Demographic change and HIV epidemic projections to 2050 for adolescents and young people aged 15-24

ABSTRACT

Background: Ending AIDS as a public health threat by 2030 is a significant challenge, as new HIV infections among adolescents and young people have not decreased fast enough to curb the epidemic. The combination of slow HIV response and increasing youth populations 15–24 could affect progress towards 2030 goals.

Objective: This analysis aimed to describe global and regional trends from 2010–2050 in the HIV epidemic among adolescents and young people by accounting for demographic projections and recent trends in HIV interventions.

Methods: 148 national HIV estimates files were used to project the HIV epidemic to 2050. Numbers of people living with HIV and new HIV infections were projected by sex and five-year age group. Along with demographic data, projections were based on three key assumptions: future trends in HIV incidence, antiretroviral treatment coverage, and coverage of antiretrovirals for prevention of mother-to-child transmission. Results represent nine geographic regions.

Results: While the number of adolescents and young people is projected to increase by 10% from 2010–2050, those living with HIV is projected to decrease by 61%. In Eastern and Southern Africa, which hosts the largest HIV epidemic, new HIV infections among adolescents and young people are projected to decline by 84% from 2010–2050. In West and Central Africa, which hosts the second-largest HIV epidemic, new infections are projected to decline by 35%.

Conclusions: While adolescents and young people living with HIV are living longer and ageing into adulthood, if current trends continue, the number of new HIV infections is not projected to decline fast enough to end AIDS as a health threat in this age group. Regional variations suggest that while progress in Eastern and Southern Africa could reduce the size of the epidemic by 2050, other regions exhibit slower rates of decline among adolescents and young people.

KEYWORDS:

• HIV
• HIV/AIDS
• epidemiology
• demography
• epidemic modelling

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

The authors acknowledge Jennifer Requejo for writing support and assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Not applicable.

Paper context

HIV incidence among adolescents and young people is not decreasing fast enough to end AIDS as a public health threat by 2030. While experts fear that increasing youth populations could further impede progress, this paper demonstrates that improvements in the HIV response could change the trajectory of the HIV epidemic despite demographic factors. New HIV infections must decrease faster and HIV prevention programmes must appropriately target adolescents and young people to secure an AIDS-free generation.

Data availability statement

The data that support the findings of this study are openly available in national HIV estimates files published through UNAIDS at http://www.unaids.org/en/dataanalysis/datatools/spectrum-epp.

Additional information

Funding

None.

Notes on contributors

Aleya Khalifa

Tyler Porth (T.P.) and Priscilla Idele (P.I.) conceived of the idea to project the HIV epidemic for adolescents and young people and conducted an initial analysis. Aleya Khalifa (A.K.), Chibwe Lwamba (C.L.), Mary Mahy (M.M.) and John Stover (J.S.) designed the full analysis. J.S. provided the tool in which to conduct the analysis and produced the results. A.K. and C.L. analysed the results. C.L., M.M., T.P. and P.I reviewed preliminary results and proposed improvements to the analysis. All authors contributed to the interpretation of the final results. A.K. drafted the work, while T.P., P.I., J.S., M.M. and C.L. revised it critically for intellectual content. All authors approved the final work to be published and agree to be accountable for all aspects of the work.