Fast-forward to 2030: What does the HIV epidemic look like for adolescents?

The world pledged to end AIDS by 2030. Though great strides have been made toward this goal for young children, adolescent girls and boys are being left behind. We used existing trends to project what the future will look like for adolescents, and we found that the outlook depends mostly on the region of the world where they live.

Greater and sustained improvements in HIV prevention, treatment and care for all adolescents will require careful attention to two key trends, both of which vary significantly by region: The projected growth of adolescent populations and the current effectiveness of HIV responses to them.

Growing adolescent populations

Between 2018 and 2030, adolescent populations are projected to rise by 37% in West and Central Africa, but by just 4% in East Asia and the Pacific. Within that wide range, increases are expected to be about 17% in Eastern Europe and Central Asia, 24% in Middle East and North Africa, and 27% in Eastern and Southern Africa.

One important observation is that the two regions with the greatest adolescent population growth (those in sub-Saharan Africa) are the same two regions that currently account for three-quarters (76%) of new HIV infections among adolescents aged 10–19. However, those two regions’ HIV responses to adolescents are on very different trajectories, a situation that could have equally divergent implications for adolescents’ risks and vulnerability to HIV.

These trends are why we embarked on an ambitious analysis of projecting the HIV epidemic to 2030. While we can’t predict the future, projections can shine a light on promising progress in the fight against AIDS – as well as gaps in the global response.

Regional progress, projections and shifts

Although Eastern and Southern Africa has long been the epicenter of the global HIV epidemic – and it continues to be the region where the largest numbers of people are living with HIV – the HIV response in this part of the world has also been impressive. For example, the number of new HIV infections among adolescents in 2017 was 25% lower than in 2010, and coverage of prevention of mother-to-child transmission (PMTCT) of HIV services reached 93%.

When projecting the HIV epidemic in this region, we found that the increasing adolescent population did not reverse these recent gains. Progress in the last five years has been so great that even with anticipated demographic shifts, new HIV infections are expected to decrease by 44% between 2018 and 2030 (and let’s note that although this achievement is worth celebrating, it is still not fast enough to reach Global Goals).

On the other hand, West and Central Africa, the region with the second-highest burden, has observed more limited progress. New HIV infections among adolescents in 2017 (69,000) were about the same as in 2010 (70,000). UNICEF’s projections of the HIV epidemic in this region found that this minimal progress, combined with a 37% increase in the adolescent population, will likely result in only a 15% decrease in new HIV infections between 2018 and 2030.

While the numbers of infected individuals are comparatively small, new HIV infections among adolescents are expected to decline by only 14% in Latin America and the Caribbean and possibly even increase in Eastern Europe and Central Asa.

Such diverging trends across regions are why our findings serve as a warning.  The evidence shows that promising trends in East and Southern Africa could be offset by increases in HIV risk among adolescents in other regions. West and Central Africa, Latin America and the Caribbean, and East Asia and the Pacific are, unfortunately, poised to become more prominent contributors to the global HIV epidemic among adolescents.

 

What this means for the global HIV response

Although this projected shift signals where more targeted focus is needed, it should not be construed as suggesting that HIV prevention efforts among adolescents should be reduced in Eastern and Southern Africa. That region will still be home to huge numbers of adolescents living with HIV, all of whom will need effective and consistent treatment, care and support to help them stay healthy and minimise their likelihood of transmitting HIV to others (including other adolescents).

Rather, the progress made in Eastern and Southern Africa despite the magnitude of the epidemic, sets an example for other regions in the world to step up the pace in HIV prevention, treatment and care. One initiative that has contributed to this success is All In to End Adolescent AIDS (All In). Other parts of the world can learn from countries that have used All In as a platform to strengthen political will and adolescent participation in HIV programming. Furthermore, the initiative advocates for stronger adolescent-specific data that can be used to both monitor and improve the HIV response.


We must prioritize adolescent-specific HIV interventions
. The report, Children, HIV and AIDS: The World in 2030 highlights some innovative solutions for the HIV epidemic. Adolescents at risk of HIV infection around the world can benefit from adolescent-friendly health services, digital platforms, targeted use of pre-exposure prophylaxis (PreP) and other biomedical innovations. Learn more at unicef.org/hiv

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Acknowledgements:

We could not have conducted this analysis without the technical input and expertise of Avenir Health and the Strategic Information and Evaluation Department at the Joint United Nations Programme for HIV/AIDS (UNAIDS).

 

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