The science of eliminating the HIV/AIDS epidemic is advancing faster than ever, yet, policy barriers, and disparities across age, geography, as well as gender persist, especially among adolescents in African countries like Nigeria.
HIV-related deaths have decreased by only 27 percent since 2002 among those aged 10-19 years, compared to a reduction of 80 percent among children aged 0-9 years. Moreover, over a quarter of new HIV infections occur among young people and adolescents.
Sub-Saharan African countries like Nigeria, remain disproportionately impacted, with HIV/AIDS being the leading cause of death among adolescents in the region.
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Over a quarter of new HIV infections occur among young people and adolescents globally according toUNAIDS.
In 2022, 85 percent of adolescents living with HIV and 67 percent of those newly diagnosed lived in sub-Saharan Africa (SSA).
Also, in 2023, 85 percent of adolescentsliving with HIV and 66 percent of those newly diagnosed lived in sub-Saharan Africa. According to UNAIDS, if current trends continue, there will be 183,000 new HIV infections among adolescentsworldwide by 2030. Additionally, HIVtreatment coverage among adolescents is low: only 70 percent in Eastern and Southern Africa and 58 percent in Western and Central Africa are on antiretroviral treatment.
According to UNAIDS, gender power inequities, intimate partner violence, and gender-based violence lead tosignificantly higher incidence of HIVamong adolescent girls and young women (AGYW). HIV incidence in the region is nearly six times higher for girls than for boys. Anticipated stigma, fear, and experiences of violence impede HIVtesting among AGYW.
Those who test positive face additional barriers to seeking, receiving, and adhering to optimal treatment and support.
World Health Organisation (WHO) advises eliminating age-related barriers preventing adolescents (defined as 10-19 years) from seeking HIV services.
The United Nations Population Fund (UNFPA) strongly recommends setting the age of consent at 12 years for medical treatment and 10 years of age for accessto sexual and reproductive health services. UNFPA also suggests that the age of access to HIV services should be considered separately from other forms of medical treatment to broaden access toHIV testing and treatment.
Ultimately, the goal of age-of-accesspolicies should be to protect adolescentsfrom harm by ensuring optimal access toHIV services that are age-appropriate and respond to their risks and vulnerabilities.
In the Global AIDS Strategy 2021-2026, UNAIDS calls for countries to address “structural and age-related legal barriersfaced by adolescents.” The HIV PolicyLab’s July 2024 issue brief “Unlocking Access: Reforming HIV Age of Access for Adolescents in Africa” examines the age of access for HIV testing, treatment, and pre-exposure prophylaxis (PrEP) in Africa and a human rights framework to support policy reform.
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Today, a new HIV Policy Lab report from the Center for Global Health Policy and Politics at the Georgetown University O’Neill Institute for National and Global Health Law provides a comprehensive review of age-of-access policies in Africa.
Thankfully, the HIV Policy Lab report was launched at the International AIDS Conference in Munich, Germany amidst news of significant breakthroughs in HIVprevention technology, penultimate Thursday.
The new legal analysis reveals major law and policy barriers to the young people most in need of accessing these scientific breakthroughs.
In particular, the authors highlight significant variations in whether laws allow young people to consent to their own HIVservices.
For instance, only 27 percent of African countries have adopted age-of-accesslaws and policies for HIV services aligned with guidance from the United Nations and public health agencies.
In 16 countries adolescents can legally consent to sex before they can accessHIV testing services without parental consent.
24 countries have delinked AOA for HIVtesting from the age of majority. Inconsistencies in defining minors and mature minors create confusion among healthcare providers and adolescents.
In addition, the age at which young people can access services without consent barriers varies widely among countries, ranging from 12 to 21 years. Studies have shown that the lack of confidentiality and the need for parental consent help explain the gaps.
“We know that stringent parental consent laws are restricting adolescents’ access toHIV services,” said Dr. Matthew Kavanagh, the director of the Center for Global Health Policy and Politics. “While these laws are often meant to protect young people, they do the opposite– pushing youth away from life-saving HIVtesting, treatment, and prevention. When laws protecting young people from early marriage or coerced sex are separated from the age of access or HIV services, it advances young people’s right to health. It helps reduce unacceptably high levels of AIDS-related deaths among young people.”
The new HIV Policy Lab report emphasises the need for countries toaddress structural and age-related legal barriers that adolescents face when seeking effective health care and services. The authors underscore that meaningful reform is only possible if governments involve adolescents in law and policymaking related to HIV and other sexual and reproductive health issues. The authors further recommend that Laws and policies on the age of consent for HIVtesting, treatment, and prevention including access to pre-exposure prophylaxis (PrEP) should be harmonized for consistency and clarity.
Aligning laws with global normative guidance that ensures all young people at risk from at least 12 years old can consent to an HIV test and the services that follow from the result is important in Nigeria and other African countries.
In Nigeria and other African countries, adolescent-centric services and delivery models should be developed and implemented to address the diverse needs of adolescents living with HIV.
