16 March 2018
Public-health leaders in the fight against HIV/AIDS have come to an ominous realization: Progress in cutting new infections has slowed, in part because of a persistent cycle of transmission among young women in sub-Saharan Africa. New HIV infections have been reduced around the world since the late 1990s by diligent efforts at education, the rollout of antiretroviral drugs and other factors. But declines have lost momentum, for the first time since infections began coming down. Today, the numbers are far from targets set by the United Nations, which call for them to fall to about a quarter of their current level by 2020.
Teenage girls and young women in parts of sub-Saharan Africa, a growing and vulnerable population, continue to be infected at high rates. At the same time, the rapid expansion of the continent’s youth population means greater numbers of young women are at risk every year. The slowdown has alarmed public-health experts, who warn that infections could start rising again. A reversal would erase progress against one of the most significant infectious disease epidemics of modern times, costing lives, economic prosperity and billions more dollars than governments and organizations have already spent to fight it over decades.
More public-health officials and researchers say breaking the cycle of infection for young women is critical to keeping the virus in check. Successful prevention methods, including circumcision and condom use, have been geared mainly to men. Now, researchers are working to develop new ways to protect women, including education programs, drug regimens and other prevention tools. “They are the key to global epidemic control of HIV,” said Salim Abdool Karim, director of the Center for the AIDS Program of Research in South Africa, known as Caprisa, a consortium of South African and North American scientists that researches HIV in young women.
Sizeni Soni said she wasn’t surprised to learn at the age of 23 that she had HIV. Ms. Soni, who lives in Vulindlela, an impoverished community in the hills of South Africa’s KwaZulu-Natal province with some of the highest HIV rates in the world, believes she contracted the virus from her former boyfriend, a migrant worker four years her senior. “It has become normal—you test, you test positive,” Ms. Soni said on a visit to her local health clinic for a refill of the antiretroviral drugs she takes daily.
Young women ages 15 to 24 accounted for 20% of the 1.8 million people globally who were newly infected in 2016, more than any other age group of men or women, according to the Joint United Nations Program on HIV/AIDS. In sub-Saharan Africa, where nearly two-thirds of all new HIV infections in 2016 occurred, more than twice as many young women were infected as young men. In the rest of the world, more young men were infected than young women.
In a unique cycle of transmission, researchers say young women in parts of eastern and southern Africa are often infected by older men, whom many date because the men help them financially. When those women reach their late 20s and 30s, they become involved with men closer to their own ages, passing the virus onto them, according to Caprisa and other researchers. As those men date younger women, they can transmit HIV to the next wave. It is less common in other parts of the world for different generations to infect each other, which helps limit transmission.
“You’ve got this ongoing cycle” of transmission fed by a constant supply of girls reaching teenhood, said Quarraisha Abdool Karim, Caprisa’s associate scientific director, who founded the consortium with her husband, Salim Abdool Karim, and other institutions in 2002. In a 2016 study, she and other researchers at Caprisa found that women ages 15 to 24 in Vulindlela and a nearby community were infected by men an average of 8.7 years older. Researchers cite both consensual sex and rape as sources of infection. The dramatic results showed that 60% of the women in the next age group, from 25 to 40, were infected, revealing the area to be one of the most HIV infected in the world.
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