HIV: Viral Suppression, Prevention still a Challenge among Youths
By Sharon Atieno
Despite the progress made to ensure access to antiretroviral therapy (ART) and HIV prevention tools like condoms, pre-exposure prophylaxis (PrEP) and others, viral suppression and prevention of new infections among young people remains a challenge.
These sentiments were shared during the first International Conference on Reducing HIV among Adolescents and Youths (RHAY) in Eastern and Southern Africa held in Kisumu, Kenya which will run from 21-24, June 2022.
Speaking at the conference, Prof. Elizabeth Bukusi, Kenya Medical Research Institute (KEMRI) said though there has been great improvements in reducing the number of people acquiring HIV and AIDS-related deaths, the HIV burden remains high in adolescents and young people, particularly adolescent girls and young women (AGYW).
“While effective prevention and treatment interventions are available, use by the AGYW remains sub-optimal,” she said, adding that the world urgently needs new ways to make effective interventions more acceptable to AGYW and other populations with elevated risk.
The United Nations AIDS (UNAIDS) statistics show that though AGYW represent only 10% of the population in sub-Saharan Africa, they account for one in four new infections in the region.
According to Obino Tai, a clinical officer, Tigoi Health Centre, viral suppression among adolescents and children is still a challenge. There is need for clinicians to go beyond caregivers and include the community especially schools, to ensure continuity of care, he said.
Tai shared findings of a qualitative study examining causes of poor adherence among adolescents. The study carried out from September to November, 2019 involved 40 adolescents living with HIV aged 10-19 years.
Challenges in storing drugs (either in personal boxes, with school staff) and carrying drugs during school activities, was mentioned as a leading cause for poor adherence. “Those whose drugs were stored by school staff had challenges making frequent visits/ accessing drug stores every day at specific times,” he said.
Lack of privacy while taking the medication was also cited as an issue as the young people find identifying private spaces to take pills difficult resulting in poor timing, skipping dosages, swallowing pills without water or taking pills in toilets away from glaring eyes.
Because of the school set up, especially boarding schools, the adolescents are constantly surrounded by their peers or school personnel and the situation is made worse during extra-curriculum activities, Tai said, adding that sometimes their friends would follow them in the toilets to see what they are doing if a routine was noticed.
Additionally, complexity of coordinating clinic schedule with school activities is a concern. This is because the adolescents constantly have to weigh between missing a school activity over a clinic- related activity leading them to choose the latter, he explained.
Stigma, Tai said, is still a very big challenge as there is poor handling of discussions around HIV by students and staff. “Students responded to negative discussions by stopping medication after losing hope, walking away or fighting back,” he added.
Other factors leading to poor drug adherence include packaging of ART (large noisy and visibility of drug names) and inability to track medication times (some don’t have watches or watches were stolen while some relied on school programs to estimate time leading up to 2 hours in difference).
“There is need for coordination of support for students living with HIV between the Ministry of Education and the Ministry of Health if viral suppression is to be achieved for Students Living with HIV,” he said.
“To achieve this, considerable effort is required to understand what works best for adolescents, and more innovative and targeted interventions are needed to contribute to improved health outcomes.”
In order to increase ownership and uptake, Dr. Elizabeth Irungu Regional Technical Advisor Jhpiego, Kenya noted that youths should be involved in decisions regarding HIV care, treatment and prevention programs. Additionally, they should be included in research and in provision of services such as peer led services.
Eastern and Southern Africa carries the biggest burden of HIV/ AIDS in the world and the youths are disproportionately affected. In 2020, there was an estimated 1.22 million children and adolescents aged 10-19 years living with HIV/AIDS in Eastern and Southern Africa while there was an estimated 100,000 new HIV infections among the same group, according to United Nations International Children’s Emergency Fund (UNICEF).
In Kenya alone, four in 10 of adult new HIV infections occur among adolescents and young people (15 to 24 years old), according to the 2021 HIV Epidemiology in Kenya.
Worse still, over 30% of adolescents and 40% of young adults on ART have not attained viral suppression, National AIDS Control Council (NACC) report says.
The RHAY conference which will run until 24th June, 2022 aims to open a new chapter by bringing AYP in Eastern and Southern Africa (ESA) to the forefront in the fight against HIV, not just on a conference platform but in shaping the long-term prevention and care/treatment research and program agenda towards epidemic control by 2030.
It also aims to move beyond the rhetoric of youth involvement to showcase what it truly means to engage young people, hear their voices, give them a platform, and built their capacity to hold the steering wheel in the fight against HIV, in the spirit of Nothing for Us without Us.