Preventing HIV in Youth: Successes and Challenges in 15 sub-Saharan African Countries

Preventing HIV Among Africa’s Growing Youth Population: Successes and Challenges
Youth counselor speaking to young men about HIV prevention. Photo by Thom Pierce.

Every day, more than one thousand (1,100) young people (aged 15 – 24 years) become infected with HIV globally. Sub-Saharan Africa remains the epicenter of the HIV epidemic, accounting for nearly 60 percent (59%) of new HIV infections in 2021. Many countries in the region are also experiencing a significant surge in their youth population, commonly referred to as the “youth bulge.” This, in turn, results in a sharp increase in the absolute number of young people who are at risk of contracting HIV.  

Preventing HIV in Youth Critical to Ending HIV

Recognizing the urgency in addressing HIV in this population, CDC recently published a special issue on HIV prevention among youth in the journal AIDS Education and Prevention that looks at the successes and challenges of HIV interventions for youth in 15 countries with a high burden of HIV supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Topics featured include HIV testing behaviors, risk factors among adolescent girls and young women (AGYW), gender-based violence, access to pre-exposure prophylaxis (PrEP), voluntary medical male circumcision (VMMC), and how faith leaders can support outreach to youth.  

“Addressing the HIV epidemic among youth is critical to ending HIV worldwide,” said Regina Benevides, PhD, Gender & Youth Team Lead at CDC’s Division of Global HIV & TB. “The breadth of these papers significantly adds to what is known about available support for young persons and remaining gaps especially in sub-Saharan Africa where the burden of HIV among youth is highest,” she said.  

Report Demonstrates Need for Continued Focus on Youth

Preventing HIV Among Africa’s Growing Youth Population: Successes and Challenges
Adolescent girls participating in a DREAMS workshop. Photo by Thom Pierce.

The supplement features six scientific papers demonstrating the need for continued focus on youth and novel approaches to deliver HIV services to young people successfully. The analysis is based on data from 15 countries in sub-Saharan Africa including, Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, South Sudan, Tanzania, Uganda, Zambia, and Zimbabwe.  

  • One analysis, in Malawi, shows that most young persons aged 15-16 years there have yet to receive an HIV test. While global data show that young people are less likely to know their HIV status than older adults, this is equally true in Malawi, where nearly a quarter (24%) of youth aged 15 – 24 years living with HIV are unaware of their status.  
  • Another study highlights that in PEPFAR-supported countries in 2021, adolescent boys and young men aged 15-19 years made up the highest proportion (50.4%) of those who received VMMC – a procedure that reduces the risk of heterosexual HIV transmission by up to 60%. The analysis underscores that the VMMC platform can be an important entry point for sexual health services for youth.  
  • Three other papers revealed that AGYW continue to face greater risks for HIV than their male counterparts. The papers highlight possible drivers of these inequities and ways to reduce HIV risk for AGYW.  
  • A final paper explored faith leaders’ role in shaping attitudes and beliefs about HIV prevention to eliminate stigma and discrimination, which prevent many, including youth, from accessing services.  

While the supplement does not capture all the challenges that youth encounter in accessing HIV prevention and treatment services in sub-Saharan Africa or globally, it does provide meaningful data assessing many aspects of the HIV prevention and treatment cascade.  

The latest UNAIDS data show that protecting youth and young adults from HIV is paramount for making HIV epidemic control by 2030 a tangible reality. The compilation provides recommendations for further research to address critical gaps in HIV prevention and treatment among young persons. This research, the authors say, can inform evidence-based, comprehensive services for AGYW and young members of key populations.  

CDC’s Impact in the Response to HIV Among Youth

This special issue on HIV prevention among youth is but one small component of CDC’s larger effort, as part of PEPFAR to make an impact in the fight against HIV among young people. CDC is addressing the unique needs and experiences of adolescents and young adults, through a range of targeted programs and approaches. CDC’s efforts are far-reaching and include, for example: 

Preventing HIV Among Africa’s Growing Youth Population: Successes and Challenges
Participant at a Family Matters! Program workshop. Photo by Thom Pierce.
  • DREAMS –a multi-pronged approach to help adolescent girls and young women live Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe lives.  
  • Voluntary Medical Male Circumcision (VMMC) – CDC supports the implementation of VMMC throughout Southern and Eastern Africa. As of September 30, 2021, CDC has supported VMMC procedures for 15.5 million men in Southern and Eastern Africa – over half (52%) of all VMMC procedures supported through PEPFAR during that time. 
  • Families Matter! – A CDC program where girls aged 9–12-years-old and their families are equipped with skills and the confidence to have open parent-child discussions. 
  • Together For Girls/Violence Against Children and Youth Surveys (VACS) – As part of a global public-private partnership, CDC and partners are addressing the dual epidemics of violence and HIV. 

“Tackling HIV among the younger generation is a top priority for us at CDC and we are dedicated to finding evidence-based solutions,” said Carlos Toledo, PhD, Chief of the HIV Prevention Branch at CDC’s Division of Global HIV & TB. “This report provides crucial insights that will help shape the path forward to better reach young people where they are, with services designed to meet their needs.”