As homophobic discrimination continues to sweep across the African continent, we should be acutely mindful of the diverse ways it harms societies. While we are most aware of the direct effect of homophobic physical violence on sexual minority groups, it is also crucial that we are cognisant of the other insidious and multifaceted ways in which stigma and discrimination impact not just on sexual minorities but also on society at large.
Adolescents and young people (AYA) aged 12 – 24 in Africa and Asia are more likely to be adherent to antiretroviral therapy (ART) than their counterparts in North America and Europe, according to research published in AIDS this week. The study points to the fact that the HIV epidemics in North America and Europe are concentrated among key populations who are often marginalised from society, meaning they are hidden and have inadequate access to HIV services, such as treatment.
Globally, 62 percent of AYA were over 85 percent adherent or had a suppressed viral load. The percentage figures between regions varied, with 52.7 percent adherence for North America, 62 percent for Europe, and 83.8 and 83.9 percent for Africa and Asia respectively. These geographic variations are broadly attributed to the different types of epidemic in these regions, as well as the healthcare environment. However the authors acknowledge that a wealth of factors can be attributed to the discrepancies. In the case of Africa, the HIV epidemic is generalised, particularly in Southern and Eastern Africa, with a large focus on HIV testing, treatment and care, including a wide breadth of services for a variety of needs. There is also a lot of funding and focus on targeting those most at risk with HIV services, particularly woman. In Europe and North America, where the epidemics are concentrated, healthcare services are not HIV-specific, and it may be that the populations who are affected are ones rarely access healthcare services to begin with.
AYA represented over 40 percent of new HIV infections globally in 2012 – making them an extremely vulnerable group to HIV. Their needs are complex because of the physical and emotional transformations that happen during this period in their lives, and an increased potential for high risk-taking behaviours. Life expectancy for AYA has improved dramatically, however this improvement can be hampered if efforts aren’t channelled to improve adherence. It is especially important now that effective treatment adherence is known to have a prevention impact. The authors recommend proactively engaging with this group to improve adherence to ART.