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Beginning in early 2015, UNICEF with UNAIDS, WHO, and other organizations initiated the All In to #EndAdolescentAIDS program. The program has some good points – e.g, asking for better treatment for HIV-positive adolescents.
However, the program is off the mark on HIV prevention. It says nothing about risks adolescents in Africa face to get HIV from blood-contaminated instruments during health care (blood tests, dental care, injections, etc) and cosmetic services (tattooing, manicures, hair styling).
Ignoring such risks while focusing only on sex stigmatizes those who are already infected (aha! you had careless sex!) and misleads those who are HIV-negative to ignore blood-borne risks.
Sex? The best available evidence – from national surveys – suggests less than half of HIV infections in African adolescents came from sex. For example, in national surveys in Kenya, Lesotho, and Tanzania, majorities of HIV-positive youth aged 15-19 years reported being virgins (Table 1). Across these three countries, 57% (36 of 63) HIV-positive youth in the survey samples reported being virgins.
Some virgins may have acquired HIV as babies from their mothers – but without antiretroviral treatment (ART), which arrived late in Africa, few babies with HIV survive to adolescence. Thus most adolescent virgins with HIV likely got it from blood contacts. If virgins are getting HIV that way, some non-virgins are likely getting it the same way — just because an HIV-positive adolescent had sex with one or more partners does not mean sex was the source of his or her HIV.
Using data from national surveys in Lesotho, Swaziland, and Zimbabwe, and assuming no lying about sexual behavior, Deuchert in a 2011 paper estimates only 30% of HIV-positive never-married adolescent women aged 15-19 years got HIV through sex.
What if some lied? National surveys in Lesotho, Swaziland, Zimbabwe, and Zambia included 5,570 never-married women aged 15-19 years. Three percent (250) were HIV-positive, of which 116 (46%) reported being virgins. Even supposing that some women lied, a recent PhD dissertation estimates only 50% of infections came from sex (the author assumed some HIV-positive girls lied about being virgins, but this was more than offset by some non-virgins getting HIV from non-sexual risks).
But let’s cast the net wider: Over the last 15 years, 45 national surveys in Africa reported %s of virgin and non-virgins youth aged 15-24 years with HIV (Table 2). Among those who said they weren’t virgins, the % with HIV was often no or only moderately greater than for self-reported virgins.
For example, in Congo (Brazzaville), Rwanda, Guinea (2012), Democratic Republic of the Congo, and Gambia, the % of young women HIV-positive was equal or higher among self-reported virgins than among all young women. Among young men, the % with HIV was the same or higher among virgins than among all young men in Tanzania (2007-08), Congo (Brazzaville), Sierra Leone (2013), Guinea (2oo5), Mali, Sao Tome and Principe, Burundi, Benin, Burkina Faso, Niger, and Gambia.
Across all 45 surveys, the median ratio of the %s of self-reported virgin young men with HIV to all young men with HIV was o.75 (last line, Table 2). Across all 45 surveys, the median ratio of the %s of self-reported virgin young women with HIV to all young women with HIV was 0.33 (last line, Table 2). And, as noted above, many infections in non-virgins likely came from bloodborne risks.
The only way to say most HIV infections in adolescents in Africa come from sex is to throw away the best evidence we have – to assume survey data are wrong because self-reported HIV-positive virgins are lying.
That seems to be what bureaucrats and experts at UNICEF, WHO, UNAIDS, and other international organizations have done – ignoring evidence to accuse HIV-positive adolescents of unwise sex, and accusing them also of lying if they say they are virgins.
Stigmatizing HIV-positive African youth for unwise sexual behavior is a form of abuse – not sexual abuse, but abuse nonetheless. Because young women are more likely than young men to be exposed to HIV during more frequent health care and cosmetic procedures, not warning about bloodborne risks contributes to unrecognized violence and abuse targeting African women.
1. Brewer DD, Potterat JJ, Muth SQ, Brody S. Converging evidence suggests nonsexual HIV transmission among adolescents in sub-Saharan Africa. J Adolescent Health 2007; 40: 290-293. Partial draft available at: https://www.deepdyve.com/lp/elsevier/converging-evidence-suggests-nonsexual-hiv-transmission-among-105k5VXKQE (accessed 19 December 2015).
2. Deuchert E. The Virgin HIV Puzzle: Can Misreporting Account for the High Proportion of HIV Cases in Self-reported Virgins? Journal of African Economics, October 2011, pp 60-89. Abstract available at: http://jae.oxfordjournals.org/content/20/1/60.abstract (accessed 19 December 2015).
3. Tennekoon VSBW. Topics in health economics. PhD dissertation. Washington State U, 2012. Available at: http://research.wsulibs.wsu.edu:8080/xmlui/bitstream/handle/2376/4270/Tennekoon_wsu_0251E_10484.pdf?sequence=1 (accessed 18 December 2015). See also an earlier paper by