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• W2163585119 abstract "See Related Article p. 118 See Related Article p. 118 Globally, HIV continues to exact a substantial toll on the health and well-being of millions, causing considerable suffering, morbidity, and death. The pandemic insidiously exploits and amplifies existing social and economic disparities, particularly in sub-Saharan Africa where productivity has been adversely affected, and national revenues have consequently declined [1UNAIDS Report on the Global AIDS Epidemic.Joint United Nations Programme on HIV/AIDS. Switzerland, Geneva2008Google Scholar, 2Zuniga J.M. Threat of global AIDS pandemic over? Says who?.J Int Assoc Phys AIDS Care. 2008; 7: 155-156Crossref Scopus (1) Google Scholar, 3Barnett T. Whiteside A. Desmond C. The social and economic impact of HIV/AIDS in poor countries: a review of studies and lessons.Prog Dev Stud. 2001; 2: 151-170Crossref Scopus (43) Google Scholar]. Early death and prolonged illness is incapacitating social systems, including governance. The net effect is reduced state capacity, creating an environment that further exacerbates the pandemic. The prospect of HIV infection remains one of the most significant public health risks facing adolescents [4Blum R.W. Nelson-Mmari N. The health of young people in a global context.J Adolesc Health. 2004; 35: 402-418Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar, 5Kiragu K. Youth and HIV/AIDS: Can We Avoid a Catastrophe? Population Reports, Series L. No. 12. The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD2001Google Scholar, 6Monasch R. Mahy M. Young people: the centre of the HIV epidemic.WHO Tech Rep Series. 2006; 938: 15-41PubMed Google Scholar]. Twenty-five percent of all global HIV infections occur among people between the ages of 15 and 24 years, with new infections among some subgroups reaching record proportions. Sub-Saharan Africa has been disproportionately impacted by the HIV epidemic, as approximately three-quarters of all youth living with HIV/AIDS reside there with HIV the leading cause of death among adolescents/young adults 15 to 29 years old [[5]Kiragu K. Youth and HIV/AIDS: Can We Avoid a Catastrophe? Population Reports, Series L. No. 12. The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD2001Google Scholar]. Sub-Saharan Africa is a richly diverse mosaic of nations, cultures, traditions, customs, languages, and religions. Likewise, the HIV epidemic is fueled by concurrent epidemics of poverty, internecine conflict, deeply embedded cultural practices, and of course, other prevalent diseases. Understanding the full spectrum of issues and subsequently creating efficacious HIV risk-reduction interventions for sub-Saharan adolescents will require intensified research efforts. The articles in this issue of the Journal of Adolescent Health shed light on factors that drive the HIV epidemic, and offer promise for designing prevention programs. Articles by Akpabio and colleagues [[7]Akpabio II, Asuzu M.C. Fajemilehin B.R. Ofi A.B. Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria.J Adolesc Health. 2009; 44: 118-123Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar] (Nigeria), Birungi and colleagues [[8]Birungi H. Mugisha J.F. Obare F. Nyombi J.K. Sexual behavior and desires among adolescents perinatally infected with human immunodeficiency virus in Uganda: implications for programming.J Adolesc Health. 2009; 44: 184-187Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar] (Uganda), and Mathews and colleagues [[9]Mathews C. Guttmacher S.J. Flisher A.J. et al.The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference?.J Adolesc Health. 2009; 44: 188-190Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar] (South Africa) each provide unique evidence. Respectively, these studies address school-based intervention, the need to intervene with teens who acquired HIV perinatally, and the value of youth-friendly HIV testing and counseling services. The quasi-experimental study of Nigerian students attending urban secondary schools (in an area with 8% seroprevalence) demonstrates the feasibility and efficacy of a school nurse-delivered education program designed to foster favorable attitudes toward HIV prevention [[7]Akpabio II, Asuzu M.C. Fajemilehin B.R. Ofi A.B. Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria.J Adolesc Health. 2009; 44: 118-123Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar]. In addition to sexual protective practices, several methods of averting blood-to-blood transmission were included in the 29-item assessment. Although participating students in the school randomized to the nurse-delivered condition had significantly more favorable attitudes than those in the school receiving this same program plus a parent seminar installing knowledge about HIV prevention, the difference was quite small (a mean score of 20.59 vs. 19.20). In contrast, students in the control school had far less favorable attitudes (mean = 12.34). The next important step is to develop and test refinements to nurse-delivered programs that will lead to adolescents’ adoption of HIV-protective behaviors. Moving from a general population of adolescents in Nigeria to a very specific population of adolescents in Uganda, Birungi, and colleagues provide a number of insights into an often neglected population: teens living with HIV/AIDS since birth [[8]Birungi H. Mugisha J.F. Obare F. Nyombi J.K. Sexual behavior and desires among adolescents perinatally infected with human immunodeficiency virus in Uganda: implications for programming.J Adolesc Health. 2009; 44: 184-187Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar]. This preintervention study powerfully suggests that prevention programs for these teens are urgently needed. Given the need to prevent HIV transmission from teen to teen, and HIV superinfection among teens already infected, a powerful case emerges for intensified prevention efforts for HIV-positive teens. About one-third of the sample reported being sexually experienced, with less than one-half reporting condom use (most often inconsistently). Given that 39% were in HIV serodiscordant relationships, these findings alone are cause for action. Contextual barriers to prevention behaviors are prominent, given that the vast majority expressed worry about transmitting HIV to others. Of great interest, approximately one-third of the sample expressed a desire for HIV-negative sex partners, thereby raising the question of HIV-status disclosure. Understanding and changing teen's barriers to disclosure of their HIV-positive status is an important next step. Linking ongoing condom promotion efforts to the treatment of HIV-positive teens may provide them with the desire and capability to practice safer sex after disclosing their HIV status. The studies from Nigeria and Uganda point to the need to acknowledge and understand adolescents’ sexuality in a world of AIDS. As the pandemic takes increasing victims, it is painfully clear that adolescents are vulnerable targets of infection. In this context, a third level of investigation is also warranted regarding the provision of voluntary HIV counseling and testing services designed for adolescents. Findings from Mathews and colleagues [[9]Mathews C. Guttmacher S.J. Flisher A.J. et al.The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference?.J Adolesc Health. 2009; 44: 188-190Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar] provide several insights regarding this question. For example, adolescents posing as clients commonly experienced breaches in confidentiality. This was true for the clinics certified under the National Adolescent Friendly Clinic Initiative (NAFCI) (suspected during 33% of all testing visits) as well as clinics not certified under NAFCI (25% of visits). Condom use demonstration was provided during only 11% of the visits to NAFCI clinics and only 24% of the visits to non-NAFCI clinics. Moreover, condoms were provided in only 23% and 17% of the NAFCI and non-NAFCI clinics, respectively. Although many of the assessed indicators did indeed suggest that high-quality counseling was provided to adolescents, the missed opportunity to fuse counseling with the promotion of safer sex is a signal to examine and improve voluntary HIV counseling and testing services in South Africa. The most encouraging finding from this study was that simulated clients visiting NAFCI clinics were significantly less likely to report having to return for testing (19% of visits) compared to non-NAFCI clinics (37% of visits). As the sub-Saharan HIV epidemic escalates, the need for more effective HIV prevention efforts becomes an increasing priority [[10]Hartell C.G. The status of HIV/AIDS among education research among adolescents in South Africa.Int J Adolesc Youth. 2003; 11: 113-133Crossref Google Scholar]. Across these three articles, one theme is quite clear: this emerging science is contingent on recognizing adolescents’ sexual desires and HIV prevention needs in the context of high HIV seroprevalence and incidence rates. Innovative research must continue, encompassing principles of adolescent development and being responsive to changes in the sociosexual factors influencing adolescents’ risk behavior. Coordinated multilevel and multisectoral interventions that optimize HIV prevention efforts will require prioritizing the development and evaluation of innovative, theory-based, empirically driven, and rigorously designed research tailored to the cultural, gender, and sociodemographic characteristics of the target population [11DiClemente R.J. Salazar L.F. Crosby R.A. Rosenthal S.L. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective—a commentary.Public Health. 2005; 119: 825-836Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar, 12DiClemente R.J. Crosby R.A. Salazar L.F. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach.J Pediatr Psychol. 2007; 32: 888-906Crossref PubMed Scopus (199) Google Scholar]. Understanding the vast array of factors associated with sub-Saharan adolescents’ HIV risk behavior and subsequently intervening must be the result of carefully calibrated programs of research that also mobilize community support. As individuals and as a global community, we must undertake, through all available channels, a strategic plan and course of action, to guide the long climb toward our vision—a generation free of HIV. This journey will challenge our patience, persistence, and determination; however, we must succeed, as failure is simply not acceptable." @default.
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• W2163585119 title "Preventing HIV Among Adolescents in Sub-Saharan Africa" @default.
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