The youth tipping point: opportunities and challenges

SHARE staff

Looking at where we have come from, and where we are in southern Africa’s fight against HIV, it is clear that we have had some monumental successes and some incredible failures along the way, both of which we can learn from to do better. One clear theme throughout the first day of the 2nd International Workshop on HIV Adolescence: Challenges and Solutions was that we have not consistently and adequately gained the insights of the very people who are enrolled in studies to generate evidence on how to address the needs of these populations. Further, we have not committed the resources required to conduct the research on the populations that are difficult to reach, whether due to challenging ethical enrolment or stigma and criminalization of key populations. One presenter from Wits RHI stated that youth are often under-represented in research: a review of 111 studies on sexually-transmitted infections revealed that only 9% included adolescents. Considering that youth are not only the largest demographic in southern Africa, but also bear the greatest burden of new HIV infections, it seems that our resources and trial priorities are not aligned to address this population’s needs. The youth population is also growing in Africa, with researchers anticipating that by 2030, this group will have doubled since the start of the HIV epidemic. This population expansion is increasing the strain on health services that are already struggling to cope with multiple disease burdens in the region.stigma

However, done right, this “youth bulge” demographic could be an incredible opportunity to shift the trajectory beyond eliminating HIV towards a more prosperous and just society in the future. Presenters noted that we cannot simply extrapolate our knowledge on behavior from adults or children and apply it to adolescents.[1] We have to design interventions specifically for adolescents and recognize the variability within the population in terms of their maturity, resources, and cultural contexts. Adolescents have barriers working against them at multiple levels. These barriers are not necessarily unique but are perhaps more greatly pronounced in youth populations. They include the stigma associated with sexual activity/debut before marriage, the incredible importance of peer acceptance at this age of development, and the ethical requirement of parental consent in a context where parents may understand less about HIV than the adolescents themselves. Young people are "digital natives" and many have never known a world without cell phones and the Internet, meaning that the way they communicate with one another is fundamentally different from adult populations even just a decade older. digital-natives

They are also a highly variable and mobile population, resulting in clinical trials struggling to maintain youth participation as they mature and navigate their own busy lives. Still, if we can harness the energy of the youth, particularly those who experience multiple vulnerabilities, and empower them with knowledge, resources and leadership opportunities, they can guide us towards more robust and effective trials through better advocacy, recruitment, retention, and community relations. This in turn will guide us towards more effective interventions, led and owned by young people, and will shift the tide towards the lofty, but not impossible, goal of no new HIV infections in southern Africa.


[1] However, with a degree of certainty we can extrapolate pharmacodynamic outcomes from adult populations and have guidance from both the US FDA and the EMA on how to do so.


clinical trials, adolescents, adolescent health, adolescent HIV, adolescent treatment services, 2nd International Workshop on HIV Adolescence, research, stigma and discrimination, key populations, criminalization, youth, HIV prevention, adolescent-friendly services