There are now 220,000 adolescents living with HIV in the Asia-Pacific region, with large cities the hubs of new infections. Risky behaviour is on the rise, and policymakers need to address the problem, Wing-Sie Cheng writes.
At a time when we are tantalisingly close to ending the global HIV and AIDS epidemic, a new trend gives cause for concern. Although new AIDS-related deaths are falling in most countries, they are rising among certain groups of adolescents in Asia-Pacific.
A new report, Adolescents under the Radar, reveals that in Asia-Pacific there were an estimated 50,000 new HIV infections among adolescents aged 15-19 in 2014, accounting for 15 per cent of new infections. There are now around 220,000 adolescents living with HIV in the region, with large cities like Bangkok, Hanoi and Jakarta hubs of new infections. The rise in new infections coincides with an increase in risky behaviour, such as multiple sexual partners and inconsistent condom use.
These trends are not limited to Asia-Pacific. In parts of Africa, AIDS is now the leading cause of death among adolescents.
In Asia-Pacific, the epidemic is growing fastest among young gay and bisexual men, and the rise of mobile dating or hook-up apps play a role as enablers of risky behaviour. Gay men are now using mobile dating apps to meet up for sex and are having more casual sex with more people with the convenience of geographic tracing of the nearest sexual interest.
Unlike Internet dating, their precursor, mobile apps are location-based – they show other users available in the immediate area, in real time. This means spontaneous, easy sex that is also likely to be unprotected sex.
But, it’s important to emphasise that the apps should not be scapegoats. Dating sites and apps have changed the world. They have helped isolated, stigmatised and often criminalised sexual minorities connect to one another. They therefore clearly have positive effects, aside from potentially harmful ones. We need to foster an environment that protects and supports those most at risk of contracting HIV. Mobile apps can and should play a part in this; many in fact already spread messaging about safe sex and there is great potential to do more. But apps can only do so much to curb a hidden epidemic.
We are already working with governments to develop better data on adolescents, strategies for HIV prevention, and adolescent-specific laws and policies. But the pace needs to outstrip the spread of HIV. There is also a need for comprehensive sexuality education in schools and through social media, information on where to get an HIV test, condom use, and HIV testing and treatment services that are sensitive to adolescents.
It is vital for adolescents to know their HIV status, and get treatment if they need it, but in many countries, they are turned away from HIV testing centres. Only 11 countries in the region are known to have laws and policies enabling independent consent for young people to access HIV testing and related services.
It will not be possible to end the AIDS epidemic as a public health threat by 2030 without tackling the epidemic among adolescents. The situation of HIV among this age group has been consistently neglected in national HIV response. A sharp focus on adolescents will require new investment, new action from the highest levels of government, from civil society, and new ways of reaching adolescents at risk of and living with HIV.
Finally, we need to really listen to those whom our investment matters. Adolescents themselves can provide a reality check on the most effective HIV programmes and policies for them and their peers. Their participation – or lack of – can make or break our effort to end AIDS.