“YOUNG AFRICAN WOMEN ARE ESPECIALLY VULNERABLE TO

HIV/AIDS”

By Jon Cohen (Nov. 21, 2016 )

HIV (human immunodeficiency virus) is a virus that attacks cells that help the
body fight infection, making a person more vulnerable to other infections and
diseases. It is spread by contact with certain bodily fluids of a person with HIV, most
commonly during unprotected sex (sex without a condom or HIV medicine to prevent
or treat HIV), or through sharing injection drug equipment.

If left untreated, HIV can lead to the disease AIDS (acquired

immunodeficiency syndrome). The human body can’t get rid of HIV and no effective
HIV cure exists. So, once you have HIV, you have it for life. However, by taking
HIV medicine (called antiretroviral therapy or ART), people with HIV can live long
and healthy lives and prevent transmitting HIV to their sexual partners. In addition,
there are effective methods to prevent getting HIV through sex or drug use, including
pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). First
identified in 1981, HIV is the cause of one of humanity’s deadliest and most
persistent epidemics.

Young women in sub-Saharan Africa are living through a “particularly

dangerous time” when it comes to risk of HIV infection, according to the annual
World AIDS Day report of the Joint United Nations Programme on HIV/AIDS
(UNAIDS) in Geneva, Switzerland. About 19% of the estimated 2.1 million new
cases worldwide in 2015—the most recent data for most analyses in the report—
occurred in women between the ages of 15 and 24. And younger women in some
places are at far higher risk than men of the same age; in southern Africa, for
example, 91% of new infections in the 15- to 19-year-old group were in adolescent
girls. “Young women are in an age group that is the least likely to have taken an HIV
test and know their status. It’s really amazing,” says UNAIDS Executive Director
Michel Sidibé.

The reasons are complex, according to the report. Many young women do not
perceive that they are at risk, and they live in what UNAIDS calls “challenging
environments,” with insufficient access to food and education. In addition, many are
involved in relationships with older men.

The new update for World AIDS Day, 1 December, offers a far more nuanced
take on the epidemic than it has in previous years. For the first time, the report
examines the disease in four age brackets that it calls “the life-cycle approach to
HIV.” UNAIDS suggests this breakdown—0 to 14, 15 to 24, 25 to 49, and 50-plus—
should lead to a clearer view of the epidemic’s “complex dynamics” and a more
targeted response. One of the most surprising details is that Nigeria alone accounts
for more than one-fourth of the 150,000 new infections in children last year.
(Children are defined as 14 and younger; some of their infections occur during birth
and some during breastfeeding.) Sidibé says he is “more disappointed than surprised”
by the finding. “It’s a little bit our collective failure, including mine.”

Two factors underlie the problem in Nigeria, Sidibé says: little effort to focus
resources on the regions of the country that have the biggest problems, and no strong
“culture of accountability” to ensure funds are well spent. “I didn’t take the same bold
approach I took in South Africa with Nigeria,” Sidibé says. “That should be my major
new agenda.” In South Africa, more than 95% of HIV-infected pregnant women
receive lifesaving antiretrovirals (ARVs), which also prevent mother-to-child
transmission (MTCT). Nigeria is still analyzing its data, but UNAIDS told Science
that the latest figures suggest that about 30% of HIV-infected pregnant women in that
country were receiving ARVs.
 Other trends are encouraging, according to the report. Roughly half, or 18.2
million, of the estimated 36.7 million HIV-infected people in the world have access to
ARV treatment. New infections in children globally dropped 51% between 2010 and
2015, thanks to widespread programs to prevent MTCT. Annual AIDS-related deaths
fell from 2 million in 2010 to 1.1 million.

In poor and rich countries alike, people are living longer with HIV/AIDS,
thanks to effective ARV treatment. The oldest group of HIV-infected people, 50-plus
years of age, is growing and now accounts for 17% of the total. And if treatment
continues to become more widely available, as hoped, the number of HIV-infected
people in this oldest age bracket could jump by 47% over the next 4 years.

But there’s grim news as well. The number of new infections in men and
women between 25 and 49 years old has not changed. Not surprisingly, men who
have sex with men, people who inject drugs, and sex workers accounted for 45% of
the new infections in 2014. Although the risks are well known, “few countries and
cities have mounted comprehensive responses for key populations,” which often face
significant stigma and discrimination as well as laws that punish them for their
behavior.

Funding remains an issue. Last year, roughly $19 billion was spent to combat
HIV/AIDS in low- and middle-income countries, which are hardest hit by the
epidemic, and just over half that money came from the countries’ own budgets. But
UNAIDS says an additional $7 billion is needed each year to close gaps in prevention
and treatment. “Reaching and sustaining this level of investment until 2030, and
focusing these resources on delivering the most effective HIV services to the people
in greatest need across the life cycle, will result in millions of additional lives saved
and tens of millions of additional HIV infections averted,” the report concludes.