Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15–24 Years — Seven African Countries, 2015–2017

Brown, Kristin; Williams, Daniel B.; Kinchen, Steve; Saito, Suzue; Radin, Elizabeth; Patel, Hetal; Low, Andrea; Delgado, Stephen; Mugurungi, Owen; Musuka, Godfrey; Barr, Beth A. Tippett; Nwankwo-Igomu, E Amaka; Ruangtragool, Leala; Hakim, Avi; Kalua, Thokozani; Nyirenda, Rose; Chipungu, Gertrude; Auld, Andrew F.; Kim, Andrea A.; Payne, Danielle; Wadonda-Kabondo, Nellie; West, Christine; Brennan, Elizabeth; Deutsch, Beth; Worku, Anteneh; Jonnalagadda, Sasi; Mulenga, Lloyd; Dzekedzeke, Kumbutso; Barradas, Danielle T.; Cai, Haotian; Gupta, Sundeep; Kamocha, Stanley; Riggs, Margaret A.; Sachathep, Karampreet; Kirungi, Wilford; Musinguzi, Joshua; Opio, Alex; Biraro, Sam; Bancroft, Elizabeth; Galbraith, Jennifer; Kiyingi, Herbert; Farahani, Mansoor; Hladik, Wolfgang; Nyangoma, Edith; Ginindza, Choice; Masangane, Zandile T; Mhlanga, Fortune; Mnisi, Zandile; Pasipamire, Munyaradzi; Zwane, Amos; Burke, Sean; Kayigamba, Felix B; Nuwagaba‐Biribonwoha, Harriet; Sahabo, Ruben; Ao, Trong; Draghi, Chiara; Ryan, Caroline; Philip, Neena M.; Mosha, Fausta; Mulokozi, Aroldia; Ntigiti, Phausta; Ramadhani, Angela; Somi, Geoffrey; Makafu, Cecilia; Mugisha, Veronicah; Zelothe, Julius; Lavilla, Kayla; Lowrance, David; Mdodo, Rennatus; Gummerson, Elizabeth; Stupp, Paul; Thin, Kyaw; Frederix, Koen; Davia, Stefania; Schwitters, Amee; McCracken, Stephen; Duong, Yen T; Hui‐Kang, David; Parekh, Bharat; Justman, Jessica; Voetsch, Andrew C.

doi:10.15585/mmwr.mm6701a6

Cited by 60 publications

(55 citation statements)

References 3 publications

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“…28 Increased research on men and masculinities, 29 coupled with a long-standing LGBT rights movement 30 and new movements of men for gender equality 31-33 has drawn attention to the ways in which dominant constructions of masculinity and femininity can be damaging to the health of boys/men and gender minorities, just as they are to girls/women. The inability of the health sector to make significant progress on some key health challengessuch as persistently high maternal mortality in the poorest communities, 34 the alarming incidence of HIV among adolescent girls in southern Africa, 35 higher rates of vehicular accidents among young men than women, and the disproportionately high suicide rates among LGBT persons 37 brings into sharp focus the significant role that gender norms have on health behaviours, exposure, and vulnerability. Meeting Goal 3 of the Sustainable Development Goals (SDGs) 38 (ensure health and well-being for all) mandates that the health sector address gender inequalities and restrictive gender norms, 39,40 which also has the potential to leverage progress on multiple SDGs, 41 including SDG 5 (achieve gender equality and empower all women and girls) and vice versa.…”

Section: Introductionmentioning

confidence: 99%

Gender equality and gender norms: framing the opportunities for health

et al. 2019

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The Sustainable Development Goals offer the global health community a strategic opportunity to promote human rights, advance gender equality, and achieve health for all. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the significant impact of gender inequalities and restrictive gender norms on health risks and behaviours. In this paper we draw on evidence from the Series on Gender Equality, Norms and Health to dispel three myths on gender and health and describe persistent barriers to progress. We propose an agenda for action to reduce gender inequality and shift gender norms for improved health outcomes, calling on leaders in national governments, global health institutions, civil society organisations, academia, and the corporate sector to 1) focus on health outcomes and engage actors across sectors to achieve them; 2) reform the workplace and workforce to be more gender equitable; 3) fill gaps in data and eliminate gender bias in research; 4) fund civil society actors and social movements; and 5) strengthen accountability mechanisms. Paper 5 Lancet Series on Gender Equality, Norms and Health Key Messages of the Series • Gender norms and inequalities affect health outcomes for girls and women, boys and men, and gender minorities.

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Section: Introductionmentioning

confidence: 99%

Gender equality and gender norms: framing the opportunities for health

et al. 2019

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“…A tenacious driver of the higher rates of morbidity and mortality amongst adolescents living with HIV (ALHIV) is suboptimal adherence to HIV treatment [1][2][3][4] Although the global target is to get 95% of those on treatment to be virally suppressed, combined data from East and Southern African countries show that only 45% of adolescent girls living with HIV are virologically suppressed (vs. the goal of 86% under UNAIDS 95-95-95 targets for 2030) [5]. This makes them more vulnerable to treatment failure.…”

Section: Introductionmentioning

confidence: 99%

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Bernays

Tshuma

Willis³

et al. 2020

J Intern AIDS Soc

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Introduction Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. The provision of peer support has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges which underpin suboptimal adherence. Little is known about the impact on young peer supporters themselves, which is the focus of this paper. Methods We present qualitative findings from the Zvandiri trial investigating the impact of a peer support intervention on the viral load for beneficiaries (ALHIV, aged 13 to 19 years) in Zimbabwe. The Zvandiri peer supporters aged 18 to 24 years, known as community adolescent treatment supporters (CATS), are themselves living with HIV. Individual in‐depth interviews were conducted in late 2018 with 17 CATS exploring their experiences of delivering peer support and their own support needs. Interviews were analysed iteratively using thematic analysis. Results The CATS reported that being peer supporters improved their own adherence behaviour and contributed to an improved sense of self‐worth. The social connections between the CATS were a source of comfort and enabled them to develop skills to manage the challenging aspects of their work. Two substantial challenges were identified. First, their work may reveal their HIV status. Second, managing the emotional labour of this caring work; given how commonly the complexity of the beneficiaries’ needs mirrored the circumstances of their own difficult lives. Both challenges were ameliorated by the support the CATS provided to each other and ongoing supervision from the adult mentor. There was variation in whether they felt their roles were appropriately valued through the remuneration they received and within the health system. There was a consensus that their experience meant that they would graduate from being a CATS with transferable skills that could enhance their employability. Conclusions Their experiences illustrate the advantages and opportunities of being a CATS. To minimize potential harms, it is vital to ensure that they feel valued in their role, which can be demonstrated by the provision of appropriate remuneration, recognition and respect, and that there is continued investment in ongoing support through ongoing training and mentoring.

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“…However, only a minority of adolescents have ever been tested [3]. In the United Republic of Tanzania, for example, less than half of female youth with HIV infection are aware of their status [4]. Low rates of testing result in late diagnosis, delayed care, and high mortality among youth [3,5]; it also results in increased mother-to-child transmission [6].…”

Section: Introductionmentioning

confidence: 99%

Uptake of HIV testing among adolescents and associated adolescent-friendly services

Kidman

Waidler²,

Palermo

2020

BMC Health Serv Res

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Background HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. Methods The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. Results Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. Conclusions We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.

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Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15–24 Years — Seven African Countries, 2015–2017

Cited by 60 publications

References 3 publications

Gender equality and gender norms: framing the opportunities for health

Gender equality and gender norms: framing the opportunities for health

Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Uptake of HIV testing among adolescents and associated adolescent-friendly services

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