New strategies needed in fight against HIV among adolescents

With 135,000 new HIV infections annually of which over 19,000 are children, the number of children that requires treatment will continue to increase.

According to statistics from Uganda’s Ministry of Health and UNAIDS, about 110,000 children are living with HIV/Aids in the country. Of these, 50,000 children are in need of Anti retroviral treatment. With 135,000 new HIV infections annually of which over 19,000 are children, the number of children that requires treatment will continue to increase.

In order for HIV treatment to improve the quality of life for HIV positive children, it has to be taken in the right dose, at the right time and in the correct manner or what is called adherence.

If adherence to HIV treatment is a challenge for adults, it is even worse for children and most especially adolescents. Whereas adolescence is a challenging stage in development, adolescence with HIV is even worse.
According to research findings, HIV positive adolescents on ART want to fit in and “be normal” like their colleagues , they do not want others to see them take their drugs (especially in boarding schools). When they travel they forget to take their medication.

Given the stigma associated with HIV, many adolescents are apprehensive about disclosing their HIV status to parents, friends and sexual partners. They may be unwilling or fearful of facing the potential consequences of disclosure, primarily rejection. Because of failure to disclose, they can not rely on their parents, friends and partners for support to adhere to treatment.

In addition, there are few places where “adolescent - friendly” services are available, where young people can feel at ease and have their needs addressed. Many providers still lack knowledge about specific paediatric ART issues, and do not have the skills to communicate with caretakers and clients around complex and sensitive issues such as disclosure, dealing with stigma, and the very real challenges of adherence.

Adherence means taking the right dose of medication at the right time all the time. Adherence is very important in ARV treatment because it can improve a person’s health and quality of life and enable him or her to live longer. If adherence is very good, the amount of HIV in a person’s body will reduce very quickly after a few weeks or months. This allows their immune system to start to recover, so that illness is reduced and health is regained.

A very high level of adherence is necessary for ARV treatment to work effectively. Missing even a few doses of drugs can cause treatment to fail and opportunistic infections or drug resistance to develop.

HIV - positive adolescents may have difficulty adhering to their medicines because of drug fatigue, feeling it is too difficult/not worth it/don’t care; stress of taking the drugs at the right time every day; being too busy; not involving others – alternative caretakers and health workers; and, concerns about disclosure and stigma.

Health care providers can play a central role in aiding an adolescent’s psychosocial adjustment following an HIV diagnosis and should be trained to help them cope with an HIV - positive result and to adhere to their treatment.

HIV positive adolescents need assistance in learning to navigate health care systems as well as seeking and arranging medical care. Additionally, the structure of health care visits should be covered with a focus on adherence to appointments. It is also important to note that while many HIV positive adolescents would not be eligible for medications yet, an intervention should begin to prepare them for medication management.

Some factors have been seen to increase adherence and these include disclosing to the adolescent and including them in maintaining the drug regimen; seeing the results of what happens when one stops taking the drugs (falling sick); a good relationship between the caretaker and the child; and social support from other caretakers/family members, the health worker, and/or treatment supporters.

Critical components of an intervention that would help adolescents cope with HIV positive results include individual counseling, individual sessions, group sessions, and the availability of other services such as an HIV - positive peer buddy system, individual counseling, nutrition services and management.

Involving adolescents in support groups is important because they realise they are not alone in their age group and that other teenagers have the disease. It also helps them talk to someone about what they face.
Other critical skills that HIV positive adolescents need are HIV/AIDS education, stress management, social skills training, and problem solving skills.

The capacity of the health care centres, caregivers of HIV positive adolescents and community should therefore be strengthened to provide a supportive environment for these boys and girls, including providing appropriate counselling and psychosocial support, which will enable them embrace the future to which they are entitled.

The writer works with the Johns Hopkins Bloomberg School of Public Health,
josephw@hcpuganda.org