Facing the Challenge: Reproductive health for HIV-positive adolescents
Research on HIV and AIDS has generated valuable breakthroughs in the last 20 years. Children born with HIV are more likely to survive with treatment, and vertical transmission has been reduced with the provision of antiretroviral drugs to 45 per cent of pregnant women living with the virus in low- and middle-income countries in 2008. The global community has also made great strides to protect children and facilitate access to education and health services for HIV-positive children and orphans. Organizations such as UNICEF, faith-based organizations and women’s networks such as the World Young Women’s Christian Association (YWCA) have directed resources to train caregivers in social protection policies and to defend children’s rights to information and dignity.
Many of those living with HIV are adolescents. These young people do not fit any one model: They are in school, out of school, living with foster parents, in stable families, heading families or seeking employment. But all of them deserve a nurturing environment and coherent support to make informed decisions about their particular condition. In the last two years, the World YWCA conducted a series of dialogues with HIV-positive adolescent girls on the particular issues they face. We discovered three key challenges that adolescents living with HIV contend with: disclosure, education and developing relationships.
First, in terms of disclosure, many children and young people are not informed of their HIV-positive status. Caregivers may not be prepared to tell them for a variety of reasons. Parents may feel an overwhelming guilt for unintentionally “infecting” their child, for example, or they may dread answering questions about how HIV is transmitted. They may also wonder whether their child will be able to live a “normal” life, knowing she or he is HIV-positive, or have fulfilling relationships (sexual or otherwise) in the future. Counselling for both caregiver and child is indispensable when handling disclosure.
Some adolescents know their status but do not disclose it to others because they fear rejection or exclusion. Both circumstances put young people at risk of transmitting HIV to others. In order to stop the spread of this virus, we must counteract prevailing stigma. It is imperative that policies and programmes – especially those established by governments – provide safe spaces for adolescents to feel comfortable disclosing their status, secure in the knowledge that they will be supported.
The second challenge is that comprehensive information on reproductive health for HIV-positive adolescents is still scarce. Health-care systems and family support networks lack the means to break down such information to show its relevance to a particular age group or gender. “Aunt, should I stop taking the medicine now that I have started my period?” asks 15-year-old Tendai from Zimbabwe. Tendai was born HIV-positive and worries that taking medication during her period could result in side effects or adversely affect the chance of her having a child later in life. Local health-care workers and caregivers need training to provide answers to such questions about the fertility risks for HIV-positive adolescents. Providing education and accessible information to people living with HIV is pivotal to eliminating the epidemic.
The third challenge is developing relationships. Whether with friends or family, relationships are fraught with difficulty for young people living with HIV. UNICEF recently organized a dialogue with HIVpositive adolescents in Zimbabwe. These wonderful, bright voices brought painful and piercing messages. Conscious of their HIV status, adolescents fear they may never experience a sustainable romantic relationship. If they are blessed with a loving and understanding partner, will the partner’s family accept them? If so, how do they go about conceiving a child? In such resource-poor countries, what are the risks and options?
It is the duty of governments to make sure medication and services such as counselling are available to all those living with HIV, including young people. International organizations such as Save the Children and community groups such as Rozaria Memorial Trust must join hands to enable HIV-positive adolescents to enjoy all their rights, especially their right to sexual and reproductive health. Most adolescents living with HIV struggle for recognition, rights, protection and support. They seek advice and information, not judgement. The sooner these adolescents’ questions are answered, the sooner they will be empowered with the confidence that only knowledge can provide.
As World YWCA General Secretary, Nyaradzayi Gumbonzvanda leads a global network of women in 106 countries, reaching 25 million women and girls. She previously served as Regional Director for the United Nations Development Fund for Women (UNIFEM) and as a human rights officer with UNICEF in Liberia and Zimbabwe. She is the founder and chairperson of Rozaria Memorial Trust and serves on various boards, including those of Action Aid International and Save the Children UK. She is an active member of women's organizations, including the Zimbabwe Women Lawyers Association.