Call to action: HIV among adolescents in Sierra Leone

Sierra Leone, a west African country with an approximate population of 8·5 million people, is experiencing a steady increase in HIV prevalence, despite a low national HIV prevalence of 1·7%.¹ The country’s vulnerability to an HIV epidemic is compounded by many risk factors, such as poverty, economic deprivation, and a history marred by a decade-long civil strife and an Ebola virus outbreak that claimed more than 4000 lives.² These collective adversities pose major obstacles to effective HIV prevention and control measures, particularly among the population aged up to 24 years. These destabilising events exacerbated the HIV crisis, resulting in an increasing number of adolescents facing great hurdles to accessing HIV prevention, diagnosis, and treatment services.³ In Sierra Leone the rising HIV/AIDS issue is particularly distressing. The HIV epidemic disproportionately affects children and adolescents. Although there are no disaggregated data available for adolescents, statistics show that of the 76 000 people living with HIV in Sierra Leone, 66 000 are people aged older than 15 years, and 10 000 are children aged between 0 and 14 years.⁴ Nearly 40% of people living with HIV are unaware of their HIV status; 70% of young people living with HIV have advanced HIV disease at first presentation to a hospital in Sierra Leone.⁵ Despite the rising number of HIV/AIDS infections, antiretroviral therapy (ART) coverage is still poor. The adult ART coverage stands at 76%, which is still below the 95–95–95 target set by UNAIDS; however, the situation for children is far more dire, with a dismal coverage rate of 25%.⁴ This stark difference underscores the pressing need to prioritise HIV care for children and adolescents. Compounding the crisis is the fact that only a small number of patients with HIV reach viral suppression. Although the viral suppression rates among adolescents in Sierra Leone are not well documented, the rates among adults are low, hovering around 26%. Extrapolating from data on similar sub-Saharan settings, the viral suppression rates are expected to be much lower among adolescents than among adults in Sierra Leone. This stark reality underlines an urgent need for attention and resources to address the burgeoning HIV crisis among Sierra Leone’s youth; this disproportionately affected group is not currently receiving adequate attention. Major barriers to adequate health-care access and ART adherence should be addressed. Without prompt intervention, the country risks a surge in HIV cases and poorer outcomes that might lead to a broader HIV epidemic.