Dear International AIDS Vaccine (IAVI) fellow,I hope you are well settled by now. I hope you enjoyed speaking with Professor Linda-Gail Bekker today about her discipline of adolescent health. Indeed, you believed you initially arrived to just look at the issues of HIV and TB infection among young people. After speaking with Linda-Gail, I am sure you appreciate that the aim of the fellowship is to understand the determinants of mental and physical health of adolescents, with the aim of preventing disease and promote health. Young people, as your read from Linda-Gail’s grant application to the Oppenheimer foundation, is a time of transitions – social and physiological – which heighten risk of STIs.
Were you not surprised to learn that HIV deaths have been rising in South African adolescents? According to the data collected, unlike the fall in HIV in other groups, there has been a rise in deaths among adolescents. I wonder if this means there has also been a rise in HIV infections in young people. A rise in HIV prevalence in adolescents is a typical marker of incident infections, as most infections in young people happen soon after sexual debut, while those already infected move out of the young age groups over time. In Namibia, the falling prevalence in the 15-24 age group – adolescents – was evidence of falling incidence. If prevalence is rising in South Africa among adolescents, this means more infections happen in young people – rather surprising since South Africa, like Namibia were you are from, has implemented massive behavioral change programs, distributed condoms and treated HIV positive people, all of which ought to stem new infections, at least in the overall population. What is happening to adolescents?
That was my first diary entry in the form of a letter from the Fellowship committee to myself. I am still reeling from the fact I have this fellowship! In the process, I have come to appreciate adolescents have particular vulnerabilities regarding HIV and I wonder if I captured this in my model of the HIV epidemic in South Africa. In my project, I simulate the whole epidemic, by modelling a population of 20 000 people, men and women, where some men also have sex with men. I do not believe it accurately captures how adolescents chose their partners – to do they go for older, richer partners (the "sugardady and sugarmammi" phenomenon). In my model, the way we specified teenagers chose partners may have come from mere assumptions about the age-difference in partners. I wonder what the literature says
I better than begin a review of the literature. As part of my job to systematize – give structure – to this IAVI fellowship, I need to ask each person in the organization for their top 3 papers in the field. Linda-Gail has written on the ethical issues of adolescents partaking in human subjects and perhaps that is where I will begin.