A lack of comprehensive research into why young people engage in risky behaviour that can lead to HIV infection and then drop out of treatment is impeding progress in reducing prevalence in this group, said experts at a session at AIDS 2016, in Durban last month.
Not only are young people contracting the virus in greater numbers compared to other age groups, according to the World Health Organisation’s (WHO) adolescent health and HIV consultant, Alice Armstrong, emerging data also shows that they have higher loss to follow up rates, meaning there are more young people starting treatment than can be traced later on.
“In a study [we conducted] in seven African countries, adolescents and young people up to 24 years had higher loss to follow up compared to adults in all countries, reaching statistical significance in three countries”, she said. “This is also seen in Prevention from Mother To Child Transmission (PMTCT) services where adolescent girls are significantly less likely to engage in services leading to worse outcomes for them and their babies.”
“This highlights the potential challenge we face in scaling up treatment for all adolescents,” said Armstrong.
UNAIDS estimates published on 19th July, show that children and adolescents have been priotised in starting treatment but she warned that this “does not provide the whole picture”.
Armstrong attributed the lack of data to the way age groups have been categorised. “Historically, we’ve been grouping people say from 10-20 years but there is so much difference in between,” she said. “Also a lot of researchers don’t include adolescents in clinical trials due to the ethical considerations associated with the group.”
Dr Rashida Ferrand, clinical epidemiologist and a specialist physician in HIV medicine and sexual health at the London School of Hygiene and Tropical Medicine, noted there is need for data which can be obtained by interviewing the young people themselves.
“A vast majority of a person’s life is not spent in a clinic but at home, school and the community. Since HIV is associated with attitudes, what happens in these communities could have an impact on the adherence to the treatment.”
Poverty is a leading factor
Ludo Bok, team leader development effectiveness at the United Nations Development Programme (UNDP), said poverty is one of the leading factors in the increase in new infections among adolescents.
Bok cited a 2013 study which took place in Malawi in which girls in school were being given stipends and the results showed a drop of HIV infection among the girls by 65 per cent and a dramatic increase school attendance.
The study suggested that cash payments to vulnerable individuals has proved to reduce poverty, improve health and achieve other development-related outcomes.
The report concluded that recent evidence from Malawi and Tanzania suggests that cash transfers can impact on HIV-related behaviours and outcomes and, therefore, could serve as an important addition to HIV prevention efforts.
Depression link to risky behaviour
“We need to address the social factors, gender inequalities and punitive laws by taking a multi-sectorial approach,” said Bok.
“Why is it that young people are falling down? Of course poverty has a big impact but that’s just one of the things. A lot of young people have no jobs, are depressed and they think they have no future. Most of them end up engaging in risky behaviours.”