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AIDS is the leading cause of death among adolescents (aged 10–19) in sub-Saharan Africa and the second most common cause of death among adolescents globally.
The UNAIDS 2016 Fast track report shows that 15-24 years of age is highly dangerous time for adolescent and young girls as they remain at high risk for HIV infection, have low rates of HIV testing and poor adherence to treatment.
Adolescence is a critical period for building personal autonomy and responsibility for individual health and establishing life-long health behaviours. Peer pressure, gender norms, sexuality and the resulting inclusion in, or exclusion from, society dramatically shape vulnerability to HIV.
Attitudes and norms particularly marginalise young LGBT people, young people who sell sex and young people who use drugs. Many of these adolescents face a higher risk of HIV infection, which is further compounded by human rights violations, criminalisation, stigma and discrimination.
A global increase in HIV testing and treatment means that, more than ever, adolescents and young people born with and living with HIV know their status and are living longer on antiretroviral treatment.
This huge step forward brings its own challenges as it means many are now going through adolescence, while also learning to live with HIV, often facing complex challenges including disclosure to partners, managing mental health issues and stigma, understanding safer sex and options for safer contraception while on ART. HIV and SRH services are failing these young people, and much more is needed to meet their diverse, complex needs.
Existing sexual and reproductive health (SRH) services rarely meet young people’s needs in an effective way. Often, they fail to take into account factors that compound their vulnerability to HIV and other sexually transmitted infections (STI) such as imbalanced power dynamics, gender inequality, an increased propensity to risk, attitudes and norms relating to adolescents and sex, and a lack of confidentiality.
Our approach puts adolescents at its centre. We are committed to meaningfully involving adolescents in leading, designing, implementing and evaluating our work at every step.
For instance, during the start-up phase of the Alliance-led Link Up programme we met with a diverse range of young people and adolescents most affected by HIV to establish what mattered most to them in relation to their sexual and reproductive health and rights (SRHR). This enabled us to deliver age-appropriate services for adolescents including HIV prevention and SRHR information, male and female condoms, lubricants, HIV testing and treatment, family planning, STI diagnosis and treatment, cervical cancer screening, post-violence care and harm reduction.
Through Link Up we also supported young people to make a difference in their own communities by designing and implementing peer-to-peer mentorship and peer educator programmes. Through this, many incredible role models emerged. Some went on to become inspiring advocates, representing their views and those of their peers with decision-and policy-makers.
By supporting the evolving capacity of young people and adolescents in all their diversity to develop resilience and leadership skills, and supporting their ability to create change and hold others to account, we are able to ensure their realities shape local, national and global responses to both HIV and SRHR.
Yet we also recognise that adolescents are part of broader communities that influence their lives and decisions. This means we work with key gatekeepers, such as parents and schools, to promote human rights and gender equality, and challenge harmful social norms that act as barriers to young people’s agency, decision-making and wellbeing.
By taking this approach we are able to increase adolescents’ access to integrated HIV and SRHR services, delivered by people they can trust – their peers or trained, relatable adults – to understand their needs.
- The Alliance is collaborating with other organisations to expand our work with adolescents and young people and has started implementing a portfolio of projects called READY. READY stands for Resilient & Empowered Adolescents & Young People. Below is a description of two of the READY projects that are underway.
- READY+ is a four-year programme in southern Africa that will reach 30,000 adolescents and young people living with HIV in Mozambique, Swaziland, Tanzania, and Zimbabwe. It will provide HIV and SRHR education, peer support and high quality integrated HIV/SRHR and mental health services. It will also support young people to participate in local, national, and global SRH/HIV advocacy activities to address structural barriers to accessing SRH services and realising their sexual and reproductive rights.
- READY Teens focuses on 10-19 year olds living with and most affected by HIV in Burundi, Ethiopia and Uganda. The project particularly recognises the vulnerabilities and marginalisation experienced by adolescents from key populations, including adolescents living with HIV, selling sex, using drugs and from sexual minorities.
- Link Up was a ground-breaking SRHR and HIV integration project implemented by a consortium led by the Alliance in 2013-2016. Approximately 940,000 adolescents and young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda were reached with a package of integrated HIV and SRHR services.
- In 2016, Alliance Linking Organisations and partners reached 776,500 adolescents and young people with HIV prevention services and 193,300 adolescents and young people living with HIV with comprehensive services.
- In addition, in 26 countries the Alliance has supported organisations and representatives of adolescents, women and girls and key populations to advocate for their SRHR.
Information, strategies and resources to help programmers implement HIV programming for adolescents.
These key resources have been developed to help those looking to enable young people most affected by HIV to understand and claim their SRHR and access youth-friendly, integrated services.
Lessons from Link Up about the unique challenges and opportunities in engaging 10-19 year-olds in integrated HIV and SRHR services.
A guide to facilitating a workshop for those working with vulnerable children and young people.