by Alexis Palmer-Fluevog
This week marks Youth Week in British Columbia. Globally, there have never been more young people than there are today: as of 2009, there are an estimated 1.8 billion people ages 10 to 24. These are the leaders of tomorrow, and will be the ones to determine the health and wellbeing of the next generation.
Adolescents and young adults (AYA) are facing what can be a confusing and emotionally charged time. Youth is a phase in life that is full of self-determination, transitions and the development of one’s personality, hopes and dreams. Adding in a life-threatening, highly stigmatized illness such as HIV can make life even more complicated. Unfortunately, this is the reality for an estimated 5 million people around the world.
Despite recent significant scientific advances in prevention and treatment, HIV continues to affect young people worldwide, in B.C. and in Canada. To add to this, they may not be accessing treatment at the same rate as other individuals living with HIV.
Of approximately 35 million people living with HIV globally, young people under the age of 24 make up almost half of all new infections (46%). In 2013, there were approximately 6,000 new HIV infections per day with approximately 1,716 of these among young people ages 15-24 years (33%). Adolescent girls and young women in particular make up one in four of these new infections. In Canada, nearly one-quarter of all new HIV diagnoses in 2013 were among youth.
Highly Active Antiretroviral Therapy (HAART) has the potential to affect the lives of people living with HIV by improving lifespan, health and wellbeing – while drastically reducing the likelihood of spreading the disease. This forms the basis of the made-in-BC Treatment as Prevention¨ (TasP¨) strategy – which has been effective in reducing new AIDS cases in BC by 88 per cent between 1994 and 2013. Unfortunately, some youth living with HIV in B.C. are not being reached by TasP¨. A recent provincial analysis by the BC-CfE shows individuals under the age of 30 living in B.C. to be less likely be successful on the treatment pathway to virologic suppression and optimal health. (See Cascade of Care below.)
Compared to older people in the HIV Cascade of Care in B.C. (representing a measurable approach to implementing TasP¨) young people are less likely to be linked to care, be retained in care, and be on treatment. Among those who are on treatment, young people are less likely to be adherent and to achieve virologic suppression. Each step in the cascade of care represents numerous opportunities to engage clients in effective, sustained treatment and curb the spread of HIV. As part of the TasP¨ initiative, it lays out the roadmap that could eventually lead to an AIDS-free generation.
The importance of supporting AYA living with HIV plays out over their life course as people living with HIV on sustained treatment can have life expectancies nearing those of HIV-negative individuals. Initiating treatment in a timely manner, supporting optimal adherence and assisting AYA to remain in care will set them up for fewer health burdens, lowered transmission risk and fewer comorbidities over their life course. For young people who are initiating HIV treatment while negotiating dating and new sexual relationships, adhering to HAART and maintaining virologic suppression has enormous potential to normalize sexuality of sero-positive youth.
The BC-CfE is committed providing reserach related to HIV care and treatment regarding young people living with HIV, in order to help youth realize their full potential and to assist them in enjoying good health. The transition from adolescence to adulthood presents an optimal opportunity to promote healthy living. According to the World Health Organization, approximately 70 percent of premature deaths in adults are a result of patterns and behaviours developed in adolescence.
In order to support youth living with HIV on their path towards wellbeing, it is important to identify factors associated with accessing stepping stones along the Cascade of Care. It is not enough to know young people have worse treatment and care adherence than older people. We need to know how to improve adherence and how to design effective interventions. We have a number of studies looking into these topics. Please stay tuned for more info!
Alexis Palmer-Fluevog is a Research Assistant in the BC-CfE’s Epidemiology and Population Health program.