While the intention of age of consent laws for medical services is often to protect children, in practice such laws do the opposite, by discouraging adolescents from accessing the services they need to stay healthy.

Age of consent laws for medical services require people aged younger than 18 years to obtain permission from a parent or guardian before accessing sexual and reproductive health services, HIV testing and treatment, pre-exposure prophylaxis and other health services. They particularly affect adolescent girls, whose sexuality tends to be stigmatized and who bear the physical and social burdens of unwanted pregnancies.

In 2017, 78 of 110 reporting countries stated that they required parental consent for a child under 18 years to access HIV testing, and 61 of 109 reporting countries required parental consent for HIV treatment. In addition, 68 of 108 reporting countries required parental consent to access sexual and reproductive health services.

Comprehensive sexuality education plays a central role in preparing adolescents and young people for a safe, productive and fulfilling life, and it is an important component of an HIV prevention package for young people. It provides opportunities to learn and acquire complete, accurate, evidence-informed and age-appropriate knowledge on sexuality and sexual and reproductive health issues.

Comprehensive sexuality education―defined as a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality―have been shown to contribute to delayed initiation of sexual intercourse, decreased frequency of sexual intercourse, decreased number of sexual partners, reduced risk taking, increased use of condoms and increased use of contraception among young people.

Despite the importance of comprehensive sexuality education, however, access to it is far from universal.

In 2017, approximately 47% of new HIV infections globally were among key populations and their sexual partners.

Members of key populations are at a significantly higher risk of contracting HIV. The available data suggest that the risk of HIV acquisition among gay men and other men who have sex with men was 28 times higher in 2017 than it was among heterosexual men. Similarly, the risk of acquiring HIV for people who inject drugs was 22 times higher than for people who do not inject drugs, 13 times higher for female sex workers than adult women aged 15–49 years and 13 times higher for transgender women than adults aged 15–49 years.

The earlier that a baby who has been born with HIV is diagnosed and starts treatment, the better the outcome.

To diagnose children younger than 18 months of age with HIV requires virological testing, which detects the virus or its components. Serological testing―which tests for HIV antigen and/or antibody generated as part of the immune response to infection―is used for children older than 18 months and adults. Serological testing cannot be used for infants, since it can’t differentiate between HIV antibody produced by the mother and then passed to her baby during the pregnancy, with the baby remaining uninfected, and HIV antibody produced by an HIV-infected baby.

Virological testing is not consistently available in most low- and middle-income countries, however, and when it is available it is often expensive and time-consuming, involving several clinic visits for mothers and infants, the transport of samples to centralized laboratories and potential delays in the return of results.

Globally, only half of infants who are exposed to HIV during pregnancy are tested before eight weeks of age. Since mortality among untreated infants is highest in the first three months of life, prompt diagnosis and linkage to treatment are crucial.

While the incidence of HIV infection globally for all ages declined by 22% between 2011 and 2017, HIV infections among people who inject drugs appear to be rising. HIV incidence—the number of new HIV infections among a susceptible population during a certain time—among people who inject drugs rose from an estimated 1.2% in 2011 to 1.4% in 2017.

There is compelling and comprehensive evidence that harm reduction—including opioid substitution therapy and needle–syringe programmes—prevents HIV infections among people who inject drugs. However, criminalization of drug use and possession for personal use and the widespread stigma, discrimination and violence faced by people who use drugs hampers access to health and harm reduction services.

In its new report, Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs, UNAIDS has outlined a set of recommendations for countries to adopt for a public health and human rights response to drug use.

The number of new HIV infections globally continues to fall. Modelled estimates show that new infections (all ages) declined from a peak of 3.4 million [2.6 million–4.4 million] in 1996 to 1.8 million [1.4 million–2.4 million] in 2017—the year for which the most recent data are available. However, progress is far slower than that required to reach the 2020 target of fewer than 500 000 new HIV infections (see graph below).

For people living with HIV to remain healthy and to prevent transmission, the HIV within their bodies needs to be suppressed to undetectable or very low levels through sustained antiretroviral therapy. In 2017—the year for which the most recent data are available—less than half of all people living with HIV were virally suppressed.

There are three gaps on the path to viral suppression (see graph below):

• The testing gap: people living with HIV who have not been tested and are unaware of their infection.
• The treatment gap: people living with HIV who have been diagnosed but have not initiated treatment.
• The viral suppression gap: people living with HIV who have initiated treatment but are not virally suppressed.

By far the biggest gap is the testing gap—one quarter of all people living with HIV were unaware that they were living with the virus in 2017. A further 16% were aware of their HIV status but not on treatment and an estimated 11% were on treatment but not virally supressed.

Although the gap in knowledge of HIV status is the largest, the viral suppression gap is growing more prominent. Knowledge of HIV status and treatment coverage has increased more rapidly than viral suppression. As a result, the percentage of people of people living with HIV and on antiretroviral therapy who are not virally suppressed has remained static at 11% in recent years, and the viral suppression gap’s share of the total gap has grown from 18% in 2015 to 21% in 2017 (see graph below).

Addressing HIV-related stigma and discrimination, providing treatment adherence support, monitoring viral load suppression and responding quickly to evidence of treatment failure can bring the world closer to the 2020 target of viral suppression among 90% of people living with HIV on treatment.

Women are disproportionality affected by HIV, particularly in sub-Saharan Africa. However, in some countries the imbalance is severe.

According to data collected in the Demographic and Health Surveys 2009–2017—a programme that collects and disseminates data on health and populations in developing countries—in the past decade HIV prevalence has been up to three times higher among 20–29-year-old women than men in some of the countries with the highest HIV burden in western and central Africa: Cameroon, Côte d’Ivoire and Ghana (see graph below). 

Data for 20–29-year-olds show the importance of HIV transmission through sex. Since men tend to start having sex at an older age than women, data for people who are 20–29 years old better cover both sexually active women and sexually active men. It is clear that women in the region are not being reached with the range of HIV prevention options they need to stop them becoming infected with HIV through sex.

With the ongoing drive in western and central Africa to match the progress made against HIV in eastern and southern Africa, there is a vital need for awareness of the disproportionate impact that the HIV epidemic has had, and continues to have, on women in the region. 

In February 2018, the Executive Director of UNAIDS called for the establishment of an Independent Expert Panel on prevention of, and response to, harassment, including sexual harassment, bullying and abuse of power at the UNAIDS Secretariat.

The Panel has completed its report, which was distributed to the members of the UNAIDS Programme Coordinating Board (PCB) on 4 December, together with the UNAIDS Secretariat management response. The Panel’s report and the UNAIDS management response will be presented to the PCB on 11 December at its 43rd meeting.

The decision on when the report will be communicated more broadly will be made by the voting members of the PCB. UNAIDS does not decide how the report is communicated to the PCB members and/or the public. The PCB will take a decision on the public release of the report on 6 December.

“I fully respect the decision of the Programme Coordinating Board in determining when the report of the Independent Expert Panel will be shared with staff and the public. It is important to have full transparency of the process,” said Michel Sidibé, UNAIDS Executive Director. “Our staff and key partners are keen to see the report and know the findings and recommendations, as well as contribute to discussions on the next steps.”

At the request of the Executive Director, the PCB structured the Independent Expert Panel to be fully independent of the management of the UNAIDS Secretariat, including on all decisions around communication.

The UNAIDS management response proposes an agenda for change to transform the UNAIDS Secretariat into a model working environment for all staff that ensures safety and inclusivity and upholds the highest standards of accountability and integrity. The agenda underscores that harassment, including sexual harassment, bullying and abuse of power at any level, will not be tolerated and that perpetrators will be held accountable for their actions.

“UNAIDS has always championed human rights, justice and protection of all people in its work, everyday,” said Mr Sidibé. “Transparency builds trust which helps make a safe and inclusive workplace.”

The senior management team of UNAIDS looks forward to further consultation with all staff and our partners as we move forward on these critical issues.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Victoria Beckham continues to be a champion for people living with and affected by HIV, especially women and children. Reducing stigma and discrimination and ensuring that people have access to testing, treatment and prevention services are her priorities. Victoria Beckham shared her thoughts in a special interview with Media Planet on the occasion of World AIDS Day.

Why is supporting the HIV cause so important to you, and why did you want to become a UNAIDS international goodwill ambassador?

I have always been a strong believer in women supporting other women. In my life I’ve been lucky enough to have been inspired and supported by fantastic women who have changed my outlook on life and who have inspired me to believe in myself and in my abilities.

Working with UNAIDS has given me the opportunity to meet some incredible women living with HIV and the people supporting them—the community health workers, peer support groups, the nurses, doctors who have dedicated their lives to helping people living with HIV. If I can lend my support to make change by using my voice to share their stories, then of course I’m going to do it – who wouldn’t?

What challenges do we still face in the fight against HIV?

What I didn’t realise is the huge impact that HIV is still having on families and communities, particularly in Africa. There are around 37 million people now living with HIV around the world, the highest number ever, and most are in Africa. Living with HIV isn’t easy.

Firstly, you have to know your status and get tested— 9.4 million people  living with HIV still don’t know they have the virus, which is why UNAIDS is focusing this year’s World AIDS Day Campaign around testing.

Secondly, you have to deal with the stigma that is still rampant in many parts of the world — do I tell my family? How do I protect my partner? What if my employer finds out? Are my kids OK?

Thirdly, you have to start taking treatment every day for the rest of your life… It’s a tough disease to deal with both physically and mentally, and people are still becoming infected at an alarmingly high rate.

As UNAIDS has shown, we still have miles to go to end AIDS. 1.8 million people became newly infected last year—it’s clear that a lot more needs to be done.

What have been your most powerful experiences as a UNAIDS international goodwill ambassador?

"For me, it has been meeting the women who are struggling every day to make a better life for their children. Some are literally putting their lives on the line just to make ends meet so that they can make sure their children are fed, are healthy and can go to school in the hope that they will have better life in the future. As a mother I can’t help but be moved by that.

When you have children, the most important thing is making sure that they’re OK—our kids come first, always. And it’s the children I met while I was travelling in Ethiopia with UNAIDS, children born with HIV whose parents have died of AIDS. This is a tragedy that is still happening around the world today despite the availability of preventative medicines.

Are you optimistic that we can one day live in a world that is free of HIV?

I strongly believe that finding a vaccine and a cure is possible, and I am confident that will happen in my lifetime. Until then, there are many things that we can do today to stop the impact HIV is having on people, on families and on communities.

Overcoming the stigma will allow young people to get the right information about how to protect themselves and stop new infections. It will allow people who think they may have been at risk of HIV to come forward to get tested and it will allow people living with HIV to not be afraid of taking treatment and seeking the care and support they need. Ending AIDS, yes one day—ending the impact of HIV…. we can do that today.