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HIV Nursing Matters / Page 4 Complications of Long-Term HIV and and Being Exposed to HIV Infection HIV Nursingg matters A Magazine of the Southern African HIV Clinicians Society The psychosocial challenges of HIV positive youth- the silent epidemic The Sexual and Reproductive Health Needs of Adolescents Living with HIV Voluntary Medical Male Circumcision and Adolescents March 2013 Volume 4 No.1 Ad publicP.fh11 2/22/13 12:04 PM Page 1 C M Y CM MY CY CMY K Composite Ad publicP.fh11 2/22/13 12:04 PM Page 1 C M Y CM MY CY CMY K inside Guest editorial Health Needs of Adolescents Dr Harry Moultrie 4 Living with HIV 26 Voluntary Medical Male Message from the Circumcision and Adolescents 30 president Tool to aid disclosure for HIV positive adolescents to their Dr Francesca Conradie 6 HIV Nursing romantic partners 34 Improving engagement, retention matters News of care and ARV treatment adherence What are PMTCT Options 8 amongst adolescents 38 focuses on Youth & Adolescent Dietician’s column Love life report New Year’s resolutions with FAD Youth Friendly Services programme Issues dieting 10 in some public health clinics 42 Current issue Behavioral, Psychiatric, and Profile Cognitive Problems in Adolescents CHIVA South Africa Organisation 46 on cover with Perinatal HIV Infection 14 The psychosocial challenges of HIV Dealing with stigma within Youth What to do 49 Friendly services 18 positive youth- the silent epidemic The psychosocial challenges of HIV positive youth: the silent epidemic 22 Where to go 50 The Sexual and Reproductive Health Needs of Adolescents Living with HIV Clinical update The Sexual and Reproductive Voluntary Medical Male Circumcision and Adolescents March 2013 / page 3 Composite guest editorial incidence of 5.5 (95%CI 4.3-6,6) per 100 women years. ALHIV require access to adolescent guest editorial friendly services which address their lescent health care utilisation rates are specific needs. These include HIV unfortunately limited, the high preva- diagnosis; diagnosis and treatment lence of teenage pregnancy and cura- of complex clinical conditions arising ble STIs amongst school-going children from chronic HIV and/or ART expo- indicate that clinics are not delivering sure; sexual and reproductive health adolescent friendly sexual and repro- services including Pap smears and HPV ductive health services.The reintroduc- vaccinations and, most importantly, tion of school health services through screening, diagnosis and treatment for the Integrated Schools Health Policy mental health conditions and psycho- could dramatically improve access to social problems. health services for children and ado- lescents as there are approximately 8 Anecdotal reports suggest that access times as many schools as health clinics to HIV Counselling and testing for ado- Dr Harry Moultrie in South Africa. In order to realise this lescents remains challenging despite potential however the ISHP needs to clear guidance from the Children’s Adolescence is a developmental deliver sexual and reproductive health Act (Act 38, 2005) that children 12 stage during which children transi- services that are adolescent friendly years and older with sufficient maturity tion into adults through progressively and which are effectively co-ordinated can independently consent for an HIV developing their autonomy and tak- with clinic services. test. Slow progressors often remain ing responsibility for their own lives, undiagnosed into older childhood and including their health. It is a time of The population of South African chil- adolescence.A study of perceptions of intense physical, psychological and dren with HIV is ageing into adoles- risk and acceptability of PICT amongst emotional change. Risk-taking is part cence as a result of a maturing HIV adolescents and their caregivers con- of adolescent development. Many of epidemic; earlier paediatric diagnosis; cluded that providing information of the important determinants of adult ill provision of antiretroviral therapy (ART) late diagnosis of MTCT in adolescents health such as harmful alcohol use, to HIV-infected children and increased could facilitate uptake of PICT as HIV- tobacco use, unhealthy diet and lack coverage of the PMTCT programme infection in this population was widely of physical activity have their origins with better regimens.In addition to the assumed to be exclusively sexually in adolescence. Adolescence is also emergence of adolescents with perina- acquired and which carried significant generally the period in which sexual tal HIV-infection, recent estimates indi- stigma. activity commences and sexual identi- cate that young women aged 15-24 ties are developed. The safe develop- years in South Africa have the highest Adolescents with perinatal HIV infec- ment of healthy sexual identities is par- incidence of HIV of any demographic tion (PHIA) often have complex medi- ticularly challenging for adolescents group in the country, with an estimated cal conditions related to both long-term living in South Africa as a result of the HIV and ART exposure. The majority generalised HIV epidemic and gener- of current PHIAs in South Africa are ally unhealthy gender norms. likely to have been initiated on ART Anecdotal reports suggest that after 5 years of age. As a result of their access to HIV Counselling and All adolescents need positive adult role testing for adolescents remain delayed commencement of ART, many models and safe and enabling environ- challenging despite clear guid- current PHIA would have already had ments which provide opportunities to ance from the Children’s Act advanced HIV disease at the time of exercise healthy choices. Adolescents (Act 38,2005) that children 12 commencing ART. In particular HIV- also require access to adolescent years and older with sufficient associated neuro-developmental delay, friendly services which address their maturity can independently cognitive deficits, attention disorders sexual and reproductive health needs consent for an HIV test. and psychiatric disorders are of including prevention, diagnosis and concern in PHIA. In addition, less com- treatment. While routine data on ado- mon but important renal and cardiac HIV Nursing Matters / page 4 complications of long-term HIV and and being exposed to HIV infection. ART exposure need to be diagnosed Mental health issues such as depres- and managed. sion and traumatic life events have been implicated in adolescent sexual Clinical management is often further and substance abuse risk behaviours complicated by HIV drug resistance and ability to maintain adherence to mutations. As a result of the prolonged medication. In South Africa, nearly high viral loads in children the dura- a quarter of adolescents reported bility of ART regimens is shorter and feelings of sadness, or hopelessness in the development of drug resistance the preceding 6 months and 21% had The Team mutations more likely. A review of attempted suicide, with 29% of these Guest Editorial: Dr Harry Moultrie outcomes of children on ART in South requiring medical treatments. Gender Africa demonstrated that the three year based violence is very common in President: Dr Francesca Conradie probability of virological failure in chil- South Africa, with orphaned and vul- dren is 19.3% (95%CI 17.6 – 21.1%). nerable children at greater risk. Mental Editorial Advisory Board: Of concern is that only 38% of chil- and psychosocial services need to be Dr Elizabeth Mokoka dren with confirmed virological failure specifically capacitated to be gender Ms Stacie Stender Dr Natasha Davies in this study had been switched to sec- sensitive and to be able to address the Dr Liezl Smit ond line therapy, with a median time psychosocial consequences of gender Ms Laurie Schowalter from failure to switch of 5.7 months based violence. Ms Nelouise Geyer (IQR: 2.9–11.0). While this delay is Dr Michelle Moorhouse partly explained by the previous South This edition of HIV Nursing Matters is African guidelines which advocated focused on Youth and HIV. Monica Contributors: Monument Trust for a more conservative approach to Nkwanyana shares some lessons Advertising: Chriss Nyalungu switching therapy than current guide- learned on how best to structure HIV E mail: [email protected] lines, ongoing viral replication in the and sexual and reproductive health Tel: (011) 341 0162 presence of ART is associated with services in order to minimise stigma. drug resistance. Brian Zanoni draws our attention to the Article/Letter submission: importance of screening adolescents Ms Nonhlanhla Motlokoa PHIA face considerable challenges in with perinatal HIV infection for behav- E mail: [email protected] achieving autonomy as a result of both ioural, cognitive and mental health Tel (011) 341 0162 problems which can result in poor psychosocial and physical manifesta- For more information contact tions of HIV as a result of high rates adherence to ART, loss from care and/ SA HIV Clinicians Society of developmental delay, orphaning, or substance abuse.While disclosure Suite 233 Post Net Killarney recurrent bereavement, and increased of HIV status to older children and Private Bag X2600 vulnerability to violence and abuse. In adolescents has received considerable Houghton particular there is a high prevalence attention in recent years, disclosure 2041 www.sahivsoc.org of physical delay, including stunting by adolescents living with HIV to their Tel: Tel +27(0) 11 341 0162 and sexual maturation in PHIA which romantic and sexual partners has Fax: +27(0) 11 341 0161 can result in internal and external received comparatively little attention. E-mail: [email protected] stigma and discrimination. A review Shanaaz Randeira tackles this chal- of children attending Harriet Shezi lenging topic in a superb article which The opinions expressed are the opinions of Children’s Clinic at Chris Hani Barag- provides guidance on a 5-step process the writers and do not necessarily portray wanath Hospital in 2010 indicated to support disclosure by adolescents the opinion of the Editorial Staff of HIV Nursing Matters or the Southern African that more than 50% of children over to their partners. CHIVA’s adolescent HIV Clinicians Society. The Society does the age of 5 years had lost at least programme profile provides inspira- not accept any responsibility for claims one parent.
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