Responding to paediatric HIV has been high on every national political agenda for the last decade, with encouraging results in terms of declining new infections among children by 70% between 2000 and 2015. Yet, adolescents aged 10 to 19 years old continue to pay a high toll to HIV in terms of new infections, AIDS-related deaths and lack of access to antiretroviral therapy (ART) and other relevant services. This age group represented 260,000 [81,000 to 450,000] of the total 1,800,000 [1,600,000 to 210,000] new infections (all ages) in 2016, with new infections and AIDS-related deaths expected to continue to increase. Among adolescents and young people, subgroups most at risk of acquiring HIV such as those who use drugs have not been adequately addressed yet, prompting an increase in HIV infections through injecting and non-injecting drug use.
However, new HIV infections among adolescents are not all related to drug use, as illustrated in sub-Saharan Africa, where new HIV infections are high among young women and adolescent girls. In South Africa alone, adolescent girls represented 24% of all new infections in 2012. International organizations, funders, civil society and national authorities are teaming to address the stigma, the policy barriers and the lack of gender- and age-tailored interventions for this subgroup, while their investments in other subgroups, such as those who use drugs, remain marginal.
It is accurate, nevertheless, that the policy response to HIV among adolescents who use drugs (AWUD), at the international level, is extremely complex. The complexity of the response is based on multilayered interactions between a large set of conventions, political declarations and resolutions from the HIV and AIDS, drug control, and children’s and human rights sectors. However, this complex response needs to be efficient, as it is necessary to address an alarming situation. While there is no disaggregated data on the prevalence of drug use or injection among adolescents, or on the prevalence of HIV among adolescents who use or inject drugs, people who inject drugs (PWID) of all age groups are the key population with new infections increasing by 30% between 2011 and 2015, while the 2011 political declaration on HIV and AIDS committed its signatory countries to halve the transmission among this population. Moreover, 86% of PWID who know their status did not have access to ART in 2013.
To achieve the All In 2020 targets and end AIDS among AWUD by 2030, this commentary will focus exclusively on policy development by reviewing countries’ obligations through legally binding conventions (Convention on the Rights of the Child (CRC), 1989; drug control conventions, 1961, 1971, 1988) as well as non-binding commitments countries took through designated political declarations (on the world drug problem, 2009 as complemented by the UNGASS 2016 outcome document; on ending AIDS by 2030, 2016; and on the public health dimension of drugs at the WHA, 2017). It will then lay down the role of the Sustainable Development Goals (SDGs) as a general policy framework allowing a multisectoral response to HIV among AWUD, before framing HIV and drug use within the SDGs agenda to illustrate the needed policy interventions to end AIDS among adolescents by 2030.