Sub-Saharan African countries where adolescents 15 or younger could be tested for HIV without sign-off by parents or guardians show 11 percent higher rates of testing for the virus among those from 15 to 18 years old than in countries where the legal age of consent for testing is 16 or older, according to a study published in the World Health Organization’s January Bulletin.
The findings, across 15 sub-Saharan countries, could have important implications not just for increasing rates of HIV diagnosis among teenagers, but by opening access to both treatment and counseling for an underserved population, potentially lowering incidence of the virus among the most vulnerable age group, the researchers note.
While deaths caused by AIDS-related illnesses have declined across every other age group from 2000 to 2016, they have not dropped for adolescents, for whom HIV remains the leading cause of death in sub-Saharan Africa. Of an estimated 1.8 million adolescents living with HIV worldwide, about 1.5 million — or 84 percent — live in sub-Saharan Africa. Among them are teenagers who were infected through mother to child transmission, but never diagnosed, young people exposed to the virus through blood transfusions, as well as those who were exposed to the virus through sex or injecting drug use. The World Health Organization recommends that testing for the virus, with counseling and links to treatment and prevention services be routine for all adolescents. UNAIDS has projected that if, by 2020, 90 percent of all people living with HIV are aware of it, 90 percent of them are accessing treatment, and if treatment is consistent and effective enough to suppress the virus to undetectable levels in 90 percent of them, HIV could cease to be a global public health threat by 2030.
Recent data, however, has shown only 23 percent of adolescent girls and just 16 percent of adolescent boys reporting that they have ever been tested for the virus. Barriers to testing include fear, stigma, and access to testing sites, the researchers note. Requirements for young people to have parental or guardian consent for testing also have been seen as possible barriers, but whether the requirements actually affect testing rates had not previously been studied.
The researchers examined testing data pertaining to more than 69,000 adolescents between the ages of 15 and 18, nearly 40,000 of them teenaged girls and the rest teenaged boys, across 15 sub-Saharan countries. Of the countries, six had laws setting the age of consent for HIV testing at 15 or younger (in South Africa and Uganda adolescents as young as 12 can be tested independently, the researchers note), and nine set the age for testing without adult consent at 16 or higher. Teenagers in all of the countries can be tested independently by the time they are 18.
The association between living in countries where laws allow younger adolescents independent access to HIV testing and higher rates of testing among adolescents was stronger in teenage girls than in teenage boys, according to the report.