 2012, by age and sexMales Females

Ann

ual A

IDS

mor

talit

y ri

sk (%

)

41. Invest more and invest smarter in

adolescents

2. Deliver what works and strengthen Data on adolescents

3. Empower and Engage adolescents

4. Accelerate our response

What is needed?

Investment Framework (IF)

Reduce RiskReduce the

likelihood of transmission

Reduce mortality and

morbidity

Critical Enablers

Basic Programme Activities

o PMTCTo Condom promotion and distributiono Key populations o Treatment care and support to PLWH o Male Circumcisiono Behavior Change programmes

Social Protection, Education, Legal Reform, Gender Equality, Poverty Reduction, Gender-Based Violence, Health Systems (inc. STI treatment & blood safety), Community Systems, Employer Practices

SYNERGIES WITH

DEVELOPMENT SECTORS

Smarter investments can decrease new infections

Generalized epidemic settings

Source: Stover, J. et al., JAIDS. (66) Jul, 1, 2014

New HIV Infections

Effective combination prevention:

Cash, care and HIV-risk for adolescents in South Africa

L Cluver, M Orkin, M Boyes, L SherrIAS, July 2014

Hunger

Community violence

Parental HIV/AIDS

Informal settlement

2011Structural deprivation

2012HIV-risk behavior

incidence

Poverty & family AIDS predict adolescent HIV-risks: how?

Transactional sex

Age-disparate sex

Sex using substances

Multiple partners

Unprotected sex

Pregnancy

controlling for: baseline HIV-risk, age, gender

all p<.001

12-14 years 15-17 years0

1

2

3

4

5

6

7

8 % Incidence of

transactional sex (OR .49 CI .26-.93*)

South Africa: Child grant reduces incidence & prevalence of transactional sex and age-disparate sex for girls

No cash transfer

Child cash transfer

Cluver, Boyes, Orkin, Pantelic, Molwena, Sherr (2013). The Lancet Global Health.

12-14 years 15-17 years

% Incidence of age-dis-parate sex

(OR .29 CI .13-.67**)

Estimated Resource Needs for Adolescents: Modeling Results

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020$0

$1,000,000,000

$2,000,000,000

$3,000,000,000

$4,000,000,000

$5,000,000,000

$6,000,000,000

$7,000,000,000

Prog

ram

sEn

able

rsSe

ctor

Syn

ergi

es

33%

25%

40%

Source: Stover, J. et al., JAIDS. (66) Jul, 1, 2014

Tailored DELIVERY Informed by DATA

Adolescent Key Populations

EMPOWER & ENGAGE Adolescents