This blog is the first of a series of entries about FHI 360’s work with adolescent girls and microbicides.
Almost one-quarter of all people living with HIV are less than 25 years old, and youth (ages 15-24) account for 41% of all new HIV infections. Adolescent girls are particularly vulnerable; females comprise more than 60% of all young people living with HIV. In sub-SaharanAfrica, girls are three to five times more likely to be infected with HIV than boys of the same age. Factors such as lack of education, involvement in cross-generational or transactional sexual relationships, pressure to contribute to a family income, and early marriage all contribute to girls’ risk of becoming infected.
New female-initiated HIV prevention methods, including oral and topical microbicides, are urgently needed to address young women’s vulnerability. Unfortunately, adolescent girls are often excluded from studies that explore the effectiveness of these types of methods. There are numerous challenges to recruiting and retaining young women in HIV prevention trials. For example, adolescents might be too young to legally consent to trial participation, and their participation is often opposed by their communities.
However, there are many important scientific, programmatic and ethical reasons to include adolescents in studies on female-initiated HIV prevention methods. Without research on the effectiveness and acceptability of microbicides among adolescents, regulatory bodies are unlikely to allow microbicides to be marketed to adolescents. The failure to include younger adolescents in most microbicide trials also is resulting in missed opportunities for HIV prevention programming. And, given the high HIV incidence rates among female adolescents and the challenges they face in using other risk-reduction methods, including young women in clinical microbicide trials is also a matter of social justice.
To address these issues, FHI 360 is currently conducting a ground-breaking study, “Adolescents Women and Microbicide Trials: Assessing the Opportunities and Challenges of Participation,” in Tanzania and India among young women ages 15-21. This multiphase study is (1) exploring the differences in HIV risk among girls ages 15-17 versus those ages 18-21; (2) evaluating the factors that lead to the exclusion of adolescent girls from HIV prevention trials; and (3) aiming to determine the acceptability of microbicide use among this population. When the study is done, researchers will recommend whether or how trials on microbicides and other HIV prevention methods should be adapted to include adolescent participants. This study is one step toward increasing adolescent girls’ autonomy and decreasing their risk of HIV.