Support for HIV positive adolescents
10 March 2011
ANOVA IN THE NEWS: Anova's team responsible for developing a series of resources to support HIV positive teens contributed an oppinion piece to The Star's series on HCT in schools this week. The team caution that teens are ill preparted for puberty and particularly HIV positive adolescents require support in order for them to make healthy choices pertaining to their sexual and reproductive wellbeing.
Support for HIV positive adolescents
Marnie Vujovic, Saranne Meyersfeld and Helen Struthers
Government’s decision to introduce HIV Counselling and Testing (HCT) in high schools has sparked heated debate around the sexual and reproductive health needs of adolescents. Judging from the high prevalence of teenage pregnancies, it is a discussion that is way overdue – but it is also one that needs to be approached with sensitivity.
The obvious appeal of testing and counselling in schools would be to prevent new infections and ensure early diagnosis of existing ones. But there is another dimension to testing in schools that requires urgent consideration: due to improved antiretroviral treatment, a new generation of teens is entering high school – young adolescents who have been born with HIV, having acquired the virus from their mothers. Adequately meeting the needs of these youths and dealing with the stigma they face adds a new complexity to the proposed testing campaign and underlines the urgency of developing youth friendly services that are geared to meet the specific and varied needs of HIV positive adolescents.
Teens living with HIV are already a sizeable and prominent sub-group in the South African HIV epidemic. Of these, an estimated 280 000 are under the age of 15, having predominantly acquired the virus perinatally. In 2006 alone, some 64 000 children were infected with HIV through mother-to-child transmission. Positive adolescents between 15 and 18 years, on the other hand, are most likely to have been infected through unprotected heterosexual sex.
Based on interaction with what are classified as very young adolescents (aged 10 to 14) in both rural and urban settings, we’ve found that teens are alarmingly unprepared for puberty. Sex and sexuality are still very new and often bewildering concepts to them and without appropriate guidance and support, these young teens often stumble blindly towards sexual experimentation – either out of total ignorance or because of peer pressure.
At present, no guidelines exist to give clear and simple instructions to healthcare providers for meeting the sexual and reproductive health needs of positive adolescents.
This silence is partially the result of conflicting cultural and societal value systems, blinding councillors and educators to the true importance of empowering young teens with knowledge about their bodies. Added to this is the common fear that talking about sex might encourage teens to become sexually active. Many adults also simply find “having the talk” too embarrassing. The silence is even more pronounced for South Africa’s our alarmingly high number of orphaned teens, who have virtually no one to turn to.
As a result, very young adolescents have virtually nothing in the way of basic sex education to help them navigate the labyrinth towards sexual maturity. Those among them who are living with HIV are even less prepared.
The taboo associated with teens seeking guidance on issues linked to sexual activity only compounds the situation. Without adequate guidelines and training, healthcare providers and facility staff may convey judgemental and stigmatising attitudes that could put young people off of seeking advice and information entirely.
For any child the transition to adulthood is fraught with challenges. Young teens are expected to define their identities, make plans for the future, interact with peers and deal with their sexuality. The HIV positive boy or girl faces a barrage of additional demands, including dealing with concerns about treatment regimens, doctor’s appointments, reduced life expectancy, disclosure, stigma and the possibility of infecting others.
It is particularly important that the hopes and dreams of positive adolescents are nurtured and reinforced to help them realise their full potential and to imbue them with a sense of responsibility for maintaining their own health and that of others.
These additional challenges and considerations create a distinctive environment that frames positive adolescents’ daily experiences and interactions with those around them and it necessitates a distinctive response.
Unsafe sexual practices, early sexual debut, adolescent pregnancy, multiple and concurrent sexual partners and gender violence all increase the risk of detrimental sexual and reproductive health outcomes for these teens. On the other hand, reinforcing healthy practices and promoting a reduction in risk behaviours can allow HIV positive adolescents to lead longer, more meaningful and fulfilling lives.
In the absence of an environment where HIV positive adolescents can comfortably talk about their sexuality, address their anxieties about infecting others and explore safe sex practices, a support group lead by a trained healthcare provider can offer relief from the confusion and isolation. In the relative safety of a community of peers and under the guidance of an informed and compassionate councillor, it becomes possible to consistently counter the confusing messages that young positive teens encounter. These groups also build resilience and are instrumental in alleviating the sense of isolation that many HIV positive adolescents experience. This in turn, fosters a more positive attitude towards the future and helps teen establish a sense of personal identity.
The value of support groups makes it an absolute priority to ensure that the healthcare providers who facilitate them are properly prepared. The Anova Health Institute is responding to this need by developing a set of guidelines for healthcare professionals that provides simple, succinct and age-appropriate information, complete with suggested activities that can be used in a variety of settings. The resource is based on thorough research and interaction and was developed in consolation with adolescents, making it a reliable, comprehensive and appropriate tool that will be invaluable for those supporting adolescents in safely and responsibly dealing with their sexuality and self-identity.
Learning to deal with the sexual and reproductive needs of teens in an emphatic and insightful manner will also go a long way to ensuring that we have a truly meaningful conversation about the causes and consequences of teen pregnancy.
With the necessary support and follow-up services in place, the HCT campaign will provide an important opportunity to ensure that adolescents who test positive get the treatment, care and support they need. But such a transition necessitates a revamp of the existing life skills curriculum to achieve the attitude changes needed by teachers, parents and caregivers.
Like any other young person, HIV positive adolescents should be able to enjoy relationships that are safe, fulfilling and pleasurable.
Marnie Vujovic and Saranne Meyersfeld are collaborating with Helen Struthers at the Anova Health Institute to develop a series of manuals tailored to the particular needs of HIV positive adolescents in early, middle and late adolescence. The resource will be available for download soon from www.anovahealth.co.za. The Anova Health Institute is grateful for funding from USAID and PEPFAR.
Download the original article here.