Adolescents And HIV
16 August 2022
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Key facts

Over 1.5 million adolescents and young adults aged 10–24 years died in 2020, nearly 5000 every day.
Young adolescents aged 10–14 years have the lowest risk of death of all age groups.
Injuries (including road traffic injuries and drowning), violence, self-harm and maternal conditions are the leading causes of death among adolescents and young adults
Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.
Early onset of substance use is associated with higher risks of developing dependence and other problems during adult life, and people of younger ages are disproportionately affected by substance use compared with people of older ages.
Globally, there were 41 births per 1000 to girls aged 15–19 years in 2020.

Survival chances for adolescents and young adults vary greatly across the world. In 2020, the probability of dying among those aged 10–24 years was highest in sub-Saharan Africa, Oceania (excluding Australia and New Zealand), northern Africa and southern Asia (1). The average global probability of a 10-year-old dying before age 24 was 6 times higher in sub-Saharan Africa than in North America and Europe.

Main health issues
Unintentional injuries are the leading cause of death and disability among adolescents. In 2019, nearly 100 000 adolescents (10–19 years) died as a result of road traffic accidents (2). Many of those who died were vulnerable road users, including pedestrians, cyclists or users of motorized two-wheelers. In many countries, road safety laws need to be made more comprehensive, and enforcement of such laws needs to be strengthened. Furthermore, young drivers need advice on driving safely, while laws that prohibit driving under the influence of alcohol and drugs need to be strictly enforced among all age groups. Blood alcohol levels should be set lower for young drivers than for adults. Graduated licences for novice drivers with zero-tolerance for drink-driving are recommended.

Drowning is also among the top causes of death among adolescents; more than 40 000 adolescents, over three quarters of them boys, are estimated to have drowned in 2019. Teaching children and adolescents to swim is an essential intervention to prevent these deaths.

Interpersonal violence is among the leading causes of death in adolescents and young people globally. Its prominence varies substantially by world region. It causes nearly a third of all adolescent male deaths in low- and middle-income countries in the WHO Region of the Americas. According to the global school-based student health survey 42% of adolescent boys and 37% of adolescent girls were exposed to bullying. Sexual violence also affects a significant proportion of youth: 1 in 8 young people report sexual abuse.

Violence during adolescence also increases the risks of injury, HIV and other sexually transmitted infections, mental health problems, poor school performance and dropout, early pregnancy, reproductive health problems, and communicable and noncommunicable diseases.

Effective prevention and response strategies include promoting parenting and early childhood development; addressing school-based bullying prevention, programmes that develop life and social skills, and community approaches to reduce access to alcohol and firearms. Effective and empathetic care for adolescent survivors of violence, including ongoing support, can help with the physical and psychological consequences.

Mental health
Depression is one of the leading causes of illness and disability among adolescents, and suicide is the second leading cause of death in people aged 15–19 years (2). Mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years. Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.

Many factors have an impact on the well-being and mental health of adolescents. Violence, poverty, stigma, exclusion, and living in humanitarian and fragile settings can increase the risk of developing mental health problems. The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Building socioemotional skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen the ties between adolescents and their families and improve quality of home environments are also important. If problems arise, they should be detected and timely managed by competent and caring health workers.

Adolescent mental health fact sheet

Alcohol and drug use
Drinking alcohol among adolescents is a major concern in many countries. It can reduce self-control and increase risky behaviours, such as unsafe sex or dangerous driving. It is an underlying cause of injuries (including those due to road traffic accidents), violence and premature deaths. It can also lead to health problems in later life and affects life expectancy. Worldwide, more than a quarter of all people aged 15–19 years are current drinkers, amounting to 155 million adolescents. Prevalence of heavy episodic drinking among adolescents aged 15­–19 years was 13.6% in 2016, with males most at risk.

Cannabis is the most widely used psychoactive drug among young people with about 4.7% of people aged 15–16 years using it at least once in 2018. Alcohol and drug use in children and adolescents is associated with neurocognitive alterations which can lead to behavioural, emotional, social and academic problems in later life.

Prevention of alcohol and drug use are important areas of public health actions and may include population-based strategies and interventions, activities in school, community, family and on the individual level. Setting a minimum age for buying and consuming alcohol and eliminate marketing and advertising to minors are among the key strategies for reducing drinking among adolescents.

Tobacco use
The vast majority of people using tobacco today began doing so when they were adolescents. Prohibiting the sale of tobacco products to minors (under 18 years) and increasing the price of tobacco products through higher taxes, banning tobacco advertising and ensuring smoke-free environments are crucial. Globally, at least 1 in 10 adolescents aged 13–15 years uses tobacco, although there are areas where this figure is much higher.

An estimated 1.7 million adolescents (age 10–19 years) were living with HIV in 2019 with around 90% in the WHO African Region (3). While there have been substantial declines in new infections amongst adolescents from a peak in 1994, adolescents still account for about 10% of new adult HIV infections, with three-quarters amongst adolescent girls (4). Additionally, while new infections may have fallen in many of the most severely affected countries, recent testing coverage remains low suggesting that many adolescents and young people living with HIV may not know their status (5).

Adolescents living with HIV have worse access to antiretroviral treatment, adherence to treatment, retention in care and viral suppression. A key factor contributing to these is limited provision of adolescent-friendly services including psychosocial interventions and support.

Adolescents and young people need to know how to protect themselves from HIV infection and must also have the means to do so. This includes being able to obtain access HIV prevention interventions including voluntary medical male circumcision, condoms and pre-exposure prophylaxis, better access to HIV testing and counselling, and stronger links to HIV treatment services for those who test HIV positive.

Other infectious diseases
Thanks to improved childhood vaccination, adolescent deaths and disability from measles have fallen markedly. For example, adolescent mortality from measles fell by 90% in the African Region between 2000 and 2012.

Diarrhoea and lower respiratory tract infections (pneumonia) are estimated to be among the top 10 causes of death for adolescents 10–14 years. These two diseases, along with meningitis, are all among the top 5 causes of adolescent death in African low- and middle-income countries.

Infectious diseases like with human papilloma virus that normally occurs after onset of sexual activity can lead to both short-term disease (genital warts) during adolescence but more importantly also leads to cervical and other cancers several decades later. Early adolescence (9–14 years) is the optimal time for vaccination against HPV infection and it is estimated that if 90% of girls globally get the HPV vaccine more than 40 million lives could be saved over the next century. However, it is estimated that in 2019 only 15% of girls globally received the vaccine.

Human papillomavirus (HPV) and cervical cancer fact sheet

Early pregnancy and childbirth
Approximately 12 million girls aged 15–19 years and at least 777 000 girls under 15 years give birth each year in developing regions. Complications from pregnancy and childbirth are among the leading causes of death for girls aged 15–19 years globally.

The UN Population Division puts the global adolescent birth rate in 2020 at 41 births per 1000 girls this age, and country rates range from 1 to over 200 births per 1000 girls (6). This indicates a marked decrease since 1990. This decrease is reflected in a similar decline in maternal mortality rates among girls aged 15–19 years.

One of the specific targets of the health Sustainable Development Goal (SDG 3) is that by 2030, the world should ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

Adolescents need and have a right to comprehensive sexuality education, a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. Better access to contraceptive information and services can reduce the number of girls becoming pregnant and giving birth at too young an age. Laws that are enforced that specify a minimum age of marriage at 18 can help.

Girls who do become pregnant need access to quality antenatal care. Where permitted by law, adolescents who opt to terminate their pregnancies should have access to safe abortion.

Source: WHO

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