Closing the gap in programming for adolescents living with HIV in eastern and southern Africa: the role of social protection in positive prevention

The Eastern and Southern Africa (ESA) region has a high burden of HIV and AIDS, with an estimated 19.6 million people living with the virus (UNAIDS, 2018). All countries in the region have generalised epidemics, with an adult prevalence of 6.8% among those aged 15-49 (greater variations are observed between countries). HIV incidence and prevalence tends to be concentrated in particular sub-populations such as adolescent girls and young women (AGYW), men who have sex with men (MSM), transgender people, people who sell sex, prisoners and people who inject drugs (UNAIDS, 2018). According to UNICEF, 2.1 million adolescents aged 10-19 were living with HIV globally in 2016. Furthermore, 590,000 young people between the ages of 15 and 24 were newly infected with HIV, of whom 250,000 were adolescents between the ages of 15 and 19 in 2017 (UNAIDS, 2018). AGYW aged 15-24 are the most affected by HIV: HIV prevalence among this population in the ESA region was double that among adolescent boys and young men (ABYM) in 2016 (3.4% vs 1.6%) (UNAIDS, 2017; Govender et al., 2018). Furthermore, while HIV incidence rates are generally decreasing, they are still high in many ESA countries (UNAIDS, 2017). It is estimated that new HIV infections declined by 56% among children (aged 14 or younger) to 77,000 between 2010 and 2016 (UNAIDS, 2017). Among adults, declines were estimated at 29% over the same period, although significant variations are observed between countries.