HIV Testing and Adolescents in Sub-Saharan Africa

Adolescents (10–19 years) and young people (20–24 years) continue to be at increased risk, to HIV infection despite continuous efforts by multiple health organizations.  This is particularly true for adolescents who live in settings with a generalized HIV epidemic or who are members of key populations at higher risk for HIV acquisition or transmission. (3)  At risk groups typically include; sexually abused and/or exploited, those in prison, sex workers, men who have sex with men, transgender people, those with HIV+ Parents, and injection drug users.  In 2012, there were approximately 2.1 million adolescents living with HIV. About one-seventh of all new HIV infections occur during adolescence. (5)

Access to HIV health care and testing by adolescents is significantly lower than for adults. Data collected from sub-Saharan Africa indicate that only 10% of young men and 15% of young women (15–24 years) were aware of their HIV status. Of course, access and coverage to health resources vary considerably across countries and regions. Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%, while the global number of HIV-related deaths fell by 30% (5). This increase in adolescent HIV-related deaths is due primarily to poor prioritization of adolescents in national HIV plans and lack of support for adolescents to remain in care and adhere to antiretroviral therapy. (4)

Adolescents are a group that is so often overlooked, and when they are prioritized, their needs and special circumstances are arguably rarely ever met. The biological and social changes that take place during adolescence affect how these individuals think and behave. The main areas that health professionals must consider when approaching the difference between adults and adolescents are;

How adolescents understand information, what information and which channels of information influence their behavior, how they think about the future and make decisions in the present, how they perceive risk in a period of experimentation and first-time experiences, how they perceive sex - which is common during late adolescence, how they form relationships, how they respond to the social values and norms that surround them, and how they are influenced by the attitudes (or perceived attitudes) of their peers and others. (4)

Addressing late-testing of HIV in adolescents is not free from ethical concerns. Studies have shown that requiring parental consent to HIV services might reduce adolescent access because of perceived negative reactions from parents/guardians or health-care providers and the fear of HIV-related stigma. Adolescents may choose to not to seek care because they want to avoid telling their parents about their health problems and sexual activity. The issue of confidentiality and disclosure of HIV status to children and adolescents by providers and parents is something that must be considered on a case-by-case basis. I would argue that if an adolescent/young adult displays higher levels of maturity and expresses concern about the confidentiality of their HIV status, the health professional should respect their decision. The WHO recently published specific guidelines on HIV disclosure to children to address this exact dilemma (5). The organization recommends that children of school age should be told their HIV status and that of their parent/s or caregiver/s; younger children should be told their status incrementally to accommodate their cognitive skills and emotional maturity, in preparation for full disclosure. However, adolescents are often not aware of their own HIV status, and this non-disclosure is associated with significantly lower retention in HIV care. (5)

For future health intervention programs, it is imperative that health professionals are more aware of the special needs and attention adolescents requires in regards to HIV testing. Current HIV health services should and must be expanded to allow those under 18 years old to access HIV testing and care on a regular basis. With the 50% increase in HIV-related deaths  in adolescents from 2005 to2012, larger organizations like the World Health Organization and UNICEF must refocus their efforts in the fight against HIV to include this younger population. 

(1) Fitzgerald, Stanton, Terreri, et al. (1999). Use of western-based HIV risk reduction interventions targeting adolescents in an African setting. Journal of Adolescent Health, 25(1), 52–61.

(2) J. Fisher & W. Fisher. (2000) Theoretical Approaches to Individual-Level Change in HIV Risk Behavior. Center for Health, Intervention, and Prevention Documents. Paper 4. 1-55

(3) Gavin, Galavotti, Dube, et al. (2006) Factors Associated with HIV Infection in Adolescent Females in  Zimbabwe. Journal of Adolescent Health. 596. 11-18

 

(4) MacPhail, Pettifor, Moyo, Rees. (2009) Factors Associated with HIV Testing among Sexually Active South African Youth aged 15-24 Years. AIDS Care,  21(4), 456-46

          

(5) WHO (2013) HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV. World Health Organization Publication. 1-10