20th International AIDS Conference - Melbourne, Australia


MOAC0101 - Oral Abstract

Disparities and trends in AIDS mortality among adolescents living with HIV in low- and middle-income countries

Presented by Tyler Porth (United States).

T. Porth, C. Suzuki, A. Gillespie, S. Kasedde, P. Idele

UNICEF, New York, United States

Background: Since 2000, the burden of HIV and AIDS globally has declined significantly; however, data suggest adolescents (aged 10-19) have not experienced equal progress in AIDS mortality reductions compared to other age groups (aged 0-9 and 20+). This paper analyses estimated annual AIDS mortality risk among adolescents living with HIV to highlight adverse trends and quantify sex disparities to better inform and more precisely target HIV and AIDS programming for adolescents.
Methods: UNAIDS 2012 HIV and AIDS estimates were analysed to assess trends and to quantify Annual AIDS Mortality Risk (AMR) among people living with HIV and Male-to-Female Annual AIDS Mortality Risk Ratio (AMRR), which indicates sex disparities in AMR. Estimates from 1990 to 2012 were analysed and supplementary program coverage data were collated from nationally representative household surveys.
Results: Between 2005 and 2012, adolescents (aged 10-19) and non-adolescents (aged 0-9 and 20+) experienced similar declines in new HIV infections. Yet, these populations experienced alarmingly different trends in AIDS mortality: non-adolescents experienced a 32% decrease in AIDS related deaths between 2005 and 2012, while adolescents experienced a 50% increase. The AMR among people living with HIV was mostly similar between males and females of all ages with the exception of older adolescents aged 15-19, where girls experienced a significant reduction in AMR while rates remained constant among boys. This sex disparity has been increasing since 1994. Since 2006, adolescent boys aged 15-19 living with HIV have been approximately 75% more likely to die of AIDS each year compared to girls living with HIV of the same age.
Conclusions: Data suggest AMR increased in the transition between childhood and adulthood, perhaps indicating adolescents lost to follow-up in the transition from paediatric facilities to adult-oriented facilities. Additionally, AMR among girls aged 15-19 living with HIV decreased relative to boys living with HIV of the same age, possibly indicating these girls had increased access to life-saving services through reproductive health and antenatal care facilities as they entered their reproductive years. These findings have important implications on HIV and AIDS programs and demonstrate the need to prioritize adolescents, including adolescent boys, to enable healthy transition into adulthood.

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