Wanted: Systems for adolescents with HIV

Adolescents living with HIV and Aids represent a vulnerable group. They not only experience issues that affect people living with HIV, but also those that affect the demographic as they grapple with physical, emotional, cognitive and social changes.

Universal health coverage strategies aim to make appropriate, effective and affordable interventions to improve adolescent health and the “UHC in Africa Framework for Action” proposes five sets of actions. However, adolescent-responsive services must be specially considered.

TRAINING

Pre-service training for the health workforce should cover the needs of adolescents and multi-sectoral partnerships, such as between the ministries of Health and Education and all departments serving children, strengthened and sustained.

There is a need to recognise this vulnerable population while respecting their rights and entitlements. Worth considering are individual-level and organisational and structural factors, including transitioning from adolescent-friendly projects to adolescent-responsive health systems.

Adolescents may develop health-related behaviours that expose them to more health risks than younger children. Peer influence limits their capacity to modify behaviour. Services should suit unique needs, including challenges such as overcoming stigma.

SEXUAL HEALTH

Services should be expanded beyond sexual and reproductive health. This group requires support for holistic well-being — including psychosocial one for antiretroviral therapy (ART) adherence and positive living, nutritional support, life skills training and referrals.

Adolescents are less empowered than adults to claim their rights in health service delivery, but have greater capacity than children to seek healthcare independent of their parents. Their limited resources could impede their access to healthcare, especially if they have to open up to parents or guardians on their reasons.

Those living with HIV may have more healthcare needs and require more financial support to access health services, creating the need for pooled prepaid sources of funds.

SPECIAL NEEDS

The provision of quality standards should start with the training of healthcare providers in adolescent health and adolescent-responsive services, including special needs of those living with HIV. They desire confidentiality and autonomy in health consultations.

Expanding coverage includes mainstream services, school health services, e-health and m-health. UHC for adolescents should focus on preventive and promotive health services, which are likely to reach more adolescents if integrated with school health services and delivered through modern technology.

UHC for adolescents should start with well-designed adolescent-responsive health systems from financing, workforce capacity and service delivery.

PREVENTION

Special consideration should be given to those living with HIV and meaningful engagement of this category during decision making for more effective strategies and better health outcomes.

This year’s Maisha HIV and Aids Conference, due next month, is an opportunity for young people to provide better insights into their wish list for HIV prevention and care.

Ms Tororey is paediatrics and adolescents officer at Amref Health Africa in Kenya.