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      Pre-exposure prophylaxis for South African adolescents: What evidence?

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          Abstract

          Adolescents and young women, particularly in South Africa, are at increased risk of HIV acquisition. To date, we have had limited primary prevention options to offer. Oral pre-exposure prophylaxis (PrEP) is an additional prevention modality that has now been proven to reduce HIV acquisition in those who take it consistently during periods of HIV infection exposure. We review the PrEP evidence in adolescents and highlight some of the research gaps. Our recommendation is to increase the number of demonstration projects and other scale-up opportunities to offer oral PrEP to at-risk adolescents, and monitor carefully to answer the outstanding questions.

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          Health for the world's adolescents: a second chance in the second decade.

          The World Health Organization has produced a multimedia, interactive online report entitled Health for the World's Adolescents: A Second Chance in the Second Decade. The report provides an overview of global and regional estimates of adolescent mortality and disability-adjusted life years, disaggregated by age, sex, and cause, and country-level data on health-related behaviors and conditions among adolescents. It outlines the reasons why adolescence is a unique period in the life course requiring special attention and synthesizes current thinking about the determinants that underlie the differences in health status between adolescents. For the first time, this new report pulls together recommendations and guidance from across the World Health Organization relating to interventions directed to a range of priority health problems, including use of alcohol and other psychoactive substances, AIDS, injuries, mental health, nutrition, sexual and reproductive health, tobacco use, and violence, focusing on four core functions of the health sector: supportive policies, service provision, strategic information, and working with other sectors. The report concludes with 10 key actions that would strengthen national responses to adolescent health, and outlines the approaches that are needed to overcome the obstacles to accelerating evidence-informed actions to improve the health of adolescents worldwide--with all the benefits that this will have for public health in the present and across the life course, for this generation and the next.
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            Sexual Power and HIV Risk, South Africa1

            Among a sample of young women, limited sexual power was associated with inconsistent condom use but not directly with HIV.
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              Providing comprehensive health services for young key populations: needs, barriers and gaps

              Introduction Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both. Discussion We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs. Results YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels. Discussion YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                samj
                SAMJ: South African Medical Journal
                SAMJ, S. Afr. med. j.
                Health and Medical Publishing Group (Cape Town )
                2078-5135
                November 2015
                : 105
                : 11
                : 907-911
                Affiliations
                [1 ] University of Cape Town South Africa
                Article
                S0256-95742015001100018
                10.7196/SAMJ.2015.V105I11.10222
                26632316
                fd544f41-d8e8-4a40-987a-3d8093abef2d

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO South Africa

                Self URI (journal page): http://www.scielo.org.za/scielo.php?script=sci_serial&pid=0256-9574&lng=en
                Categories
                Health Care Sciences & Services
                Health Policy & Services
                Medical Ethics
                Medicine, General & Internal
                Medicine, Legal
                Medicine, Research & Experimental

                Social law,General medicine,Medicine,Internal medicine,Health & Social care,Public health

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