HIV Insight: Addressing the Socio-Development Needs of Adolescents Living with HIV/AIDS in Nigeria: A Call for Action

The widespread use of antiretroviral therapy and remarkable success in the treatment of paediatric HIV infection has changed the face of the Human Immunodeficiency Virus (HIV) epidemic in children from a fatal disease to that of a chronic illness. Many children living with HIV are surviving into adolescence. This sub-population of people living with HIV is emerging as a public health challenge and burden in terms of healthcare management and service utilization than previously anticipated. This article provides an overview of the socio-developmental challenges facing adolescents living with HIV especially in a resource-limited setting like Nigeria. These include concerns about their healthy sexuality, safer sex and transition to adulthood, disclosure of their status and potential stigma, challenges faced in daily living, access and adherence to treatment, access to care and support, and clinic transition. Other issues include reality of death and implications for fertility intentions, mental health concerns and neurocognitive development. Coping strategies and needed support for adolescents living with HIV are also discussed, and the implications for policy formulation and programme design and implementation in Nigeria are highlighted.

...ALHIV also have to live with the reality of possible death. Statistics continue to reveal high rates of adolescent mortality due to AIDS in both developed and developing countries. Adolescents in sub-Saharan Africa have only a 50% probability of surviving till 60 years compared to counterparts in developed countries who have up to 90% probability of surviving till 60 years²⁶. For adolescents in Nigeria, this probability could be as low as 20%¹⁶. AIDS is a leading cause of death for adolescents in sub-Saharan Africa and the second leading cause of death worldwide after unintended injuries arising from road traffic accidents and the use of psychoactive substances. In the face of this reality, how do ALHIV make life choices that affect their development and future? Do adolescents who live within cultures that place a high premium on childbearing face pressures for childbearing or succumb to familial/social pressure to have children early so that they do not die without an offspring? Do the existing HIV care and support programmes accessed by ALHIV address the fertility aspirations or concerns? Loos¹⁰ noted that for ALHIV in Uganda and Kenya, the realities of living with HIV often results in many experimenting with sex at an earlier age than their peers as as young people. Many reported that ALHIV “did not want to die without having sex”. In Zambia, this experience is different as ALHIV report that they also want children but after the completion of their education and when they have obtained a job¹².

Puberty and growth offered a new start and chance for ALHIV to transform from a social outsider to a social insider, as those previously sickly in appearance and smaller than their peers grew into healthy adults¹⁷. Peer influence becomes central to their understanding of sexuality, sexual norms and identity, with positive adolescents attempting to mirror so-called ‘normal’ behaviour. Due to notions of AIDS as a deadly virus, many adolescents “live in the moment” and want to get “the most out of a life with HIV” ¹⁰. Pubertal development is however delayed in both male and female ALHIV who acquire HIV perinatally and are not virologically suppressed²⁷. ALHIV should therefore be counselled about this potential thereby reducing a tendency for anxiety and concern as they develop into adolescents and start to observe developmental differences when compared with their peers...

Full article at: http://goo.gl/qLbfHQ