Eba Patrick M, Lim HyeYoung
Community Support, Social Justice and Inclusion Department, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland.
School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
J Int AIDS Soc. 2017 Aug 11;20(1):21456. doi: 10.7448/IAS.20.1.21456.
AIDS is a leading cause of death among adolescents in sub-Saharan Africa. Yet, legal, policy and social barriers continue to restrict their access to HIV services. In recent years, access to independent HIV testing and treatment for adolescents has gained increased attention. The 2013 WHO Guidance on HIV testing and counselling and care for adolescents living with HIV (WHO Guidance) calls for reviewing legal and regulatory frameworks to facilitate adolescents' access to comprehensive HIV services. As of 31 March 2017, some 28 countries in sub-Saharan Africa have adopted HIV-specific legislation. But there is limited understanding of the provisions of these laws on access to HIV services for adolescents and their implication on efforts to scale up HIV prevention, testing, treatment and care among this population.
A desk review of 28 HIV-specific laws in sub-Saharan Africa complemented with the review of HIV testing policies in four countries using human rights norms and key public health recommendations from the 2013 WHO Guidance. These recommendations call on countries to (i) lower the age of consent to HIV testing and counselling and allow mature adolescents who have not reached the age of consent to independently access HIV testing, (ii) ensure access to HIV counselling for adolescents, (iii) protect the confidentiality of adolescents living with HIV and (iv) facilitate access to HIV treatment for adolescents living with HIV.
Most HIV-specific laws fail to take into account human rights principles and public health recommendations for facilitating adolescents' access to HIV services. None of the countries with HIV-specific laws has adopted all four recommendations for access to HIV services for adolescents. Discrepancies exist between HIV laws and national policy documents. Inadequate and conflicting provisions in HIV laws are likely to hinder access to HIV testing, counselling and treatment for adolescents.
Efforts to end legal barriers to access to HIV services for adolescents in sub-Saharan Africa should address HIV-specific laws. Restrictive provisions in these laws should be reformed, and their protective norms effectively implemented including by translating them into national policies and ensuring sensitization and training of healthcare workers and communities. This study reiterates the need for action in all countries across Africa and beyond to review their laws and policies to create an enabling environment to accelerate access to HIV prevention, testing and treatment services for adolescents.
艾滋病是撒哈拉以南非洲青少年死亡的主要原因之一。然而，法律、政策和社会障碍继续限制他们获得艾滋病毒服务。近年来，青少年获得独立的艾滋病毒检测和治疗越来越受到关注。2013年世界卫生组织关于艾滋病毒检测、咨询及对感染艾滋病毒青少年的护理指南（《世卫组织指南》）呼吁审查法律和监管框架，以便利青少年获得全面的艾滋病毒服务。截至2017年3月31日，撒哈拉以南非洲约28个国家已通过了针对艾滋病毒的立法。但对于这些法律中有关青少年获得艾滋病毒服务的条款及其对扩大该人群艾滋病毒预防、检测、治疗和护理工作的影响，人们了解有限。
对撒哈拉以南非洲28部针对艾滋病毒的法律进行案头审查，并辅以对四个国家艾滋病毒检测政策的审查，采用人权规范以及2013年《世卫组织指南》中的关键公共卫生建议。这些建议呼吁各国：（一）降低艾滋病毒检测和咨询的同意年龄，并允许未达到同意年龄的成熟青少年独立进行艾滋病毒检测；（二）确保青少年能够获得艾滋病毒咨询；（三）保护感染艾滋病毒青少年的隐私；（四）便利感染艾滋病毒青少年获得艾滋病毒治疗。
大多数针对艾滋病毒的法律没有考虑到促进青少年获得艾滋病毒服务的人权原则和公共卫生建议。在已制定针对艾滋病毒法律的国家中，没有一个国家采纳了关于青少年获得艾滋病毒服务的所有四项建议。艾滋病毒法律与国家政策文件之间存在差异。艾滋病毒法律中不充分和相互冲突的条款可能会阻碍青少年获得艾滋病毒检测、咨询和治疗。
消除撒哈拉以南非洲青少年获得艾滋病毒服务的法律障碍的努力应涉及针对艾滋病毒的法律。这些法律中的限制性条款应予以改革，并有效实施其保护性规范，包括将其转化为国家政策，并确保对医护人员和社区进行宣传和培训。本研究重申，非洲及其他地区所有国家都需要采取行动，审查其法律和政策，以创造一个有利环境，加速青少年获得艾滋病毒预防、检测和治疗服务。
