Abdool Karim Quarraisha, Baxter Cheryl, Birx Deborah
*Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; †Department of Public Health, University of KwaZulu-Natal, Durban, South Africa; ‡Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and §Office of the US Global AIDS Coordinator, US Department of State, Washington, DC.
J Acquir Immune Defic Syndr. 2017 May 1;75 Suppl 1:S17-S26. doi: 10.1097/QAI.0000000000001316.
The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) has ensured that more infants in high-HIV burden countries survive childhood HIV-free. Although equal numbers of boy and girl children have survived to age 10, a gender divergence starts to emerge as they enter adolescence. Up to 3 times as many young women aged 15-24 years in eastern and southern Africa are living with HIV compared with their male peers. Further, more adolescent girls and young women are sick and/or dying from AIDS-related or HIV-related complications during pregnancy and in the postpartum period, underscoring the importance of strengthening HIV treatment and prevention services for this group. Failure to prevent HIV in adolescent girls and young women and keep them alive will reverse the infant HIV prevention and survival gains made under the Global Plan. The promising global declines in HIV infection in young women need to be strengthened to realize the goals of an AIDS-free generation. The DREAMS initiative of the United States President's Emergency Plan for AIDS Relief (PEPFAR), which specifically addresses adolescent girls and young women at highest risk of HIV acquisition, brings new hope for meeting the prevention and care needs of this important and vulnerable population through political commitment, leadership, financial and human resource investments, advocacy efforts, and a focus on the highest priority settings. Importantly, to achieve the goal of keeping mothers alive, we have to place more emphasis on access to sexual and reproductive health services that (1) include HIV prevention and treatment services for adolescent girls and young women; (2) increase male/paternal responsibility in mother and infant health; and (3) ensure a supportive social environment that enables young women to grow up into young adults who are free to graduate from high school and plan their pregnancies, ultimately entering adulthood safe, healthy, and free from HIV.
《到2015年消除儿童新发艾滋病毒感染并确保其母亲存活全球计划》（《全球计划》）已确保在艾滋病毒负担沉重国家，更多婴儿在无艾滋病毒的情况下度过童年。尽管男童和女童存活至10岁的人数相等，但进入青春期后，性别差异开始显现。在东部和南部非洲，15至24岁感染艾滋病毒的年轻女性人数是同龄男性的3倍之多。此外，更多青春期女孩和年轻女性在孕期及产后因艾滋病相关或艾滋病毒相关并发症患病和/或死亡，这凸显了加强针对该群体的艾滋病毒治疗和预防服务的重要性。未能预防青春期女孩和年轻女性感染艾滋病毒并确保她们存活，将使《全球计划》在预防婴儿感染艾滋病毒及提高婴儿存活率方面取得的成果付诸东流。为实现无艾滋病一代的目标，需要巩固全球年轻女性中令人鼓舞的艾滋病毒感染率下降趋势。美国总统艾滋病紧急救援计划（PEPFAR）的“梦想”倡议专门针对感染艾滋病毒风险最高的青春期女孩和年轻女性，通过政治承诺、领导力、资金和人力资源投入、宣传努力以及关注最优先领域，为满足这一重要且脆弱群体的预防和护理需求带来了新希望。重要的是，为实现确保母亲存活的目标，我们必须更加重视提供性健康和生殖健康服务，这些服务应：（1）包括针对青春期女孩和年轻女性的艾滋病毒预防和治疗服务；（2）增强男性/父亲在母婴健康方面的责任；（3）确保提供一个支持性的社会环境，使年轻女性成长为能够自由完成高中学业并规划怀孕，最终安全、健康且无艾滋病毒地步入成年的成年人。
