Abstract
Recent scientific advances centred on the use of anti-retrovirals (ARVs) – both prophylactically to prevent HIV acquisition (pre-exposure prophylaxis, or PrEP) and for treatment to minimize onward transmission (treatment as prevention, or TasP) – have led to a new-found optimism for control of the HIV/AIDS epidemic and the possibility of creating an “AIDS-free generation”. In order to translate this optimism into reality, large and sustained reductions in incident HIV infections are required. Several models have projected that with substantial programmatic scale-up of the new prevention agenda, such requirements can be satisfied. However, these models typically assume a uniform efficiency for interventions in reducing incident infections across populations, and neglect to consider their current unavailability to a key population driving the epidemic at its epicentre: adolescent girls. (Published: 8 March 2014) Citation: Abdool Karim Q and Dellar R. Journal of the International AIDS Society 2014, 17 :19075 http://www.jiasociety.org/index.php/jias/article/view/19075 | http://dx.doi.org/10.7448/IAS.17.1.19075
Highlights
In sub-Saharan Africa, which continues to bear a disproportionate burden of new HIV infections, almost a third of new infections occur in young women aged between 15 and 24 years [3]
A defining characteristic of the epidemic is the age-sex distribution in HIV acquisition, wherein women acquire HIV infection about five to seven years earlier than their male peers, often synonymously with sexual debut [4]
In South Africa, more than 20% of young pregnant women aged 15Á24 years attending antenatal clinics are HIV positive, and more than three-quarters of HIV-positive young people aged 15Á24 years are women [5]. The reasons for such high rates of new infections are complex and are compounded by a number of structural, social and biological factors; what is clear is that an AIDS-free generation cannot be realized unless new infections in adolescent girls are eliminated
Summary
In sub-Saharan Africa, which continues to bear a disproportionate burden of new HIV infections, almost a third of new infections occur in young women aged between 15 and 24 years [3]. In southern Africa, this age-sex difference in HIV acquisition rates has contributed to unprecedentedly high incidence rates in adolescent girls, and continues to sustain the epidemic.
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