Adolescents and HIV Alison Jenkins, UNICEF Tanzania Cover photo: © Khanga Rue Media/2014/Olvera

THE GLOBAL SITUATION ADAPTED FROM PRESENTATIONS BY PRISCILLA IDELE, UNICEF HQ

Half of adolescents living with HIV are in six countries

Adolescent AIDS -related deaths: increasing

Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting. ART GAP BETWEEN ADULTS AND CHILDREN BY COUNTRY Percentage of ART coverage among eligible adults (aged 15+), children (aged 0-14) and all ages in the 21 African Global Plan priority countries, 2012

Older adolescents have lowest retention rates in pre-ART care one year after enrollment year olds have the worst pre-ART retention Those retained in programs had inadequate adherence Source: 50,203 young people - 16% of all ICAP patients in 4 countries & 123 ART clinics, 2012 % lost to follow up in pre-ART care one year after enrollment (green bars) % lost to follow up one year after ART initiation (orange bars)

THE SITUATION IN TANZANIA

Adolescents in Tanzania 10.4 million adolescents (10-19 years) in Tanzania, representing 23% of the population Girls are more vulnerable: –Girls almost 3x more likely to be HIV positive than boys (THMIS 2011/12). –40% of girls pregnant or have a child by age 19 (DHS 2010). –1 in 3 girls and 1 in 7 boys experienced unwanted sexual experiences during childhood (VACS 2009) –Girls start dropping out of school at higher rates than boys at age 13 (DHS 2010).

Higher Prevalence in Women: Transition to Adulthood Age Percent HIV positive

Comprehensive HIV knowledge is low, especially girls in rural areas, with much regional variation Source: THMIS 2011/12 % of females and males with comprehensive HIV knowledge, by age

Testing in last 12 months, higher in girls, with regional variables % of females and males who tested for HIV in the past 12 months and received results, by age

Early sexual debut is common among adolescent girls and varies by region Source: THMIS 2011/12 % of females aged years who had sex before age 15 and age 18

Condom use at last high risk sex remains low Source: THMIS 2011/12 % of females and males reporting multiple partners in the last 12 months who used a condom at last sex, by age

Adolescents in Tanzania 10.4 million adolescents (10-19 years) in Tanzania, representing 23% of the population Girls are more vulnerable: –Girls almost 3x more likely to be HIV+ than boys (THMIS 2011/12). –40% of girls pregnant or have a child by age 19 (DHS 2010). –1 in 3 girls and 1 in 7 boys experienced unwanted sexual experiences during childhood (VACS 2009) –Girls start dropping out of school at higher rates than boys at age 13 (DHS 2010).

ALHIV in Tanzania ~170,000 adolescents living with HIV (97,000 girls; 69,000 boys) How many ALHIV are accessing treatment? What are their treatment outcomes and retention in care?

Conclusions If HIV is to be reversed, we must give priority to reaching adolescents, particularly girls, with knowledge, skills, and services to reduce risk, vulnerability, morbidity and mortality HIV prevention among adolescents must take into account difference in age, sex, geographic, and key populations We need to determine the knowledge and behaviour data needs for young adolescents (10-14 years) from surveys – current surveys are not designed for them – no specific questions & very low sample sizes for year olds

Conclusions Disaggregate routine health/HIV service data by age to track coverage and outcomes of treatment, care and support (10-14, vs other age groups and for key populations) Insist on age-disaggregation of upcoming DHS/TIS Improve evidence base on the impact of other development sectors – e.g. social protection (TASAF), education, employment

Children and AIDS: Sixth Stocktaking Report, 2013 focusing on the first and second decades of life: reviews the HIV burden among children and adolescents and the progress being made identifies key strategies to accelerate access to HIV prevention, treatment, protection, care and support for children and adolescents summarizes opportunities arising from recent scientific advances, new technology and emerging practice innovations seeks to mobilize national and international efforts to keep children HIV-free and ensure that children living with HIV remain AIDS- free. For supporting data and materials, please visit: Ending HIV and AIDS in Adolescents, in JAIDS 2014 Supplement To download the articles, please visit: