Reducing HIV prevalence among young people: A review of the UNGASS prevalence goal and how it should be monitored
London School of Hygiene and Tropical Medicine, UK
Authors: Dr. Mar Pujades Rodríguez and Prof. Richard Hayes
Discussion paper commissioned by WHO
At the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), in June 2001, member states committed themselves to achieving a 25% reduction in HIV prevalence among young people aged 15 to 24 years by 2005 in the most affected countries, and by 2010 in all other countries.
The present review discusses the limitations of HIV prevalence estimates when used to track changes in the HIV epidemic in young people. In particular, it highlights important factors that need to be considered in interpreting prevalence data obtained from antenatal care (ANC) surveillance. The document suggests that, despite substantial efforts made in recent years to improve the quality and representativeness of sentinel surveillance systems and to develop adjustment methods that can be used to obtain more accurate estimates of HIV prevalence in the population, current estimates may not accurately reflect trends of infection in young people. Behavioural changes, such as delay in sexual debut and changes in patterns of contraceptive use, are shown to be important factors that need to be accounted for. In particular, increases in condom use among young people may affect observed trends of HIV infection from ANC surveillance in either direction, depending on the sector of the population that is more likely to use them (e.g. high or low risk groups). Furthermore, the combined effect of the discussed factors is difficult to predict and will be determined by the characteristics of the site and the stage of the HIV epidemic.