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Ending the Epidemic Among Youth IAS 2016 | Durban | July 20, 2016

This presentation discusses the global picture of HIV among youth, the challenges to decrease the burden of HIV, and how to turn activism into action to end the epidemic. It explores the different modes of transmission and high-risk populations, as well as the issues in the HIV care cascade for youth. The presentation also highlights the importance of optimizing HIV testing, youth-friendly care, and viral suppression, while addressing barriers and motivators for preventing new youth infections. Key lessons and the need for ongoing commitment and funding are also emphasized.

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Ending the Epidemic Among Youth IAS 2016 | Durban | July 20, 2016

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  1. Ending the Epidemic Among YouthIAS 2016 | Durban | July 20, 2016 Donna Futterman, MD Director, Adolescent AIDS Program Professor of Clinical Pediatrics, Einstein College of Medicine Bronx, New York

  2. Key Questions • What is the global picture of HIV among youth? • What are the challenges to decrease the burden of HIV among youth? • How do we turn Activism into Action to end the epidemic?

  3. Globally, AIDS Deaths: Only Rising Among Adolescents Source: UNAIDS 2012 HIV and AIDS estimates AdolescentAIDS.org

  4. Global:5M Youth Living with HIV Majority perinatally infected | 250,000 new infections annually | 2/3 female Generalized Epidemics • Sexual transmission (Africa) • Perinatal (Africa) Non-Generalized: High-Risk Populations • IDUs (Asia & E. Europe) • YMSM (developed & developing countries) • Commercial & Transactional Sex • Youth in juvenile detention AdolescentAIDS.org

  5. GlobalHIV Care Cascade:How do we improve to 90-90-90 for youth? Diagnosed HIV+ Prescribed ART Suppressed Virally Most youth have inadequate access to ART & youth-friendly adherence support. Poor data & wide variance (27% -89%) in reported global viral suppression in youth. ISSUES: Most youth have not been tested. AdolescentAIDS.org

  6. Optimizing the Care Cascade:HIV Testing • Most HIV+ youth don’t know • Majority not symptomatic • Need routine, targeted and ongoing testing • Routine testing needed in clinical sites • Outreach-based (schools, communities, venues) • Address consent and confidentiality with minors • Test all youth: undisclosed sexual activity/abuse and perinatally infected

  7. Optimizing the Care Cascade:Youth-friendly Care • More intensive engagement & retention required • Providers: knowledgeable & nonjudgmental • Peer support: engage peers and cohort youth to single day • Address Coping, Stigma, Disclosure • Adherence to ARVs & Prevention • Respect minors’ confidentiality and consent • Transitioning to adult care

  8. Optimizing the Care Cascade:Viral Suppression • Immediate treatment is game changer • Check pubertal development for dosing • Developmental issues key • Concrete and present-oriented thinking • Adverse events may seem intolerable • Meds rebellion as a form of independence • Mistrust providers YET trust misinformation from peers – learn barriers and motivators • Perinatally infected have unique needs • Monitor program & follow-up defaulters

  9. Preventing New Youth InfectionsMust understand barriers and motivators • PMTCT • PrEP • Male Circumcision • Vaginal Microbicides • Vaccines • Prevention with Positives • Youth Engagement/Mobilization

  10. Key lessons to end the epidemic! • New generation every 5 years • Multiple realities: some youth feel invincible, others fear HIV is inevitable • Sex is complicated • Vulnerable youth not well served • Gender, economic, racial, & sexual orientation disparities • Youth-friendly services must be scaled up • Ongoing commitment of leadership & funding • Mobilize youth leadership through activism

  11. Acknowledgements Stephen Stafford Terri Jackson, MA, MPhil Providers & Youth Donna Futterman, MD dfutterman@adolescentaids.org

  12. Ending the Epidemic Among YouthIAS 2016 | Durban | July 20, 2016 Donna Futterman, MD Director, Adolescent AIDS Program Professor of Clinical Pediatrics, Einstein College of Medicine Bronx, New York

  13. Ending the Epidemic Among YouthIAS 2016 | Durban | July 20, 2016 Donna Futterman, MD Director, Adolescent AIDS Program Professor of Clinical Pediatrics, Einstein College of Medicine Bronx, New York

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