It is $1.8 billion a year; That’s what we’re losing by failing young people

These losses span direct health system costs, out-of-pocket expenses for young people and their families, and lost opportunities in earnings, productivity and future potential

COMMENT | ANNE GITHUKU-SHONGWE | This year’s International Day of the African Child, I ask us to consider her. She was fifteen years old, sitting in a classroom in Kampala, Nairobi, or Kigali, with plans she had not yet told anyone.

Then came a pregnancy she did not plan for. She left school and never returned. The future she had imagined quietly closed, and with it an estimated US$64,314 in lifetime earnings, the income she might have earned had she stayed in school, completed her education and reached her full potential.

This is not the story of one girl. It is a story that unfolds every day across Uganda, Kenya and Rwanda. Young people aged 15 to 24 make up between 20% and 22% of the population in these countries, well above the global average of 15.5%. This should be a demographic advantage, instead too many young people are being held back by systems that are failing to meet their needs.

A new report produced under the UN’s 2gether 4 SRHR programme calculates the annual cost of inadequate investment in HIV and sexual and reproductive health and rights for young people aged 15 to 24 in Uganda, Kenya and Rwanda. Combined, these countries lose at least US$1.8 billion every year. Kenya bears the largest burden at US$1.2 billion, equivalent to 1.1% of its GDP. Rwanda loses US$197 million, or 1.4% of GDP, while Uganda loses US$438 million, nearly 1% of GDP.

These losses are calculated across three layers that include the direct cost absorbed by the health systems, the out-of-pocket costs borne by young people and their families and the opportunity costs such as earnings, productivity and futures that never materialize. The report is explicit that these figures are conservative. Many consequences such as intergenerational harm, emotional trauma and cascading losses in productivity could not yet be fully counted. The true bill is higher.

Behind these numbers are three specific drivers.

1. Early pregnancy costs Kenya US$882 million annually, Rwanda US$175 million and Uganda US$216 million. These are not healthcare costs alone. The majority is lost lifetime earnings from girls who left school, never returned and will earn a fraction of what they would have.

2. HIV among young people costs Kenya US$79 million a year, Rwanda US$9 million, Uganda an estimated US$203 million. In Uganda, almost four in every five new HIV infections among young people are among adolescent girls and young women. That is not a coincidence. It is the result of entrenched gender inequality meeting inadequate services.

3. Gender-based violence adds a further US$235 million in Kenya, US$13 million in Rwanda, and US$19 million in Uganda, in costs and those figures almost certainly undercount the cost of real harm. Kenya, Uganda, Kenya, and Rwanda are not standing still, though. All three countries have removed the requirement for parental consent for young people to access HIV and sexual and reproductive health services. All three have laws mandating comprehensive sexuality education in primary schools. These are not small things. They represent political will that has been exercised and frameworks that have been built.

But laws and policies are only as strong as their implementation. The report is clear that current gaps in services and programmes are producing these losses in real time. The distance between political commitment and young people’s actual experience of services is where the billions are being lost.

These losses are not inevitable. They are the consequences of policy and investment choices. That is why the upcoming UN High-Level Meeting on Ending AIDS matters. World leaders will be meeting in New York at the end of this month to negotiate a new political declaration that will shape the global HIV response for the years ahead.

I urge African governments arriving in New York for this important meeting to be united behind a common position that places the intersection of HIV and sexual and reproductive health rights at its centre. The declaration being negotiated right now is not an abstract exercise. The language that makes it into the declaration will shape the HIV response in our region for years to come. What countries agree in New York needs to translate into budget lines, implementation plans and accountability frameworks at home. The cost of a weak commitment, as this report shows, is measured in billions of dollars and in futures foreclosed before they even begin.

We know what works. Peer-led programmes work. Non-judgemental clinics work. Keeping girls in school demonstrably reduces early pregnancy, by 75% and HIV infection by 87%. Community-based programmes that shift harmful gender norms reduce violence and with it, HIV risk. Governments must act on this, to treat it as the priority the numbers demand.

She was fifteen, sitting in a classroom, with plans. For every year those plans are interrupted by conditions we know how to prevent, a country pays the price.

Right now, across Uganda, Kenya, and Rwanda, that payment amounts to nearly two billion dollars annually. The question is not whether these countries can afford to invest more in their young people; at $1.8 billion a year, the evidence is clear: they cannot afford not to.”

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Anne Githuku-Shongwe is the UNAIDS Regional Director, East and Southern Africa. 2gether 4 SRHR is a joint United Nations Regional programme supported by Sweden. The programme combines the unique strengths and contributions of UNAIDS, UNFPA, UNICEF and WHO to advance sexual and reproductive health and rights for all in East and Southern Africa.