New Book on Preventing HIV Edited by Two UKZN Academics

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Efforts to confront and reduce the high level of new HIV infections among young people in Eastern and Southern Africa (ESA) are explored in a new book - edited by two UKZN academics - launched during an online event hosted by the University and the Health Economics and HIV/AIDS Research Division (HEARD).

Against a background of the slow progress being made in curbing the rate of new HIV infections in the regions, the book titled: Preventing HIV Among Young People in Southern and Eastern Africa: Emerging Evidence and Intervention Strategies, discusses the social and structural drivers of the sexual transmission of HIV, including current policy debates regarding the scale-up of HIV programmes. 

The new work, edited by UKZN’s Vice-Chancellor and Principal Professor Nana Poku and Research Director at HEARD Professor Kaymarlin Govender, has contributions from international researchers, implementing organisations, agencies and policy experts.

During the webinar Govender presented data on some key features of the HIV epidemic in ESA and pathways to infection among young people in the region.

Govender said in 2019 alone, 260 000 new HIV infections had been recorded among young people aged 15–24 in the ESA region (UNAIDS, 2020), with about three out five new infections occurring in adolescent girls and young women.

‘The latter statistics point to a deep-seated gender imbalance in the rate of new infections,’ he said, highlighting that other key groups - such as young people who sell sex, people who inject drugs, gay and transgender communities, incarcerated offenders, and other men who have sex with men - face exclusions from the AIDS response.

Govender said UNAIDS-prescribed targets for 2020 - to reduce new HIV infections to fewer than 500 000 by 2020, reduce AIDS-related deaths to fewer than 500 000 by 2020 and eliminate HIV-related stigma and discrimination by 2020 - were off course before the advent of the COVID-19 pandemic, however the pandemic had further blocked efforts toward epidemic control. ‘Lockdowns, stay-at-home orders and restrictions on movements imposed by governments in the region to minimise the spread of the Coronavirus have significantly disrupted HIV prevention, treatment and support services, with these negative effects likely to be felt long after COVID-19 pandemic.’ 

Focusing on adolescents and young people, he said while programmes aimed at reducing mother-to-child infections had been quite successful in recent years, however reducing new infections among adolescents and young adults had been slow and more difficult to achieve. ‘This is a key objective of the book – discussing current efforts to reduce the acquisition of HIV through sexual transmission- has been particularly difficult. One the one hand, this has been mainly due to the complex physical, psychological and social challenges they experience in the transition from childhood to adulthood, while on the other hand, young people face gender, economic, social and legal prejudices in accessing HIV and sexual and reproductive health services as they reach puberty and become sexually active.

‘For example, these negative stresses include cultural inhibitions against sexuality education, discrimination from health care workers when they seek sexual health services, material poverty influencing exploitative sexual relationships and, for young people of different gender and sexual orientations, the associated social and legal stigmas as they grow into young adults in many countries in the region,’ said Govender.

Speaking at the webinar on behalf of Poku, Acting Deputy Vice-Chancellor and Head of the College of Law and Management Sciences, Professor Brian McArthur, said the ESA region was the epicentre of the HIV pandemic. ‘It is indeed worrying to see our region is leading globally with 800 000 new HIV infections annually,’ said McArthur.

‘It is even more disturbing to note that our youth is at high risk which then threatens future livelihoods. This group constitutes a cohort of future scientists and the future workforce. Future economic development and growth in our region is equally at risk.’

McArthur commended HEARD for championing the book which took three years to complete and noted the relevance of the work to the University’s vision to be the Premier University of African Scholarship. ‘It is crucial for our research endeavours to remain relevant to the local, socio-cultural context. This book does just that.’

Chief Operating Officer of the Desmond Tutu Health Foundation Professor Linda-Gail Bekker, who chaired the event, cautioned against the stalling of the response to the HIV epidemic. ‘The slowing down of the HIV response was evident prior to COVID-19, so we can’t lay all the blame on the pandemic. In commending the stellar and diverse team of authors who contributed to the book, she said the publication ‘compels us to re-energise our efforts on HIV prevention and make sure that we get to the end chapter of HIV/AIDS’.

The edition which was published by Routledge, UK: Study in Health in Africa Series, provides an excellent roadmap of ways to go about reducing new infections among young people.

Five authors of chapters in the volume provide glimpses into evidence and policy debates on preventing HIV among young people.

The Co-Research Director at STRIVE Research Consortium and associate professor at the London School of Hygiene and Tropical Medicine in the United Kingdom, Professor Mitzy Gafos, said the chapter she collaborated on reviewed and synthesised findings on the effectiveness of structural interventions targeting adolescents and young people (aged 10 to 24) in ESA. She said ‘improving educational attainment (keeping young girls in school), reducing poverty, challenging harmful gender norms and mitigating the risk of gender-based violence, are important steps to interrupt the casual pathway to HIV infection’.

Associate Director of Public Policy in Advocacy at the Elizabeth Glaser Pediatric AIDS Foundation Ms Rhoda Igweta contributed to the chapter titled Global and Regional Initiatives to Prevent HIV Among Adolescents and Youth – Fulfilling the Promise in Eastern and South Africa.

Igweta said that the reduction in new HIV infections among young people and adolescents had stagnated and emphasised the importance of regional, national and global collaborations in order to reduce the number of new HIV infections among this group.

‘We conclude our chapter by making some recommendations that note that all policy commitments must be matched with the financial resources, both domestic and external. There must be ambitious targets that inspire action and guidelines that facilitate programmatic implementation that would result in an extraordinary opportunity for real change for young people in the ESA region.’

In another chapter, a professor at the Université de Paris 8 and a member of the Centre for Sociological and Political Research of Paris (CRESPPA) Professor Jane Freedman and her collaborators outline their research on challenges of young key populations (young people who sell sex and men who have sex with other men) in accessing HIV and sexual and reproductive health (SRH) services. Freedman said there was a real gap in research in young key populations due to ethical and legal challenges ‘so we felt that this was a key area in need of more ethnographic type research’. Their work supports the need to revisit exiting labels and definitions of young key populations with attention given to the context-specific lives of young people. For young people, ‘economic inequality was a key determinant of a vulnerability to HIV and to poor sexual and reproductive health’.

Associate Professor of Clinical Epidemiology in Psychiatry at the HIV Centre for Clinical and Behavioural Studies at the New York State Psychiatric Institute at Columbia University in the United States, Professor Susie Hoffman, spoke on behalf of co-authors on the chapter titled: Are Adolescent Boys and Young Men Being Left Behind? Missing Discourse and Missed Opportunities for Engagement in HIV Prevention in Eastern and Southern Africa.

Hoffman said while adolescent girls and young women were at ‘extraordinarily high risk and vulnerability’ for HIV infection, ‘we must not forget adolescent boys and young men’.

‘Although HIV prevalence peaks among young men in sub-Saharan Africa at a much later age than it does among women, young men are not at zero risk,’ she said. ‘Behavioural patterns formed during early adolescence become very ingrained in adulthood, setting the stage for adolescent boys’ increasing risk of HIV acquisition as they become young adults. But early adolescence also provides an opportunity for instilling positive sexual and reproductive health attitudes and behaviour.’

HIV/AIDS Specialist on Adolescents who is based at the United Nations International Children's Emergency Fund (UNICEF), Ms Alice Armstrong, presented on behalf of her colleagues.

‘We need better data. We need stronger, disaggregated data systems that really can drive targeted programming for adolescents and young people. Data that takes into consideration the dynamic changes that are inherent in adolescent development, including those social changes that continue into adulthood,’ she said.

Armstrong said the lack of disaggregated data by age and sex meant that ‘sub-populations of adolescents and young people had been invisible from the data driven and evidence-informed programming efforts.

‘Without this data, we have an incomplete picture of the health and social support needs of adolescents and young people,’ she added.

Preventing HIV Among Young People in Southern and Eastern Africa: Emerging Evidence and Intervention Strategies is available online - click here.

To view the book launch, click here.

Words: Raylene Captain-Hasthibeer

Images: Supplied