Mapping HIV Services and Policies for Adolescents: A Survey of 10 Countries in Sub-Saharan Africa

This 108-page technical report shares the findings from a mapping activity to identify HIV policies and services for adolescents in 10 sub-Saharan African countries: Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The technical report summarises the findings and is designed to be "a resource for program planners and policymakers working to improve services and policies for HIV prevention, care, and treatment among adolescents and ALHIV (adolescents living with HIV) in sub-Saharan Africa. The report highlights service gaps, innovative approaches, areas requiring programmatic prioritization, and potential areas for integration." The mapping exercise was conducted AIDSTAR-One with the support of the United States (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID), in collaboration with the United Nations Children’s Fund (UNICEF).

AIDSTAR-One conducted 40 in-depth key informant interviews with PEPFAR and UNICEF country offices, and 29 online surveys with implementing and government partners who are involved in HIV services for adolescents. The resulting document offers detailed survey results from each of the ten countries, based on findings along the continuum of care from prevention, to HIV testing and counselling (HTC), and care and treatment. Authors have included what they consider to be innovative approaches, as well as links to resources available. While findings differed among countries, overall the research found that while all countries understand the importance of creating adolescent-specific HIV policies and youth-friendly services, most current activities are primarily small-scale and largely uncoordinated with other services.

The research shows that the majority of HIV prevention activities are school-based, but these require a review of curriculums and greater efforts toward integration, both in terms of covering sexual and reproductive health issues and creating linkages with local organisations and health facilities. Youth clubs and corners are ways that youth issues are being addressed, but are "often described as dysfunctional or are implemented on a small scale with limited impact." The mapping exercise also found that adolescents usually access services in paediatric or adult care, with the unique transitional period in between often ignored, which results in high drop put rates. Few staff are specifically trained to provide health care services to adolescents. This lack of distinction has also made accurate data collection and reporting specific to adolescents a challenge.

Some innovative approaches for implementing HIV programmes for adolescents were identified during the mapping, which also creates opportunities for south-to-south collaborations and technical exchange as countries with more advanced and comprehensive adolescent services can support their neighbours.

The report identifies a number of opportunities for integrating HIV prevention and care services into other areas, such as education, primary healthcare, maternal and newborn healthcare, social protection, and community initiatives. This could include initiatives such as providing comprehensive HIV prevention education in schools, integrating HIV services with gender-based violence programming, and using youth-friendly events like social events and sports programming to reach out to young people.

The report also offers a number of policy recommendations. This includes involving adolescents in designing, implementing, and evaluating programming intended for them, and providing comprehensive, combination HIV prevention services for both in and out of school youth.

In terms of practice, the following are some of the recommendations that are relevent to developing communication strategies:

• "Involve adolescents. To adequately respond to adolescents' needs, they must be involved in all stages of programming, from identifying what their desired services are and setting targets and goals, to designing and testing adolescent-friendly materials and delivery systems, helping deliver those services to their peers, and monitoring and evaluating progress."
• "Address adolescents in programming for key populations. To reach the goal of an AIDS-free generation, it will be critical to implement effective HIV prevention, care, and treatment services for key adolescent populations, such as sex workers, men who have sex with men (MSM), or people who inject drugs (PWID)."
• "Clearly define the target population in programming. The needs of young people change significantly as they age through early adolescence to early adulthood. An intervention appropriate for a 12-year-old may not be applicable to an 18-year-old, and what may be appropriate for girls at a certain age may not be appropriate for boys of the same age."
• "Use data to inform programme design and progress. Current data systems pose challenges to disaggregating data on 10- to 19-year-olds. However, some smaller studies exist and as monitoring systems evolve to enable further disaggregation, programmes should be able to use available data to better target programming to meet adolescents' needs."
• "Provide comprehensive, combination HIV prevention services. Although HIV education in schools is widespread, the quality is inconsistent and messages may not be evidence based or take into account the local context of the epidemic. Adolescents not in school often do not have access to accurate information and prevention services. In order to reduce new infections, these gaps must be addressed, along with condom provision and promotion among sexually active adolescents."
• "Scale up VMMC. In countries where VMMC is supported, adolescent boys should have access to VMMC counseling and education tailored to their needs. Many VMMC programmes are reaching young men, and these programmes should ensure adolescent males are effectively linked with other HIV and health services."
• "Involve families and communities and address social norms. Adolescents spend most of their time in their communities and with their families, outside of the clinic or health care facility. HIV prevention, care, and treatment activities would be strengthened by the increased involvement of parents, guardians, and caregivers."
• "Strengthen promising multi-sector and cross-cutting collaborations. Some partnerships, like those between the health and education sector, are more obvious than others. There are opportunities for additional collaborations to address adolescents' needs, such as reaching adolescents with HIV prevention activities at sporting events or partnering with the technology industry to use social media for health programmes."