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Wednesday, 15 November 2017 08:16

Understanding HIV+ve adolescents

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While it is generally agreed that the HIV response has failed adolescents, there has been relatively little attention paid to the some two million HIV-positive adolescents in sub-Saharan Africa who have been truly “left behind”.

The Mzantsi Wakho study, which is partly funded by EHPSA, has spent the past three years trying to understand the lives and needs of positive adolescents in South Africa’s Eastern Cape province. Researchers interviewed 1,060 HIV-positive adolescents receiving care in 53 health facilities - visiting them in 150 schools and homes. This is the largest cohort of positive adolescents to be studied worldwide, and findings presented on Tuesday at the AIDS Impact Conference in Cape Town should go some way towards filling a serious evidence gap.


Mental health

A paper presented by Dr Mark Boyes gave important insights into the mental health issues experienced by adolescents living with HIV. The research aimed to identify factors that were associated with depression, anxiety and post-traumatic stress and other psychological and behavioural problems. The research showed that emotional and physical abuse, and bullying and victimisation were serious risk factors for mental health issues. On the other hand, positive parenting was strongly protective. The paper concluded that evidence-based interventions could be used to address these issues without the need to directly target HIV-positive youth.

High risk of HIV transmission

A paper presented by Dr Elona Tosca showed that 12% of the youths in the study were engaging in unprotected sex and had detectable viral loads, meaning that they were at risk of transmitting HIV to negative partners. The study identified key factors that were associated with this high transmission risk. The starkest of these were hunger, substance abuse and mental distress. Combined exposure to these risk factors increased the probability of reporting high HIV transmission risk from 2% (with none of them) to 4-9% for adolescents reporting only one risk factor, to 92% for adolescents who reported all risk factors. Protective factors were identified as good parental supervision, school feeding and adolescent-sensitive clinic care.

These findings could help to shape appropriate services for this neglected and vulnerable group of young people, and reduce the risk of onward HIV transmission. This is an important route to HIV prevention for adolescents in South Africa.

On a lighter note, Prof Lucie Cluver and Noxolo Myeketsi shared their experiences of the programme’s Teen Advisory Group (TAG) - some 30 adolescents who provided ongoing input into the study. The TAG evolved organically and was nurtured by joint fun activities including camping, hiking, canoeing and talent shows. The lives of both researchers and teens have been touched by this engagement. Myeketsi told the meeting, “It has helped us improve our own lives... it has helped us personally by teaching us ways to protect ourselves from HIV, STIs and pregnancy.”

The question remains how such structures could be taken to scale in adolescent research - particularly as they seem to require such large quantities of marshmallows to facilitate high quality input.

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