Uganda has one of the world’s youngest populations, with almost 50 per cent being below the age of 15. This comes with challenges given the current wave of HIV/Aids with prevalence among this population accounting for 1.3 per cent males and 3.9 per cent females. The introduction and increased access to antiretroviral therapy has improved the health of young people living with HIV.
Unfortunately, there is increased risk perception and behaviour characterised by multiple partners, unprotected sex and nondisclosure. In a setting where culture and taboo frown upon early sex and in light of their status, it is reasonable to assume young people living with HIV/Aids do not engage in sex. On the contrary, young positives aspire for normal lives and in transiting from adolescence to adulthood, are engaging in relationships, exploring their sexuality.
The complexity of issues affecting young positives is reinforced by the need to adhere to treatment, stigma and discrimination in society, adopting and sustaining safer sexual behaviours and limited access to reproductive health services.
Prevention efforts have focused on risk-reduction for presumed HIV-negative and at risk persons. A review of some message-focused interventions highlights the need to strengthen focus on young positives. A striking example is the HIV couple counselling and testing campaign. Whereas such interventions are applauded, they are perceived to be for ‘adults’ so they do not effectively attract young people in relationships to test with their partners.
Yet, communities and care givers tasked with the responsibility of taking care of young positives are not adequately equipped to support these young people. The responses are restricted to static facilities, have limited outreach and are overwhelmed with the magnitude of service seekers. Creating a supportive, stigma-free environment to meet their emotional needs, increase resource allocation for youth-friendly services, advice on disclosure issues and safer sex is critical.
Young positive adolescents are not unique to the experiences of adolescence. Focusing on peer to peer and mentor approaches will support young people in personalising messages, change their attitudes and behaviours if they believe the messenger identifies with them.
However, with rights come responsibility; young people need to take responsibility in supporting their health too. Strengthening the integration of reproductive health services into HIV interventions will facilitate delivery of prevention and family planning services for young positives.
Through collective efforts, policy makers need to support young positives by translating knowledge and skills into everyday experiences. This includes ability to negotiate condom use, disclosure to partners, avoiding unwanted pregnancies and safe child birth to reduce transmission.
Ms Kajja is a fellow with the Makerere University School of Public Health