Adolescents across Southern Africa face barriers to HIV prevention and treatment, contributing to increasing AIDS-related deaths in this age group.
Adolescents across Southern Africa face barriers to HIV prevention and treatment, contributing to increasing AIDS-related deaths in this age group. A regional study has highlighted areas where the current HIV response is failing young people, including in sexual health education, HIV prevention and support in adhering to treatment.
According to Roselyn Dete, country director for the Southern African AIDS Trust (SAT) in Zimbabwe, “The multi-country study was undertaken to explore and document the current psychosocial and sexual reproductive health needs of adolescents living with HIV in Southern Africa, with the aim of identifying gaps between needs and available sexual and reproductive health and HIV-related initiatives.”
The research project was developed jointly by SAT, the Network of African People Living with HIV for Southern African Region (NAP+SAR), the International HIV/AIDS Alliance and Dignitas International. It was carried out in 2012 and 2013 across 16 sites in Malawi, Mozambique, Zambia and Zimbabwe.
Despite being among the worst affected by the epidemic, children and young people remain at the margins of the world’s response.
According to Victor Chinyama, UNICEF spokesperson for Eastern and Southern Africa: “Sub-Saharan Africa is home to nearly 90 per cent of all children living with HIV. Many of the children currently in adolescence were diagnosed with HIV before effective treatment was available and were not expected to survive beyond early childhood. Now we have these improved treatments yet health systems and HIV service providers have not improved and adapted their services to better meet the needs of this growing number of young people living with HIV.”
Inadequate sex education
A lack of education about sexual and reproductive health and HIV is still a major issue in many areas. Findings from the study confirm that social and economic factors, including gender inequalities, family structure, low socio-economic status and living in rural areas are all associated with lower levels of school attendance and less access to health education.
“Adolescents living outside larger urban centres, specifically girls and those not attending school, have less knowledge about HIV and sexual and reproductive health. The sexuality of younger adolescents is often overlooked or ignored. More attention needs to be given to ensure that interventions and information campaigns on HIV transmission and sexual and reproductive health target adolescents,” the study revealed.
Adolescents in rural areas who are outside the education system have less knowledge about HIV and other related issues because of lack of access to modern technology and the internet. Access to these resources provide much needed information to young people. Also the lack of interaction with peers, through school, is a great disadvantage to them.
Parental consent is barrier to testing
Charles Siwela, Youth Engage national director in Zimbabwe, argues: “There are many obstacles which prevent young Zimbabweans from acting on their desire to postpone parenthood and stay HIV-free.”
One of these obstacles is the need for parental consent to test for HIV. But I believe every child who is capable of forming his or her views has the right to express those views freely in all matters affecting him or her. Therefore, any child aged 16 years or above – or who is married, pregnant or a parent – who requests HIV testing and counselling should be considered able to give their full informed consent.
Also, new technologies mean children are more informed on issues which concern their personal lives. Therefore, any child below the age of 16 who is considered a mature minor should also be able to give informed consent. (In some countries, including Zimbabwe, a mature minor is defined as a child who can demonstrate to the health worker that he or she is mature enough to act in his or her own best interest and make an independent judgment to consent to testing, counselling including care and treatment.)
Charles says that existing policies need clarification to ensure that no adolescent is illegally denied services because of age. “Youth-friendly sexual and reproductive health programmes should be prioritised so that HIV-positive adolescents, many of whom have been infected since birth, do not transmit the virus to yet another generation,” he adds.
Stigma and problems with adherence
Having questioned adolescents who reported having stopped treatment in the past, the regional study illustrated some of the problems young people face in adhering to treatment. Unfortunately stigma is still a major issue and programme managers must make a concerted effort to eradicate it.
For instance, in Zimbabwe, the study has revealed that stigma is high for adolescents living with HIV, making them unlikely to share their own experiences with others or disclose their status openly. It also reported that policies and guidelines on critical elements such as psychosocial support for adolescents living with HIV are needed.
The same is true in other countries in the region. A 16-year-old boy interviewed in Mzuzu, Malawi, shared his reluctance to collect HIV treatment from the health facility for fear of gossip from others at school. He said: “When they get to school they start telling people that l saw this one at the hospital, he was walking around with his file…He went in with an empty bag but came out with a full one, carrying medicine.”
Healthcare providers are also failing to educate young people about the importance of adhering to treatment. One adolescent said: “l took antiretroviral drugs for two months, then l thought it was pointless to continue taking them, since l was feeling well.”
The Zimbabwean study showed that implementation of policies needs to be monitored at grass roots level, with data collected specifically on adolescents and disaggregated by age. I believe this is vital if we are to ensure that the most marginalised young people are not excluded.
HIV and sexual and reproductive health service providers must use an integrated approach. This will strengthen the availability of the relevant information, advice and counselling, as well as safer sex and contraception methods for adolescents who are living with HIV and accessing services.
The regional study recommends HIV services for adolescents, and particularly antiretroviral therapy clinics, should be provided separately from adult services and in a setting of full confidentiality.
Other recommendations include specialised training for health services providers who work directly with adolescents, to ensure they can offer a supportive, positive, accessible and non-judgmental service.
Using web-based technologies and mobile phones to send out supportive messages, health information and support for treatment adherence, is also a way of making this information more accessible to young people.
It is vital that we involve young people in formulating policy on issues that affect them. Only then can real progress be made to reverse the rising tide of HIV infections among young people.
Read about the challenges for parents of disclosing HIV status to children born with HIV