AIDS 2020 Session: Delivering an Integrated Approach for Adolescent Mothers Affected by HIV and their Children
We are failing in our global ambitions to tackle HIV and AIDS and their impacts on children and adolescents, especially for those facing structural and social exclusion[i]. Adolescent mothers and their children, in particular, are a vast and growing population that is underserved[ii]. In Sub-Saharan Africa, levels of both HIV and motherhood amongst adolescents are high[iii]; they have poorer PMTCT service outcomes and are less likely to receive or stay on HIV treatment[iv]. This is inextricably linked to their increased risk of broader vulnerabilities, including gender inequality, poverty, violence, exclusion, poor education, poor mental and physical health, and early childhood development delays[v]; and they have less access to services and support, due, in part, to chronic stigma around adolescent motherhood itself.
Integrated approaches – that combine biomedical, social and economic support – are proven to be the most effective and affordable way of enabling excluded children and adolescents to survive and thrive HIV and AIDS, and accelerate progress across the SDGs[vi] [vii]. The involvement of communities, families, children, and adolescents themselves is critical – they are well placed to reach out to excluded groups, including adolescent mothers and their children, and they shape the environment in which they live. Additionally, pregnancy and the postpartum period are critical times for HIV prevention, especially among adolescents. Women are at considerable risk for HIV acquisition during these periods, and new infections at this time are associated with an increased chance of mother to child transmission[viii].
Delivering an integrated approach for adolescent mothers affected by HIV and their children is a transformative agenda. It challenges all of us to change how we operate as funders, governments, policy makers, researchers, activists and service providers. This includes, for example, forging new funding partnerships and coordination structures between sectors, and between communities and institutional service providers.
An AIDS 2020 satellite session, co-hosted by the Coalition and ViiV Healthcare Positive Action, was intended to further a shared vision and action plan and forge connections with a like-minded community of practice. We invite you to watch the session, in its entirety, below.
[i] The UNAIDS Start Free Stay Free AIDS Free 2019 Report outlined a chronic lack of progress towards HIV targets for children and adolescents; meanwhile, the UN Secretary General (8th May 2019) Special edition: progress towards the Sustainable Development Goals reported that progress was slowest amongst the most vulnerable groups including children, adolescents and people affected by HIV and AIDS.
[ii] Toska, E Roberts, K and Laurenzi, C (2019) Adolescent mothers affected by HIV and their children – understanding and meeting their needs in our HIV response and global commitments https://childrenandhiv.org/wp-content/uploads/2019/12/CCABA_Evidence-Note_Adolescent-mothers-and-children_FINAL_120219.pdf
[iii] The UNPD (2015). World Fertility Patterns 2015 – Data Booklet (ST/ESA/SER.A/370). New York, United Nations Population Division estimates that there are 11.4 million adolescent mothers in Sub-Saharan Africa predominantly living in adverse conditions. And UNAIDS (2019) JUNP on H. At a Glance – HIV among Women and Girls in Sub-Saharan Africa reports that around half of all women in the region have experienced pregnancy by age 18. https://www.unaids.org/sites/default/files/women_girls_hiv_sub_saharan_africa_en.pdf, and
[iv] Calahan, T. et al (2017) JIAS 2017; 20(1): 21858. ‘Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go’ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577684/
[v] Groves, A. et al (2018) ‘Addressing the unique needs of adolescent mothers in the fight against HIV,’ JIAS Jun; 21(6): e25155 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024120/
[vi] Unicef (2019) Improving HIV Service Delivery for Infants, Children and Adolescents: Towards and Framework for Collective Action
[vii] Cluver LD, Orkin FM, Campeau L, Toska E, Webb D, Carlqvist A, Sherr L. Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study. Lancet Child Adolesc Health. 2019 Apr;3(4):245-254.
[viii] See Thomson KA, et al. Increased risk of HIV acquisition among women throughout pregnancy and during the postpartum period: A prospective per-coital-act analysis among women with HIV-infected partner. J Infect Dis 2018; 218(1); and Drake AL, et al. Incident HIV during pregnancy and postpartum and risk of mother-to-child transmission: a systematic review and meta-analysis. PLoS Med 2014; 11(2).