Abstract

IntroductionAdvances in biomedical technologies provide potential for adolescent HIV prevention and HIV-positive survival. The UNAIDS 90–90–90 treatment targets provide a new roadmap for ending the HIV epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to antiretroviral therapy (ART) remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents’ capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations.DiscussionNew evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support (“cash, care and classroom”). These interventions have the potential to reduce the social and economic drivers of HIV risk, improve utilization of prevention technologies and improve adherence to ART for adolescent populations in the hyper-endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach and that it holds powerful potential for improved HIV, health and development outcomes.ConclusionsSocial protection is a largely untapped means of reducing HIV-risk behaviours and increasing uptake of and adherence to biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda: to actively combine programmes that increase availability of biomedical solutions with social protection policies that can boost their utilization.

Highlights

  • Advances in biomedical technologies provide potential for adolescent HIV prevention and HIV-positive survival

  • The UNAIDS 90Á90Á90 commitment highlights the importance of achieving better coverage of HIV testing, antiretroviral therapy (ART) initiation and retention in effective care

  • Similar efforts and commitments related to increasing access to and uptake of prevention services among adolescents are needed if the goals of HIV prevention and treatment programs are to be achieved [3]

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Summary

Introduction

Adolescent HIV support has misfired throughout the epidemic, caught in a wrinkle of under-provision and misunderstanding, with avoidable HIV infection and death as the result. Antiretroviral therapy (ART) and condoms provide the means for adolescents to live with HIV and to prevent transmission Even where these technologies are available, high rates of HIV infection, morbidity and mortality persist, in Southern and Eastern Africa. Associations between HIV infection, poverty and inequality are complex [10Á12], but a growing body of research has established that social and structural deprivation, often with gendered aspects, are key drivers of adolescent HIV infection and mortality [13] These deprivations include poverty and exclusion [14], income shocks [15,16], mental health distress, stigma [17], harsh parenting and abuse [18,19].

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