Modern medicines and therapies now make it possible for people infected with HIV to live longer than ever before. And yet, no victory over HIV is possible without aggressively addressing HIV among young people—the only population group where rates of AIDS-related deaths are rising.
Worldwide, approximately 4 million people aged 15–24 are living with HIV. An estimated 460,000 young people contracted the virus in 2019 alone. AIDS is now the second leading cause of death for young people around the world and the leading killer of youth in Africa.
These trends are worrisome. So, too, is the fact that many young people in communities with high rates of HIV infection do not get tested for the virus.
Connecting young people with testing, treatment, and care services is thus essential to stopping HIV and saving lives. On World AIDS Day, here are three considerations for doing just that.
1. Use a trauma-informed approach
Youth living with HIV experience childhood abuse, sexual abuse, and other forms of community violence at higher rates than their peers. These traumas—as well as the trauma and stigma of being diagnosed with HIV—can lead to drug misuse, anxiety, and depression. They can also make it more difficult for young people to engage with programs designed to offer support.
Health practitioners working with youth living with HIV should assume that every young person they see has experienced some form of trauma, says Athi Myint-U, a health researcher and managing director at EDC. Myint-U recommends that practitioners not only recognize this underlying trauma, but also apply trauma-informed approaches when providing HIV care.
“Trauma-informed practices address some of the root causes behind why youth may be unable or unwilling to seek services,” says Myint-U. “By applying these practices, service providers can help improve feelings of safety and trust among their young clients and can improve linkages to care and retention.”
Myint-U has been working in the field of HIV prevention since the late 1990s. Early in her career, she designed short, video-based interventions for community health clinics that were proven to be effective at preventing HIV transmission. Now, together with the NYC Department of Health and Mental Hygiene and community advisors, she is creating online trainings to help HIV service providers in New York City use trauma-informed approaches with Black, Latino, and LGBTQ+ communities—groups who have suffered from structural discrimination since the start of the epidemic.
The ultimate goal? Help ensure that all people living with HIV are quickly connected to care, engaged in care, and stay healthy.
2. Use education to address and overcome stigma
Myint-U also notes that in New York City, as in many places across the country, stigma and prejudice remain key barriers to HIV care and treatment for young people, especially for young men who have sex with men (MSM).
“There’s still stigma around being HIV positive, and there’s still a lot of homophobia,” Myint-U says. “This often prevents young MSM from getting tested and seeking care. It can also affect their experiences when they are in care.”
Lindiwe Mothemane, technical director of EDC’s USAID-funded South Africa School-Based Sexuality and HIV Prevention Education Activity, sees the same barriers. Many young people with HIV in South Africa are bullied and excluded from social life, even at a young age. This stigma makes it difficult for youth to disclose their status. And since HIV is still associated with having multiple sexual partners, young people do not always inform their partner of their diagnosis for fear of losing that person’s trust.
But not disclosing an HIV diagnosis only delays the inevitable.
“People wait until they are too sick before seeking help,” says Mothemane.
However, Mothemane believes that education can change attitudes about HIV. To reduce South Africa’s high rate of HIV among young people, the country is implementing a comprehensive sexuality education curriculum in all schools. Beginning in grade 4, the lessons include topics about what HIV is and how it is transmitted. The program also directly addresses the topic of stigma in an effort to reduce discrimination against those who have HIV—and to encourage youth who may have HIV to seek testing and treatment. In high-priority districts, these efforts will be coupled with access to sexual and reproductive health services.
Mothemane believes that this program—as well as efforts to celebrate young women who are successfully living with HIV, known as DREAMS ambassadors—can reduce the widespread stigma.
“Education is all about giving information,” says Mothemane. “Still, it has not been an easy road.”
3. Promote youth-friendly clinics and services
Mothemane identifies another issue: many young people do not feel comfortable accessing health facilities for HIV testing and treatment because they are worried about how they will be treated. For this reason, she recommends that communities create HIV services that meet the specific needs of young people.
In South Africa, this is happening through Adolescent Youth Friendly Services (AYFS). These clinics have nurses who have been trained to treat young people, and they also offer “happy hours” where only young people can visit.
While AYFS are on the rise, Mothemane wishes that more young people took advantage of these services.
“We have to make sure that youth, schools, and the community are aware of such clinics and can access them,” Mothemane says.
Another successful model is adherence clubs for HIV-positive young people who are on antiretroviral therapies (ART). In adherence clubs, young people meet at both nonclinical and clinical settings for regular counseling and medication delivery, thus relieving some of the burden of having to conduct these check-ins at medical facilities. During club meetings, members also receive a basic health assessment, including weight measurement and tuberculosis screening.
The social nature of adherence clubs is another benefit; the support helps keep young people following their ART regimen.
“Prevention remains the first step in health, and this can be achieved if all are empowered and knowledgeable,” says Mothemane. “Behavior change through continuous education can reduce new HIV infections.”