Despite the past decade’s significant successes on reducing new HIV infections and AIDS related deaths worldwide, adolescents were the only group in which AIDS related deaths increased between 2001 and 2012. Furthermore, during the same period, young people (15-25yrs) accounted for 39% of all new HIV infections.

There are currently about 1.8 billion adolescents alive today, the highest cohort ever. These adolescents represent billions of dreams and opportunities for social, political, and economic development of countries. However, adolescents are increasingly exposed to challenges and risk that directly impact their physical, mental, and social well-being. The lack of access to SRH services is one challenge that impacts adolescents and exposes them to the aforementioned risks. In Sub- Saharan Africa for instance, HIV prevalence in adolescents is higher compared to other parts of the world. Adolescent’s challenges to accessing SRH services are further exacerbated by lack of income, generalized poverty and strong religious, political and legal barriers. Many societies still do not allow reproductive health issues to be discussed with unmarried adolescents. Adolescents also face age related barriers to accessing HIV testing, counseling and treatment services. Mandatory parental notification and consent for prescribed contraceptives, HIV testing and treatment impedes adolescents use of these services. Structural challenges exist as well; most government laws and policies are still ambiguous and inconsistent with regards to Adolescents Sexual Reproductive Health (ASRH) services, specifically on sex education in schools and comprehensive access to contraceptives. These vulnerabilities hinder young people’s ability to realize their full potential and increase their risk to HIV and other sexually transmitted infections.

My fellowship placement organisation, the Joint United Nations Program on HIV/AIDS (UNAIDS), through its Program Coordinating Board, in November 2013, recommended: “revising, where appropriate, age-and sex-related restrictions that prevent adolescents from accessing effective HIV prevention, treatment and care, as well as sexual and reproductive health services”. It is against this background that I am now reviewing how age of consent policies affect HIV response programs among young people in Sub-Saharan African countries. On this project, I am working very closely with teams from my office and both the World Health Organisation (WHO) and UNAIDS headquarters in Geneva. We hope to provide a knowledge base and make recommendations on different options on how to reduce age-related barriers to access and uptake of HTC, HIV treatment and Sexual Reproductive Health (SRH) services.

UNAIDS Board devotes key session to HIV, adolescents and youth- Copyright UNAIDS 2013

After having worked with young people and adolescents for a long time, I continue to reiterate that there is a huge need to ensure availability of very accurate information on young people’s key health indicators. This can be achieved through routine collection of ASRH data, disaggregated by age, gender and marital status. These data gaps have been identified for a long time and now it is time to fill them up. The Post 2015 Development Agenda is the window of opportunity to include targets for data collection related to adolescents and young people. Furthermore, the Post 2015 Agenda should reflect the special needs of vulnerable groups of adolescents such as the HIV positive, pregnant street youth, young sex workers, orphans, adolescents affected by emergencies/disaster, very young adolescents and  adolescent girls working in informal sectors. These adolescents need to be accorded the highest priority. There is also a need to ensure adolescents’ involvement in program/policy design, implementation and evaluation. Adolescents cannot only be passive recipients or subjects of the programs and policies that affect them, but, rather, be active participants. Likewise, there is an urgent need to identify scalable, replicable, and successful adolescent interventions. Economically empowering adolescents, especially girls, as a strategy to reduce predisposing factors to risky behaviours should be expanded and reinforced to allow adolescents to realize their full potential. Some of these best practices include the recent World Bank cash transfer interventions to reduce STI/HIV infections in Tanzania, Malawi and Lesotho.

Last but not least, all countries have an obligation to respect the SRH rights of women as stipulated in the Cairo 1994 International Conference on Population Development. ASRH is an important component of overall health and essential for social, economic and human development. In line with these guiding principles, programs and policies should address socio-economic, political and cultural obstacles that hinder adolescents from gaining their reproductive freedom. Addressing SRH and HIV among adolescents and young people should be central in post 2015 development agenda.

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