Global leaders have committed to take action towards ending the AIDS epidemic among adolescents. At a meeting during the 69th session of the United Nations General Assembly, co-hosted by UNICEF, UNAIDS and the Governments of Brazil and Kenya, representatives from countries across six regions came together to join a growing movement to advance the response to HIV among adolescents.

During the meeting, participants pledged their support to All In, a joint initiative between UNICEF, UNAIDS and partners to reduce new HIV infections among adolescents by at least 75% and increase HIV treatment to reach at least 80% of adolescents living with the virus. The initiative outlines that the targets can be achieved through providing HIV prevention, testing, treatment, care and social change programmes that focus on the specific needs of adolescents living with, or at higher risk of acquiring, HIV.

A global movement to advance efforts towards ending the AIDS epidemic among adolescents is urgently needed as this is the only age group among which AIDS-related deaths are actually increasing. AIDS-related illnesses are the second leading cause of death among adolescents aged 10–19 years globally, and the leading cause of death among adolescents in Africa.

In 2013, there were an estimated 2.1 million adolescents living with HIV, more than 80% of whom live in sub-Saharan Africa. Many still do not know their status. Almost two thirds of the 250 000 new infections among 15–19 year olds in 2013 were among adolescent girls.

During the event, speakers, including young people living with HIV, called on leaders to reflect on their current efforts to prevent the spread of HIV among adolescents, and to invest more in the most effective interventions. Government representatives from around the world, including Botswana, Brazil, Thailand and Ukraine, pledged their commitment to go All In for adolescents.

The formal launch of All In is scheduled for early 2015.

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The sexual and reproductive health rights of young marginalized populations are often neglected and their collective voice in this critical area not always heard. To try to redress this imbalance young people from marginalized communities and key populations in Bangladesh, Ethiopia, Puerto Rico and Uganda met in New York this week to discuss how to put these rights issues firmly on the post-2015 development agenda, leaving no one behind. 

Taking place on 25 September, the General Assembly side event which took the form of a panel discussion, examined the vital role of community engagement, advocacy and service delivery in protecting the rights and meeting the needs of young key populations. These include men who have sex with men, sex workers and young people living with HIV.   

Young speakers, who were peer educators, directors of national and regional NGOs, actors and community leaders, argued that universal access to HIV services and health coverage could not be achieved without prioritizing the needs of the most marginalized. They also noted the contribution of comprehensive sexuality education to improving young people’s health and the role that communities can play in both promoting rights and challenging stigma and discrimination.

The event was hosted by the Government of Brazil and organized by the International HIV/AIDS Alliance, GESTOS, the Global Youth Coalition on AIDS, ATHENA, ICASO, International Civil Society Support, STOP AIDS NOW!, Stop AIDS Alliance, the HIV Young Leaders Fund, the African Services Committee, and the Global Forum on MSM and HIV, in collaboration with UNAIDS.

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The First Lady of South Africa, Thobeka Madiba-Zuma, pledged to improve the health of young women and girls in South Africa during a meeting with UNAIDS Executive Director Michel Sidibé on 4 September at the President’s official residence.

Mr Sidibé acknowledged the First Lady’s role in lobbying for a price reduction for the human papillomavirus vaccine and ensuring better access to the vaccine in developing countries. The First Lady works extensively on health issues related to breast and cervical cancer and  HIV, including prevention initiatives for young women and girls.

During his four-day visit to the country, Mr Sidibé also met with the South African Minister of Health, Aaron Motsoaledi, to discuss Africa’s response to the Ebola virus outbreak and the lessons African leaders can learn from the AIDS response. Mr Sidibé said that strengthening health systems and bridging the gap between health systems and the community are critical to addressing the outbreak effectively.

In a round-table dialogue with Mr Sidibé, members of the South African National AIDS Council’s Civil Society Forum reiterated the need to form a stronger and strategic partnership with the Government of South Africa and the critical role that civil society plays in creating demand for the services that the government provides to respond to HIV and tuberculosis. 

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The newly-formed Nigerian national youth alliance has made increasing youth-friendly HIV and sexual and reproductive health services its top priority. The group will focus its efforts on ensuring that the needs of young people are met in the post-2015 agenda. It aims to do this by working with national decision-makers and development partners to ensure the priorities of young people are adequately addressed in intergovernmental negotiations on the post-2015 agenda.  

Youth-friendly HIV services should be based on an understanding of, and respect for, the realities of young people. HIV services should be easy to access and welcoming for young people, meet their needs comfortably and should succeed in retaining young people in on-going care. Services should be provided by personnel who are trained to respond to the specific needs of young people and ensure confidentiality and trust.

Sixty youth representatives from across Nigeria participated in the ACT 2015! strategy meeting organized by Education as a Vaccine (EVA) in conjunction with UNAIDS, UNICEF, the Federal Ministry of Youth Development, the Federal Ministry of Health and the National Youth Network on HIV/AIDS. The meeting was held in Abuja from 4 to 6 August 2014.

ACT 2015! is a campaign that seeks to mobilize young people to ensure HIV remains a priority in the post-2015 agenda and that sexual and reproductive health and rights are a priority in United Nations negotiations.

Nine other countries are planning to hold similar events for young activists: Algeria, Bulgaria, Kenya, Mexico, the Philippines, South Africa, Thailand, Zambia and Zimbabwe. 

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Now a 19-year-old university student in South Africa, Noxolo Myeketsi started receiving a social welfare grant in 2005. Part of a state-run programme to assist poor households, the cash transfers allowed her to stay in school and her grandmother to buy food and pay their bills.

The grant changed Noxolo’s life for the better. Other girls turned to having sex, often with older men, in exchange for basic needs, and potentially exposed themselves to sexually transmitted infections and HIV.

“I believe that without the grant assistance, I would not have been able to make healthy decisions in my life. Maybe I would have ended up being a sugar daddy’s girl, like others from my area, or ended up contracting HIV,” Noxolo said.

Social protection schemes, including financial incentives, can make a difference in a number of ways. The World Bank reports that, globally, there is strong evidence that cash transfers improve the education, health and lifelong income of beneficiaries. 

“Cash transfer programmes work for HIV prevention and a host of other human development outcomes as well, and they are scalable,” said David Wilson, Director of the World Bank’s Global HIV/AIDS Program.

Studies conducted in South Africa show that small cash grants provided to poor households allow teenage girls to make safer sexual choices and can significantly reduce the number of new HIV infections. When psychosocial care and support are added to the cash, the results for girls are even better.

At the UNAIDS Programme Coordinating Board (PCB) meeting held in Geneva in July a thematic session was organized on addressing the social economic drivers of HIV through social protection, at which Noxolo spoke about the positive impact grants can have.

Following up on the PCB meeting, UNAIDS and the World Bank pledged to assist governments in the process of scaling up social protection programmes, including cash transfers, for HIV prevention in eastern and southern Africa, covering Botswana, Kenya, Lesotho, Malawi, South Africa, Swaziland, United Republic of Tanzania and Zambia.

“It is befitting that South Africa is the centre of the initiative because the country accounts for 23% of sub-Saharan Africa’s new HIV infections, 18% of the global HIV burden and has one of the world largest social protection programmes,” said Benjamin Ali, UNAIDS Country Director for South Africa.

Countries and partners will be urged to collaborate in a comprehensive review of social protection systems. Proposals to make such systems HIV sensitive include modifying age bands and other inclusion criteria to ensure that the groups most affected and at risk of HIV infection are covered, providing some cash directly to girls and young women and linking cash incentives to their adherence to HIV prevention and treatment programmes.

Adolescents aged 10–19 are among the people most neglected by the HIV response, yet AIDS is the second biggest contributor to adolescent death globally and the main contributor in sub-Saharan Africa. During a satellite session at the 20th International AIDS Conference in Melbourne, Australia, adolescents and young people, high-level government officials, donors, researchers and youth service providers explored ambitious but effective ways of better protecting this key group.

At the 20 July session, called Ending the Epidemic in Adolescents, UNAIDS Executive Director Michel Sidibé announced a joint UNAIDS/UNICEF initiative entitled All In. The initiative aims to ensure that adolescents infected and affected by HIV are not left behind. It is intended to become a global movement to close the prevention and treatment gap and will be concentrated in 25 countries that represent 90% of AIDS-related deaths and 85% of new infections among adolescents.

To ensure that the movement is built from the grass roots and shaped by the meaningful involvement of the focused group, Mr Sidibé asked adolescents and young people to engage and help shape the way forward for All In.

The satellite session provided an opportunity to exchange information and ideas, with presentations of the latest data on the epidemic among adolescents, which show that comprehensive knowledge about the virus, condom use, HIV testing and treatment coverage are still low in most countries. Young people living with and affected by HIV also shared their experiences and challenged assembled government and United Nations officials to do more for the AIDS response.

In addition, highlights of a Youth Action Plan, developed at this year’s youth preconference event held on 18 and 19 July, were discussed. The plan is designed to ensure that young people are at the centre of the global movement to step up AIDS advocacy, policy and treatment.