Transcript Document

AIDS 2014 – Ending the
adolescent AIDS epidemic
Ungdom og hiv
29.10.2014
Anne May Andersen, Norad
Unacceptable inequality: AIDS deaths rising among adolescents
250,000
Deaths in children aged
0 – 4 years
200,000
150,000
100,000
Deaths in adolescents
aged 10 - 19
Deaths in young people
aged 20 - 24
50,000
0
2000
Deaths in children aged
5 – 9 years
2001
2002
Children aged 0–4
2003
2004
2005
Children aged 5–9
2006
2007
2008
Adolescents aged 10-19
2009
2010
2011
2012
Young people aged 20–24
Source: UNAIDS 2012 HIV and AIDS estimates
2
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
3
A Tale of Two Epidemics
New HIV Infections in Adolescents in 20 Countries with Highest Number of New HIV
Infections, 2012
% female
% male
100%
90%
18
27
27
28
28
80%
30
30
30
30
31
31
31
31
38
40
Per cent (%)
70%
50
51
62
60%
71
71
29
29
50%
40%
82
73
73
72
72
30%
20%
10%
0%
Source: UNAIDS 2012 HIV and AIDS estimates
70
70
70
70
69
69
69
69
62
60
50
49
38
Results: M:F Annual AIDS Mortality Risk Ratio
Male-to-female AIDS mortality risk ratio among all low- and middleincome countries, 1990-2012, by age group
Ages 0-4
Ages 5-9
Ages 10-14
Ages 15-19
Ages 20-24
Ages 25+
1.8
Male-to-female annual AIDS mortality risk ratio
1.7
1.6
1.5
1.4
1.3
1.2
1.1
1.0
0.9
0.8
1990
1992
1994
1996
1998
Source: UNICEF analysis of UNAIDS, 2012 HIV and AIDS estimates
2000
2002
2004
2006
2008
2010
2012
Results: Annual AIDS Mortality Risk
Annual AIDS mortality risk among people living with HIV in all low- and
middle-income countries, 2012, by age and sex
Males
Females
10%
9.1%
9%
Annual AIDS mortality risk (%)
8%
6.8%
7%
6%
5.3%
5%
4%
3.9%
3%
2.9%
2%
1.5%
1%
0%
Ages 0-4
Ages 5-9
Source: UNICEF analysis of UNAIDS, 2012 HIV and AIDS estimates
Ages 10-14
Ages 15-19
Ages 20-24
What is needed?
1. 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
Investment Framework (IF)
Reduce Risk
Basic Programme
Activities
o
o
o
o
o
o
Reduce the
likelihood of
transmission
Reduce
mortality and
morbidity
PMTCT
Condom promotion and distribution
Key populations
Treatment care and support to PLWH
Male Circumcision
Behavior Change programmes
Critical Enablers
SYNERGIES
WITH
DEVELOPMENT
SECTORS
Social Protection, Education, Legal Reform, Gender Equality, Poverty
Reduction, Gender-Based Violence, Health Systems (inc. STI treatment &
blood safety), Community Systems, Employer Practices
Smarter investments can
decrease new infections
New HIV
Infections
Source: Stover, J. et al., JAIDS. (66) Jul, 1, 2014
Generalized epidemic settings
Effective combination
prevention:
Cash, care and HIV-risk for
adolescents in South Africa
L Cluver, M Orkin, M Boyes, L Sherr
IAS, July 2014
Poverty & family AIDS predict adolescent HIV-risks: how?
2011
Structural deprivation
2012
HIV-risk behavior
incidence
Hunger
Transactional sex
Age-disparate sex
Community violence
Sex using substances
Parental HIV/AIDS
all p<.001
Multiple partners
Unprotected sex
Informal settlement
Pregnancy
controlling for: baseline HIV-risk, age, gender
South Africa: Child grant reduces incidence & prevalence
of transactional sex and age-disparate sex for girls
8
% Incidence of transactional sex
(OR .49 CI .26-.93*)
7
% Incidence of age-disparate sex
(OR .29 CI .13-.67**)
No cash transfer
6
Child cash transfer
5
4
3
2
1
0
12-14 years
15-17 years
12-14 years
Cluver, Boyes, Orkin, Pantelic, Molwena, Sherr (2013). The Lancet Global Health.
15-17 years
$7
$6
Sector Synergies
Billions
Estimated Resource Needs for
Adolescents: Modeling Results
$5
$4
Enablers
$3
Programs
$2
$1
$0
2010
2011
Source: Stover, J. et al., JAIDS. (66) Jul, 1, 2014
2012
2013
2014
2015
2016
2017
2018
2019
2020
40%
25%
33%
Tailored DELIVERY
Informed by DATA
Adolescent Key Populations
EMPOWER & ENGAGE
Adolescents