Transition from paediatric to adult care of adolescents living with HIV in sub-Saharan Africa: challenges, youth-friendly models, and outcomes

PubMed Central

Dahourou, Désiré Lucien; Gautier-Lafaye, Chloé; Teasdale, Chloe A.; Renner, Lorna; Yotebieng, Marcel; Desmonde, Sophie; Ayaya, Samuel; Davies, Mary-Ann; Leroy, Valériane

2017-01-01

Abstract Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition. Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with information on transition were eligible. Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support. Expert commentary: Although the available HIV-related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa. PMID:28530039

Routine HIV screening in North Carolina in the era of the Affordable Care Act: update on laws, reimbursement, and tests.

PubMed

White, Becky L; Carter, Yvonne L; Records, Katherine; Martin, Ian B K

2013-11-01

Eighteen percent of the 1.2 million human immunodeficiency virus (HIV)-infected individuals in the United States are undiagnosed, with North Carolina accounting for the eighth largest number of new HIV diagnoses in 2011. In an effort to identify more HIV-infected individuals by reducing physician barriers to HIV testing, the Centers for Disease Control and Prevention have expanded their HIV screening recommendations to adolescents and adults without HIV risk factors or behaviors, eliminated federal requirements for pretest counseling, and modified the informed consent process. In 2010, the Office of National AIDS (acquired immunodeficiency syndrome) Policy released the first-ever national HIV/AIDS strategy, with the goal of reducing new infections, increasing access to care, improving HIV outcomes, and reducing HIV racial/ethnic disparities. In 2013, the US Preventive Services Task Force released A-level recommendations recommending nonrisk-based HIV screening for adults and adolescents that are consistent with the recommendations of the Centers for Disease Control and Prevention. In concert with these federal recommendations, the majority of states have modified their consent and counseling requirements. The implementation of the Patient Protection and Affordable Care Act will add requirements and incentives for federal (Medicare), state (Medicaid), and private (insurance) payers to reimburse physicians and patients for nonrisk-based HIV screening.

Antiretroviral chemoprophylaxis in children and adolescents victims of rape in Abidjan.

PubMed

Ehui, E; Couitchéré, L S; Kouakou, G A; Doumbia, A; Kassi, A N; Mossou, C M; Guié, P Y; Eholié, S

2015-08-01

We described the use of antiretroviral drugs to prevent HIV transmission among children and adolescents victims of rape in Abidjan (Ivory Coast). We conducted a retrospective and descriptive study on children (0-9 years) and adolescents (10-19 years) victims of rape between 2000 and 2013. We analyzed the patients' socio-demographic characteristics and the modality of the chemoprophylaxis. We included 10 children and 89 adolescents in the study. The median age was 16 years old (3-19 years). The median time to consultation was 23.5 hours (5-152 hours). The antiretroviral chemoprophylaxis was administered to 92 patients (93%). No HIV and HBV seroconversion was observed after a 3-month follow-up. A better management of rape victims is required in Abidjan. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya.

PubMed

Kadede, Kevin; Ruel, Theodore; Kabami, Jane; Ssemmondo, Emmanuel; Sang, Norton; Kwarisiima, Dalsone; Bukusi, Elizabeth; Cohen, Craig R; Liegler, Teri; Clark, Tamara D; Charlebois, Edwin D; Petersen, Maya L; Kamya, Moses R; Havlir, Diane V; Chamie, Gabriel

2016-09-10

We sought to increase adolescent HIV testing across rural communities in east Africa and identify predictors of undiagnosed HIV. Hybrid mobile testing. We enumerated 116 326 adolescents (10-24 years) in 32 communities of Uganda and Kenya ( NCT01864603): 98 694 (85%) reported stable (≥6 months of prior year) residence. In each community we performed hybrid testing: 2-week multidisease community health campaign that included HIV testing, followed by home-based testing of community health campaign nonparticipants. We measured adolescent HIV testing coverage and prevalence, and determined predictors of newly diagnosed HIV among HIV-infected adolescents using multivariable logistic regression. A total of 86 421 (88%) stable adolescents tested for HIV; coverage was 86, 90, and 88% in early (10-14), mid (15-17), and late (18-24) adolescents, respectively. Self-reported prior testing was 9, 26, and 55% in early, mid, and late adolescents tested, respectively. HIV prevalence among adolescents tested was 1.6 and 0.6% in Ugandan women and men, and 7.1 and 1.5% in Kenyan women and men, respectively. Prevalence increased in mid-adolescence for women and late adolescence for men. Among HIV-infected adolescents, 58% reported newly diagnosed HIV. In multivariate analysis of HIV-infected adolescents, predictors of newly diagnosed HIV included male sex [odds ratio (OR) = 1.97 (95% confidence interval (CI): 1.42-2.73)], Ugandan residence [OR = 2.63 (95% CI: 2.08-3.31)], and single status [OR = 1.62 (95% CI: 1.23-2.14) vs. married)]. The SEARCH hybrid strategy tested 88% of stable adolescents for HIV, a substantial increase over the 28% reporting prior testing. The majority (57%) of HIV-infected adolescents were new diagnoses. Mobile HIV testing for adults should be leveraged to reach adolescents for HIV treatment and prevention.

Educational effectiveness of an HIV pretest video for adolescents: a randomized controlled trial.

PubMed

Calderon, Yvette; Cowan, Ethan; Nickerson, Jillian; Mathew, Sheba; Fettig, Jade; Rosenberg, Michael; Brusalis, Christopher; Chou, Katherine; Leider, Jason; Bauman, Laurie

2011-05-01

The goal of this study was to compare the effectiveness of a youth-friendly HIV video with in-person counseling in conveying HIV knowledge and obtaining consent for HIV testing among adolescent patients of an urban emergency department. A 2-armed, randomized controlled trial was conducted on a convenience sample of 200 stable, sexually active people aged 15 to 21 years in an urban emergency department. Participants in both the in-person counseling group and the video intervention group completed preintervention and postintervention HIV knowledge measures. HIV knowledge was the primary outcome measure, and consent for HIV testing was the secondary outcome. Characteristics associated with voluntary HIV testing were identified. Of 333 eligible people, 200 agreed to participate. There was no difference in preintervention HIV knowledge scores between groups. Mean postintervention knowledge scores differed significantly between the video (78.5% correct) and the counselor (66.3% correct) (P < 0.01) groups. Overall, 51% of the video group accepted HIV testing compared with 22% in the control group (P < .01). Watching the video (OR: 3.6 [95% CI: 1.8-7.2]), being female (OR: 2.1 [95% CI: 1.0-4.2]), engaging in oral sex (OR: 2.8 [95% CI: 1.4-5.9]), and being older than 18 years (OR: 3.8 [95% CI: 1.8-7.8]) were all positively associated with testing. A youth-friendly HIV educational video improved adolescents' HIV knowledge and increased their participation in HIV testing more than in-person counseling. video-based HIV counseling can perform as well or better than in-person counseling for adolescents in the ED.

Educational Effectiveness of an HIV Pretest Video for Adolescents: A Randomized Controlled Trial

PubMed Central

Cowan, Ethan; Nickerson, Jillian; Mathew, Sheba; Fettig, Jade; Rosenberg, Michael; Brusalis, Christopher; Chou, Katherine; Leider, Jason; Bauman, Laurie

2011-01-01

OBJECTIVE: The goal of this study was to compare the effectiveness of a youth-friendly HIV video with in-person counseling in conveying HIV knowledge and obtaining consent for HIV testing among adolescent patients of an urban emergency department. METHODS: A 2-armed, randomized controlled trial was conducted on a convenience sample of 200 stable, sexually active people aged 15 to 21 years in an urban emergency department. Participants in both the in-person counseling group and the video intervention group completed preintervention and postintervention HIV knowledge measures. HIV knowledge was the primary outcome measure, and consent for HIV testing was the secondary outcome. Characteristics associated with voluntary HIV testing were identified. RESULTS: Of 333 eligible people, 200 agreed to participate. There was no difference in preintervention HIV knowledge scores between groups. Mean postintervention knowledge scores differed significantly between the video (78.5% correct) and the counselor (66.3% correct) (P < 0.01) groups. Overall, 51% of the video group accepted HIV testing compared with 22% in the control group (P < .01). Watching the video (OR: 3.6 [95% CI: 1.8–7.2]), being female (OR: 2.1 [95% CI: 1.0–4.2]), engaging in oral sex (OR: 2.8 [95% CI: 1.4–5.9]), and being older than 18 years (OR: 3.8 [95% CI: 1.8–7.8]) were all positively associated with testing. CONCLUSIONS: A youth-friendly HIV educational video improved adolescents' HIV knowledge and increased their participation in HIV testing more than in-person counseling. video-based HIV counseling can perform as well or better than in-person counseling for adolescents in the ED. PMID:21482613

Provider perceptions of stigma and discrimination experienced by adolescents and young adults with pHiV while accessing sexual and reproductive health care.

PubMed

Fair, Cynthia D; Berk, Meredith

2018-02-01

Historically, children with perinatally-acquired HIV (PHIV) were viewed as the "innocent victims" as their HIV infection was not acquired through sexual/drug related means. Today, adolescents with PHIV are surviving into young adulthood and are engaging in developmentally expected behaviors such as establishing intimate, sexual relationships. Like other youth, those living with PHIV often need to access sexual and reproductive health (SRH) services. Previous research has documented stigma and discrimination experienced by adult women living with HIV as they try to access SRH care. However, little is known about the experiences of stigma and discrimination encountered by the maturing adolescents and young adults (AYA) with PHIV when accessing services. HIV health care providers (HHCPs) who frequently care for this population are in a unique position to learn about and understand the stigma and discrimination experienced by their patients in formal service settings. HHCPs (n = 57, 28 medical and 29 social service providers) were recruited using snowball sampling, and completed an online survey based on patient-shared experiences of stigma and discrimination when accessing SRH-related health care and social services. Thirty-eight percent (22/57) of providers reported that their patients with PHIV had shared encounters of stigma or discrimination when accessing SRH services. Coded open-ended provider comments indicated that AYA patients experienced challenges with providers who were unfamiliar with PHIV and expressed surprise that someone with PHIV was still alive. Analyses also revealed prejudicial attitudes towards women with HIV. Patients reported being counseled to terminate their pregnancy and lectured about their "poor choices." As AYA with PHIV transition out of pediatric and adolescent care, it is important for providers to simultaneously help them navigate care in other health settings, as well as educate adult health care providers about possible misconceptions of caring for individuals with PHIV.

Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India

PubMed Central

Isaakidis, Petros; Paryani, Roma; Khan, Samsuddin; Mansoor, Homa; Manglani, Mamta; Valiyakath, Asmaa; Saranchuk, Peter; Furin, Jennifer

2013-01-01

Background Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10–19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India. Methods A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. Results The median age was 16 (IQR 14–18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8–250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. Conclusions Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group. PMID:23894358

Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

PubMed

Isaakidis, Petros; Paryani, Roma; Khan, Samsuddin; Mansoor, Homa; Manglani, Mamta; Valiyakath, Asmaa; Saranchuk, Peter; Furin, Jennifer

2013-01-01

Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India. A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

Reviewing independent access to HIV testing, counselling and treatment for adolescents in HIV-specific laws in sub-Saharan Africa: implications for the HIV response

PubMed Central

Eba, Patrick M.; Lim, HyeYoung

2017-01-01

Abstract Introduction: AIDS is a leading cause of death among adolescents in sub-Saharan Africa. Yet, legal, policy and social barriers continue to restrict their access to HIV services. In recent years, access to independent HIV testing and treatment for adolescents has gained increased attention. The 2013 WHO Guidance on HIV testing and counselling and care for adolescents living with HIV (WHO Guidance) calls for reviewing legal and regulatory frameworks to facilitate adolescents’ access to comprehensive HIV services. As of 31 March 2017, some 28 countries in sub-Saharan Africa have adopted HIV-specific legislation. But there is limited understanding of the provisions of these laws on access to HIV services for adolescents and their implication on efforts to scale up HIV prevention, testing, treatment and care among this population. Methods: A desk review of 28 HIV-specific laws in sub-Saharan Africa complemented with the review of HIV testing policies in four countries using human rights norms and key public health recommendations from the 2013 WHO Guidance. These recommendations call on countries to (i) lower the age of consent to HIV testing and counselling and allow mature adolescents who have not reached the age of consent to independently access HIV testing, (ii) ensure access to HIV counselling for adolescents, (iii) protect the confidentiality of adolescents living with HIV and (iv) facilitate access to HIV treatment for adolescents living with HIV. Results: Most HIV-specific laws fail to take into account human rights principles and public health recommendations for facilitating adolescents’ access to HIV services. None of the countries with HIV-specific laws has adopted all four recommendations for access to HIV services for adolescents. Discrepancies exist between HIV laws and national policy documents. Inadequate and conflicting provisions in HIV laws are likely to hinder access to HIV testing, counselling and treatment for adolescents. Conclusions: Efforts to end legal barriers to access to HIV services for adolescents in sub-Saharan Africa should address HIV-specific laws. Restrictive provisions in these laws should be reformed, and their protective norms effectively implemented including by translating them into national policies and ensuring sensitization and training of healthcare workers and communities. This study reiterates the need for action in all countries across Africa and beyond to review their laws and policies to create an enabling environment to accelerate access to HIV prevention, testing and treatment services for adolescents. PMID:28799324

"When am I going to stop taking the drug?" Enablers, barriers and processes of disclosure of HIV status by caregivers to adolescents in a rural district in Zambia.

PubMed

Mweemba, Mable; Musheke, Maurice M; Michelo, Charles; Halwiindi, Hikabasa; Mweemba, Oliver; Zulu, Joseph M

2015-10-07

Disclosure of adolescents' own HIV status by caregivers is not only challenging but low. The reasons for this remain unclear despite efforts to examine and seek to understand disclosure patterns or factors that may either facilitate or inhibit this disclosure. This study explored the enablers, barriers and processes of disclosure of HIV status to adolescents by their caregivers in Kafue district of Zambia. A case study method was used to understand factors that facilitate or inhibit caregiver's ability to disclose the HIV status of adolescents aged 10-15 years. Data collected through in-depth interviews with 30 caregivers as well as 6 key informants were analysed using thematic analysis. Overall, 17 out of 30 (56.7 %) caregivers had informed the adolescents about their HIV status. Reasons for disclosing of the HIV status included inquiries by adolescents as to why they were taking medication, threats by adolescents not to take HIV medication, desire to promote treatment self-efficacy amongst adolescents as well as facilitating adoption of safe sexual behaviour among adolescents. The disclosure processes were conducted either at the home or at the clinic. Enabling factors for HIV disclosure were adolescents' knowledge of HIV and caregivers' knowledge of and experience with HIV programs. Barriers to disclosure of HIV status included fear of psychological trauma for the adolescents, perceived inability of adolescents to keep their HIV status confidential which could attract HIV stigmatisation for the family, and caregivers', fear of being blamed by the adolescents for the infection, limited disclosure skills by caregivers as well as negative attitude by some HIV counsellors. Despite challenges associated with disclosure of adolescents' own HIV status by caregivers, environments that facilitate this process exist and can be strengthened. Promoting HIV disclosure requires in-depth and context-specific understanding of the factors that enable and undermine this process. Limitations in this understanding may have played critical roles in past strategic implementation of locally driven and relevant interventions to improve disclosure of HIV status by caregivers to adolescents in Zambia.

Cumulative Psychosocial Risk is a Salient Predictor of Depressive Symptoms among Vertically HIV-Infected and HIV-Affected Adolescents at the Kenyan Coast.

PubMed

Abubakar, Amina; Van de Vijver, Fons J R; Hassan, Amin S; Fischer, Ronald; Nyongesa, Moses K; Kabunda, Beatrice; Berkley, James A; Stein, Alan; Newton, Charles R

Little is known of mental health outcomes among vertically HIV-infected or HIV-affected adolescents in Africa. The current study set out to describe depressive symptoms and their correlates among vertically HIV-infected and HIV-affected adolescents at the Kenyan Coast. 130 adolescents (vertically HIV-infected [n = 44], HIV-affected [n = 53], and unexposed [n = 33]) and their caregivers participated in this cross-sectional study. An adapted version of the Beck Depression Inventory-11 (BDI) was administered to examine depressive symptoms in both adolescents and caregivers, together with measures of sociodemographic, medical, and anthropometric characteristics. Our analysis indicated a main effect of HIV status on mean BDI scores in HIV-infected (18.4 [SD = 8.3) and HIV-affected (16.8 [SD = 7.3]) adolescents compared to the community controls (12.0 [SD = 7.9]), F (2, 127) = 6.704, P = .002, η 2  = .095. Post hoc analysis showed that BDI scores of HIV-infected adolescents were higher than those of community controls (P < .001). Similarly, HIV-affected adolescents had BDI scores that were higher than those of community controls (P = .007). However, there was no difference in BDI scores between HIV-infected and HIV-affected adolescents (P = .304). A path analytic model indicated that cumulative psychosocial risk (orphanhood, family poverty, and caregiver depressive symptoms) were positive predictors of BDI scores among adolescents, while nutritional status had a limited role. Both HIV-infected and HIV-affected adolescents are at a high risk of experiencing depressive symptoms, largely due to the multiple psychosocial risk factors in their environment. The provision of adequate psychosocial support and counseling needs to become an integral part of the care program for adolescents from families living with HIV/AIDS at the Kenyan coast and other similar settings. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Increasing Adolescent HIV Prevalence in Eastern Zimbabwe – Evidence of Long-Term Survivors of Mother-to-Child Transmission?

PubMed Central

Eaton, Jeffrey W.; Garnett, Geoffrey P.; Takavarasha, Felicia R.; Mason, Peter R.; Robertson, Laura; Schumacher, Christina M.; Nyamukapa, Constance A.; Gregson, Simon

2013-01-01

Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested that between 2004 and 2007 HIV prevalence amongst males aged 15–17 years in eastern Zimbabwe increased from 1.20% to 2.23%, and in females remained unchanged at 2.23% to 2.39%, while prevalence continued to decline in the rest of the adult population. We assess whether the more likely source of the increase in adolescent HIV prevalence is recent sexual HIV acquisition, or the aging of long-term survivors of perinatal HIV acquisition that occurred during the early growth of the epidemic. Using data collected between August 2006 and November 2008, we investigated associations between adolescent HIV and (1) maternal orphanhood and maternal HIV status, (2) reported sexual behaviour, and (3) reporting recurring sickness or chronic illness, suggesting infected adolescents might be in a late stage of HIV infection. HIV-infected adolescent males were more likely to be maternal orphans (RR = 2.97, p<0.001) and both HIV-infected adolescent males and females were more likely to be maternal orphans or have an HIV-infected mother (male RR = 1.83, p<0.001; female RR = 16.6, p<0.001). None of 22 HIV-infected adolescent males and only three of 23 HIV-infected females reported ever having had sex. HIV-infected adolescents were 60% more likely to report illness than HIV-infected young adults. Taken together, all three hypotheses suggest that recent increases in adolescent HIV prevalence in eastern Zimbabwe are more likely attributable to long-term survival of mother-to-child transmission rather than increases in risky sexual behaviour. HIV prevalence in adolescents and young adults cannot be used as a surrogate for recent HIV incidence, and health systems should prepare for increasing numbers of long-term infected adolescents. PMID:23950938

Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes.

PubMed

Mburu, Gitau; Hodgson, Ian; Kalibala, Sam; Haamujompa, Choolwe; Cataldo, Fabian; Lowenthal, Elizabeth D; Ross, David

2014-01-01

As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. In 2010, we conducted a qualitative study among adolescents aged 10-19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents' disclosure of their status to others; and the impact of both forms of disclosure on adolescents. Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents' disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents' sexual relationships, although it did not always lead to rejection. There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process.

[Experiences of adolescents seropositive for HIV/AIDS: a qualitative study].

PubMed

Galano, Eliana; Turato, Egberto Ribeiro; Delmas, Philippe; Côté, José; Gouvea, Aida de Fátima Thomé Barbosa; Succi, Regina Célia de Menezes; Machado, Daisy Maria

2016-06-01

Explore the meanings attributed by young individuals about "living as an adolescent with HIV" in a group of patients that acquired the infection at birth and the elements involved with the adherence to antiretroviral treatment. Qualitative study, involving 20 subjects (aged 13-20 years), followed at services specialized in the treatment of pediatric Aids in São Paulo, Brazil. Semi-structured interviews were carried out of which script consisted of questions about their personal histories, experiences and difficulties they must face while living with HIV/Aids. Being "normal" and "different" were central issues voiced by the participants. However, a normal life situation is guaranteed by being responsible with one's health, the condition that the diagnosis be kept secret and concerns about HIV transmission and dissemination to a sexual partner. The answers about treatment show that adherence is a dynamic process and involves moments of greater or lesser interest in relation to care for one's health. The adolescents have plans and projects and although HIV is considered a stressor, positive perspectives for the future prevailed. To live as an adolescent with HIV involves subtle dimensions that need to be recognized and legitimized by professionals who follow the trajectory of these young individuals. It is necessary to allow a space in which the adolescents can reflect and find support regarding issues related to the construction of their sexuality and care of one's own body. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Adolescent girls and young women living with HIV: preconception counseling strategies.

PubMed

Jones, Deborah L; Echenique, Marisa; Potter, JoNell; Rodriguez, Violeta J; Weiss, Stephen M; Fischl, Margaret A

2017-01-01

Rates of pregnancy among women living with HIV are similar to those in the general population. Unintended pregnancies are also common, and among adolescents and young women perinatally infected (PHIV+) or behaviorally infected (BHIV+) with HIV, planning for both conception and contraception is an important element of HIV care that may be neglected. This pilot study examined the influence of intervention strategies targeting fertility planning, safer conception practices and patient-provider communication. It was hypothesized that preconception counseling interventions would enhance reproductive knowledge, planning and practices, as well as stimulate discussion with providers regarding conception. Adolescent girls and young women (N=34) perinatally (n=21) or behaviorally (n=13) infected with HIV, aged 16-29 years, were recruited from urban South Florida, and completed measures of reproductive knowledge, sexual practices and fertility intentions. Participants were randomized to condition, ie, video presentation plus Motivational Interviewing (MI), MI only, control. The average age of women was 22 years (SD =3.27), and the majority of them were African American. Levels of depression were higher among BHIV+ compared to PHIV+ at baseline and 6 months. Pregnancy knowledge (pregnancy, safe conception and pregnancy planning) and the proportion of those engaging in birth control planning (condom use, long-term birth control, patient-provider discussions on preventing pregnancy and fertility desires) were similar between conditions at post-intervention and 6 months. Bayes factors indicated that the data were insensitive with regard to differences between conditions, limiting support for both the null and alternative hypotheses. The impact of interventions used in this study to stimulate pregnancy planning was inconclusive. Results suggest that pregnancy planning interventions may require greater intensity to influence sexual behavior in this population. Despite adequate reproductive knowledge, HIV-infected adolescent girls and young women may fail to engage in planning behavior.

Adolescent onset of vertically transmitted untreated AIDS: A report of one case.

PubMed

Wei, Hsi-Hsien; Tsai, Li-Ping; Wu, Ping-Sheng

2016-01-01

A 12-year-old adolescent girl with intractable pneumonia and desaturation was sent to our hospital. An immunocompromised state was highly suspected because of an oral thrush persisting for a year and pneumonia of unusual severity. Laboratory tests confirmed she had human immunodeficiency virus (HIV) infection and full-blown AIDS. She lived with her adopted parents and reported no history of sexual abuse, drug abuse, or blood transfusion. We contacted the Center of Disease Control and discovered that her mother had HIV and had passed away a few years ago, thus confirming that she was a case of vertically transmitted HIV patient who had only developed AIDS recently. Even though her mother had HIV, our public health department failed to follow her as a potential HIV victim, probably because routine HIV examinations for pregnant women only started in 2005, 4 years after she was born.

High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015

PubMed Central

Harries, Anthony D.; Kumar, Ajay M. V.; Oo, Myo Minn; Kyaw, Khine Wut Yee; Win, Than; Aung, Thet Ko; Min, Aung Chan; Oo, Htun Nyunt

2017-01-01

Background The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC). Methods Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes. Results Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART. Conclusions We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing. PMID:28182786

Adolescent Linkage to Care After a Large-scale Transfer From a Hospital-based HIV Clinic to the Public Sector in South Africa.

PubMed

Ramirez-Avila, Lynn; Regan, Susan; Cloete, Christie; Crankshaw, Tamaryn; Rabideau, Dustin J; Freedberg, Kenneth A; Parker, Robert A; Walensky, Rochelle P; Losina, Elena; Bassett, Ingrid V

2017-03-01

HIV clinics formerly supported by the President's Emergency Plan for AIDS Relief are transferring patients to public-sector clinics. We evaluated adolescent linkage to care after a large-scale transfer from a President's Emergency Plan for AIDS Relief-subsidized pediatric HIV clinic in Durban, South Africa. All adolescents (11-18 years) in care at a pediatric state-subsidized, hospital-based clinic (HBC) were transferred, from May to June 2012, to government sites [primary health care (PHC) clinic; community health center (CHC); and HBCs] or private clinics. Caregivers were surveyed 7-8 months after transfer to assess their adolescents' linkage to care and their reports were validated by clinic record audits in a subset of randomly selected clinics. Of the 309 (91%) caregivers reached, only 5 (2%) reported that their adolescent did not link. Of the 304 adolescents who linked, 105 (35%) were referred to a PHC, 73 (24%) to a CHC and 106 (35%) to a HBC. A total of 146 (48%) linked adolescents attended a different clinic than that assigned. Thirty-five (20%) of the 178 who linked and were assigned to a PHC or CHC ultimately attended a HBC. Based on clinic validation, the estimated transfer success was 88% (95% confidence interval: 77%-97%). The large majority of adolescents successfully transferred to a new HIV clinic, although nearly half attended a clinic other than that assigned.

Teenage pregnancies in Mozambique: the experience of "Servicios Amigos dos Adolescentes" clinics in Beira.

PubMed

Pizzol, Damiano; Di Gennaro, Francesco; Boscardin, Chiara; Putoto, Giovanni; Cuppini, Elena; Pita, Graciana; George, Alexandra; Monno, Laura; Saracino, Annalisa; Da Dalt, Liviana; De Palma, Angela

2018-03-01

The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10-14; 15-19; 20-24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15-19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4-5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10-14 year old girls; 8% amongst 15-19 year olds; 10% amongst 20-24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique.

A human immunodeficiency virus posttest video to increase condom use among adolescent emergency department patients.

PubMed

Calderon, Yvette; Cowan, Ethan; Leu, Cheng-Shiun; Brusalis, Christopher; Rhee, John Y; Nickerson, Jillian; Leider, Jason; Bauman, Laurie J

2013-07-01

To compare the effectiveness of a theory-based HIV educational video tool with in-person HIV counseling in promoting safer sex behaviors among adolescent patients of an urban Emergency Department (ED). This was a randomized controlled trial taking place in the Emergency Department of Jacobi Medical Center in the Bronx, New York. A total of 203 stable, sexually active patients aged 15-21 years completed pre-intervention and postintervention measures. Participants were randomized to the intervention video series (102 participants), a theory-based, youth-friendly human immunodeficiency virus (HIV) educational video, or an in-person HIV counseling session with a trained HIV counselor (101 participants). Participants completed pre-intervention and postintervention measures on the primary outcomes: condom intention, outcome expectancy, and self-efficacy. Participants in the video group improved condom use intention (adjusted differential mean improvement [ADMI] = .98 units; confidence interval [CI], .20-1.77; Holm adjusted p = .028), condom self-efficacy outcome (ADMI = .26 units; CI, .04-.48; Holm adjusted p = .019), and condom outcome expectancy scores (ADMI = .15 units; CI, .07-.23; Holm adjusted p < .001) significantly more than those in the counselor group, adjusting for stage of change. The intervention helped participants progress to the next level of readiness or maintain their positive behavior, and did not differ by age, gender, or race. A theory-based, youth-friendly video can be a valid means to provide posttest HIV education and prevention messages within an urban emergency department. The theory-based prevention messages can improve teenagers' condom intentions, condom self-efficacy, and condom outcome expectancies immediately after the intervention. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

FAMILIES' RESPONSE TO AIDS: NEW INSIGHTS INTO PARENTAL ROLES IN FOSTERING HIV/AIDS KNOWLEDGE.

PubMed

Dimbuene, Zacharie Tsala

2015-11-01

Worldwide, there is a consensus that parents must be involved in children's HIV/AIDS education. However, there is little evidence that speaks to this advocacy for improving adolescent health. This study developed and tested four hypotheses about (i) the relationship between parents' and adolescents' knowledge of HIV/AIDS transmission routes and prevention strategies conditional upon (ii) parents' gender, (iii) communication about sexuality, and (iv) the parent-adolescent education gap. The sample consisted of 306 parent-adolescent dyads from the 2002 Cameroon Family and Health Survey. Adolescents were aged 12-19 years. Overall, fifteen items about HIV/AIDS transmission routes and prevention strategies were analysed. Descriptive results showed that parents fared better than adolescents regardless of the AIDS fact considered. An exception was the correct use of condoms (parents 57% vs adolescents 61%). The generation gap probably explains this result: parents are more conservative, reluctant and distant from condoms compared with adolescents, who are more receptive and open to discussing sex with peers. Multivariate ordered logistic regressions showed a significant positive effect of parents' HIV/AIDS knowledge on adolescents' HIV/AIDS knowledge, thus supporting the main hypothesis of direct parental influences. Parent-adolescent communication about sexuality showed positive and significant effects on adolescents' HIV/AIDS knowledge, suggesting an 'enhancing effect' when combined with the effect of parents' HIV/AIDS knowledge. Against the background that parents in sub-Saharan Africa do not teach their children about sexuality, the study demonstrated that families can play an important role in HIV/AIDS education. These findings have major implications for HIV/AIDS interventions involving adolescents, parents or both, in fostering accurate HIV/AIDS knowledge among adolescents, which could lead to protective sexual behaviours.

HIV/AIDS Knowledge and Beliefs Among Haitian Adolescents in Miami-Dade County, Florida

PubMed Central

Marcelin, Louis Herns; McCoy, H. Virginia; DiClemente, Ralph J.

2007-01-01

This study examined HIV/AIDS knowledge and beliefs in Haitian adolescents in an HIV epicenter, Miami-Dade Florida. This study examined survey data from 300 Haitian adolescents, aged 13 through 18, from both low-and middle-income neighborhoods. A sub-sample of 80 adolescents was selected for in-depth interviews and continuous observations with their families and networks of friends, which added rich descriptions to the quantitative data. Overall knowledge about HIV/AIDS was high with the majority of adolescents identifying unprotected sex and sharing injection drug needles as HIV transmission routes. Moreover, approximately 75% of the adolescents reported condom use as an effective preventive strategy. However, misconceptions that could reduce adolescents' adoption of HIV preventive strategies were also identified. The adolescents' sources for information about HIV/AIDS as well as implications for prevention interventions are discussed. PMID:17502921

Adaptation and Refinement of the HIV Knowledge Questionnaire for Use With Adolescent Girls

PubMed Central

Volpe, Ellen M.; Nelson, LaRon E.; Kraus, Rachel A.; Morrison-Beedy, Dianne

2008-01-01

The number of adolescent girls becoming infected with HIV has dramatically escalated to the point where they now represent one of the groups most at risk for this infection. As a component of addressing this pandemic, there is a need for psychometrically sound, tailored measures to assess an adolescent girl's level of knowledge regarding transmission and prevention of HIV. The purpose of this research was to modify an existing HIV knowledge measure used in the general adult population (brief HIV Knowledge Questionnaire [HIV-KQ]) and increase its utility by making it developmentally- and gender-specific for adolescent girls. The revised version with additional items underwent item and scale analysis to confirm psychometric properties with a sample of 62 adolescent girls. HIV-related knowledge is assessed extensively in clinical practice and educational settings and is an important component for monitoring change in successful HIV risk-reduction interventions. The final HIV-KQ for adolescent girls is a practical, specific, and appropriate instrument for use with adolescent girls in these settings. PMID:17889326

The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: implications for public health.

PubMed

Cunningham, R M; Stiffman, A R; Doré, P; Earls, F

1994-03-01

This paper explores the relationship between changes in HIV risk behaviors and physical and sexual abuse. A stratified random sampling procedure selected 602 youths from a sample of 2,787 patients seen consecutively at public health clinics in 10 cities. Face-to-face structured interviews conducted since 1984-85 provide a history of change in risk behavior from adolescence to young adulthood. Univariate and bivariate analyses assessed differences in demographic and number and type of risk behaviors between those experiencing single or multiple types of abuse and those with no abuse history at all. The results show that a history of physical abuse, sexual abuse, or rape is related to engaging in a variety of HIV risk behaviors and to a continuation or increase in the total number of these behaviors between adolescence and young adulthood. This information might help practitioners to both prevent initial involvement in HIV risk behaviors and to prevent continuation of behaviors as youths move into young adulthood.

Adiponectin, Leptin and Inflammatory Markers in HIV-associated Metabolic Syndrome in Children and Adolescents.

PubMed

Espiau, María; Yeste, Diego; Noguera-Julian, Antoni; Soler-Palacín, Pere; Fortuny, Clàudia; Ferrer, Roser; Comas, Immaculada; Martín-Nalda, Andrea; Deyà-Martínez, Ángela; Figueras, Concepció; Carrascosa, Antonio

2017-02-01

Metabolic syndrome (MetS) is more common in HIV-infected adults and children than in the general population. Adipocytokines and inflammatory markers may contribute to the pathophysiology of this condition and could be useful indices for monitoring MetS. The objective of this study was to provide information on the prevalence of MetS and investigate the role of adipocytokines and other biomarkers in this syndrome in HIV-infected pediatric patients. A cross-sectional study was conducted between October 2013 and March 2014 in the outpatient clinics of 2 tertiary pediatric referral hospitals. Fifty-four HIV-infected children and adolescents were included. MetS was defined according to the International Diabetes Federation and modified National Cholesterol Education Program Adult Treatment Panel III criteria. Measurements included anthropometry, waist circumference, blood pressure, fasting lipids, glucose and insulin, adiponectin, leptin, interleukin-6, vitamin D and C-reactive protein and clinical lipodystrophy assessment. Among the total, 3.7% of patients met the International Diabetes Federation criteria for MetS and 7.4% met the National Cholesterol Education Program Adult Treatment Panel III criteria. C-reactive protein and leptin levels were significantly higher and adiponectin level significantly lower in patients with MetS, regardless of the criteria used. Insulin resistance was observed in 40.7% of patients; abnormal quantitative insulin sensitivity check index values were found in 88.9%. Eighteen patients (33.3%) had vitamin D deficiency. The prevalence of MetS was similar to that observed in larger cohorts of HIV-infected patients in our setting. Adipocytokine dysregulation seems to be related to MetS in HIV-infected children. A high percentage of patients showed insulin resistance, which should be strictly monitored.

Why Physicians Don’t Ask: Interpersonal and Intrapersonal Barriers to HIV Testing—Making a Case for a Patient-Initiated Campaign

PubMed Central

Arya, Monisha; Patel, Sajani; Kumar, Disha; Zheng, Micha Yin; Amspoker, Amber Bush; Kallen, Michael Anthony; Street, Richard Lewis; Viswanath, Kasisomayajula; Giordano, Thomas Peter

2014-01-01

In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana’s Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons. PMID:25421929

Why Physicians Don't Ask: Interpersonal and Intrapersonal Barriers to HIV Testing-Making a Case for a Patient-Initiated Campaign.

PubMed

Arya, Monisha; Patel, Sajani; Kumar, Disha; Zheng, Micha Yin; Kallen, Michael A; Street, Richard L; Viswanath, Kasisomayajula; Giordano, Thomas P

2016-07-01

In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana's Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons. © The Author(s) 2014.

Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go.

PubMed

Callahan, Tegan; Modi, Surbhi; Swanson, Jennifer; Ng'eno, Bernadette; Broyles, Laura N

2017-08-04

HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in low-income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group. Emerging data from programmes in sub-Saharan Africa highlight that HIV-infected pregnant adolescents have poorer prevention of mother-to-child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV-infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother-to-child HIV transmission among infants of HIV-infected pregnant adolescents. While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings or targeting HIV-infected pregnant adolescents with enhanced retention and follow-up activities.

Developing family interventions for adolescent HIV prevention in South Africa.

PubMed

Kuo, Caroline; Atujuna, Millicent; Mathews, Catherine; Stein, Dan J; Hoare, Jacqueline; Beardslee, William; Operario, Don; Cluver, Lucie; K Brown, Larry

2016-01-01

Adolescents and young people account for 40% of all new HIV infections each year, with South Africa one of the hardest hit countries, and having the largest population of people living with HIV. Although adolescent HIV prevention has been delivered through diverse modalities in South Africa, and although family-based approaches for adolescent HIV prevention have great potential for highly affected settings such as South Africa, there is a scarcity of empirically tested family-based adolescent HIV preventive interventions in this setting. We therefore conducted focus groups and in-depth interviews with key informants including clinicians, researchers, and other individuals representing organizations providing HIV and related health services to adolescents and parents (N = 82). We explored family perspectives and interactions around topics such as communication about sex, HIV, and relationships. Participants described aspects of family interactions that presented both challenges and opportunities for family-based adolescent HIV prevention. Parent-child communication on sexual topics were taboo, with these conversations perceived by some adults as an invitation for children to engage in HIV risk behavior. Parents experienced social sanctions for discussing sex and adolescents who asked about sex were often viewed as disrespectful and needing discipline. However, participants also identified context-appropriate strategies for addressing family challenges around HIV prevention including family meetings, communal parenting, building efficacy around parent-adolescent communication around sexual topics, and the need to strengthen family bonding and positive parenting. Findings indicate the need for a family intervention and identify strategies for development of family-based interventions for adolescent HIV prevention. These findings will inform design of a family intervention to be tested in a randomized pilot trial (ClinicalTrials.gov #NCT02432352).

Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents.

PubMed

Toska, Elona; Cluver, Lucie D; Hodes, Rebecca; Kidia, Khameer K

2015-01-01

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10-19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers. N = 128 (14.9%) of the total sample had ever had sex, while N = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085-17.474, p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to negotiate safer sex. There is a pressing need for effective interventions that mitigate the risks of disclosure and provide HIV-positive adolescents with skills to engage in safe sex.

Sustainable Survival for adolescents living with HIV: do SDG-aligned provisions reduce potential mortality risk?

PubMed

Cluver, Lucie; Pantelic, Marija; Orkin, Mark; Toska, Elona; Medley, Sally; Sherr, Lorraine

2018-02-01

The Sustainable Development Goals (SDGs) present a groundbreaking global development agenda to protect the most vulnerable. Adolescents living with HIV in Sub-Saharan Africa continue to experience extreme health vulnerabilities, but we know little about the impacts of SDG-aligned provisions on their health. This study tests associations of provisions aligned with five SDGs with potential mortality risks. Clinical and interview data were gathered from N = 1060 adolescents living with HIV in rural and urban South Africa in 2014 to 2015. All ART-initiated adolescents from 53 government health facilities were identified, and traced in their communities to include those defaulting and lost-to-follow-up. Potential mortality risk was assessed as either: viral suppression failure (1000+ copies/ml) using patient file records, or adolescent self-report of diagnosed but untreated tuberculosis or symptomatic pulmonary tuberculosis. SDG-aligned provisions were measured through adolescent interviews. Provisions aligned with SDGs 1&2 (no poverty and zero hunger) were operationalized as access to basic necessities, social protection and food security; An SDG 3-aligned provision (ensure healthy lives) was having a healthy primary caregiver; An SDG 8-aligned provision (employment for all) was employment of a household member; An SDG 16-aligned provision (protection from violence) was protection from physical, sexual or emotional abuse. Research partners included the South African national government, UNICEF and Pediatric and Adolescent Treatment for Africa. 20.8% of adolescents living with HIV had potential mortality risk - i.e. viral suppression failure, symptomatic untreated TB, or both. All SDG-aligned provisions were significantly associated with reduced potential mortality risk: SDG 1&2 (OR 0.599 CI 0.361 to 0.994); SDG 3 (OR 0.577 CI 0.411 to 0.808); SDG 8 (OR 0.602 CI 0.440 to 0.823) and SDG 16 (OR 0.686 CI 0.505 to 0.933). Access to multiple SDG-aligned provisions showed a strongly graded reduction in potential mortality risk: Among adolescents living with HIV, potential mortality risk was 38.5% with access to no SDG-aligned provisions, and 9.3% with access to all four. SDG-aligned provisions across a range of SDGs were associated with reduced potential mortality risk among adolescents living with HIV. Access to multiple provisions has the potential to substantially improve survival, suggesting the value of connecting and combining SDGs in our response to paediatric and adolescent HIV. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

HIV-associated cognitive disorders in perinatally infected children and adolescents: a novel composite cognitive domains score.

PubMed

Phillips, Nicole J; Hoare, Jacqueline; Stein, Dan J; Myer, Landon; Zar, Heather J; Thomas, Kevin G F

2018-04-22

Accurate assessment of HIV-associated cognitive disorders in perinatally infected children and adolescents is challenging. Assessments of general intellectual functioning, or global cognition, may not provide information regarding domain-specific strengths and weaknesses, and may therefore fail to detect, impaired trajectories of development within particular cognitive domains. We compare the efficacy of global cognitive scores to that of composite cognitive domain scores in detecting cognitive disorders in a sample of perinatally HIV-infected children, and a demographically matched HIV negative control group, drawn from the Cape Town Adolescent Antiretroviral Cohort (CTAAC) study. All children were administered a comprehensive neuropsychological test battery. Using data from that test battery, we created ten separate composite cognitive domains: general intellectual functioning, attention, working memory, visual memory, verbal memory, language, visual spatial ability, motor coordination, processing speed and executive function. Within each domain, each test bore a high level of association with each of the other tests in that domain (Cronbach's α ≥ .70 for all domains). We found that composite domain scores calculated on whole-sample data were significantly higher than those calculated using control-sample data. Our comparison of a global cognitive score to composite domain scores suggested that the latter provided more detailed information (regarding strengths, weaknesses, areas of impairment), and when compared to global scores, were more sensitive in detecting HIV-associated cognitive disorders, and were able to distinguish HIV-infected patients from uninfected controls. Hence, we recommend using this method of composite cognitive domains scores, rather than global aggregate scores, when assessing cognitive function in paediatric HIV. This method provides a convenient and relatively accurate assessment that might help with cross-cultural and cross-region comparisons as researchers try to detect cognitive impairment patterns in HIV-infected children and adolescents globally.

Trends in Drug Resistance Prevalence, HIV-1 Variants and Clinical Status in HIV-1-infected Pediatric Population in Madrid: 1993 to 2015 Analysis.

PubMed

Rojas Sánchez, Patricia; Domínguez, Sara; Jiménez De Ory, Santiago; Prieto, Luis; Rojo, Pablo; Mellado, Pepa; Navarro, Marisa; Delgado, Rafael; Ramos, José Tomas; Holguín, África

2018-03-01

The expanded use of long-term antiretroviral treatments in infected children may exacerbate the problem of drug resistance mutations selection, which can compromise treatment efficiency. We describe the temporal trends of HIV drug resistance mutations and the HIV-1 variants during 23 years (1993 to March 2016) in the Madrid cohort of HIV-infected children and adolescents. We selected patients with at least one available HIV-1 pol sequence/genotypic resistance profile, establishing different groups according to the sampling year of first resistance data. We determined the prevalence of transmitted drug resistance mutations or acquired drug resistance mutations (DRM), the drug susceptibility among resistant viruses and HIV-1 variants characterized by phylogeny across time. A total of 245 pediatric patients were selected, being mainly female, Spanish native, perinatally infected and carrying HIV-1 subtype B. At first sampling, most pediatric patients were on antiretroviral therapy and heavily pretreated. During 1993 to 2016, transmitted drug resistance mutations was found in 13 (26%) of 50 naive children [non-nucleoside reverse transcriptase inhibitors (NNRTI), 14.6%; nucleoside reverse transcriptase inhibitors (NRTI), 10.4%; protease inhibitors, 8.7%]. DRM appeared in 139 (73.2%) of 190 pretreated patients (NRTI, 64.5%; NNRTI, 36%; protease inhibitors, 35.1%). DRM to NNRTI was higher in last 5 years. Non-B variants infected 14.5% of children and adolescents of the Madrid Cohort, being mainly intersubtype recombinants (76.5%), including complex unique recombinant strains. They caused 3.4% infections before 2000, rising to 85.7% during 2011 to 2016. Periodic surveillance resistance and molecular epidemiology studies in long-term pretreated HIV-infected pediatric populations are required to optimize treatment regimens. Results will permit a better understanding of long-time dynamics of viral resistance and HIV-1 variants in Spain.

HIV/AIDS stigma and knowledge among predominantly middle-class high school students in New Delhi, India.

PubMed

Pramanik, Suneet; Chartier, Maggie; Koopman, Cheryl

2006-03-01

This study examined stigmatizing attitudes toward HIV/AIDS among predominantly middle-class adolescents in New Delhi high schools. This study was specifically designed to: 1) assess stigmatizing attitudes toward HIV/AIDS and sexuality; HIV/AIDS knowledge, and awareness of HIV-related health resources; and 2) examine whether HIV-related stigma and knowledge are related to one another and to gender, parents' education, and exposure to HIV/AIDS education. In four high schools in New Delhi, 186 students completed a questionnaire assessing stigmatization of HIV/AIDS, stigmatization of sexuality, knowledge of HIV/AIDS, HIV/AIDS education and resources, and demographic characteristics. Adolescents varied in how much they stigmatized persons with HIV/AIDS. They generally lacked accurate knowledge about the disease and of related health resources. However, those with greater exposure to HIV/AIDS education demonstrated significantly greater HIV/AIDS knowledge. Female adolescents demonstrated significantly less knowledge about HIV/AIDS compared with male adolescents, while the males reported significantly greater exposure to HIV/AIDS education compared with the females. These results suggest a need for greater HIV/AIDS education and awareness of health resources, especially among female adolescents. Education must directly address stigmatizing attitudes about HIV/AIDS, gaps in HIV/AIDS knowledge and awareness of HIV-related health resources.

Mental health challenges among adolescents living with HIV.

PubMed

Vreeman, Rachel C; McCoy, Brittany M; Lee, Sonia

2017-05-16

Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed.

Mental health challenges among adolescents living with HIV

PubMed Central

Vreeman, Rachel C.; McCoy, Brittany M.; Lee, Sonia

2017-01-01

Abstract Introduction: Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. Methods: For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. Results and Discussion: Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. Conclusions: Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed. PMID:28530045

HIV-Infected Adolescent Mothers and Their Infants: Low Coverage of HIV Services and High Risk of HIV Transmission in KwaZulu-Natal, South Africa

PubMed Central

Horwood, Christiane; Butler, Lisa M.; Haskins, Lyn; Phakathi, Sifiso; Rollins, Nigel

2013-01-01

Objectives Rates of pregnancy and HIV infection are high among South African adolescents, yet little is known about rates of mother-to-child transmission of HIV (MTCT) in this group. We report a comparison of the characteristics of adolescent mothers and adult mothers, including HIV prevalence and MTCT rates. Methods We examined patterns of health service utilization during the antenatal and early postnatal period, HIV prevalence and MTCT amongst adolescent (<20-years-old) and adult (20 to 39-years-old) mothers with infants aged ≤16 weeks attending immunization clinics in six districts of KwaZulu-Natal between May 2008 and April 2009. Findings Interviews were conducted with 19,093 mothers aged between 12 and 39 years whose infants were aged ≤16 weeks. Most mothers had attended antenatal care four or more times during their last pregnancy (80.3%), and reported having an HIV test (98.2%). A greater proportion of HIV-infected adult mothers, compared to adolescent mothers, reported themselves as HIV-positive (41.2% vs. 15.9%, p<0.0001), reported having a CD4 count taken during their pregnancy (81.0% vs. 66.5%, p<0.0001), and having received the CD4 count result (84.4% vs. 75.7%, p<0.0001). Significantly fewer adolescent mothers received the recommended PMTCT regimen. HIV antibody was detected in 40.4% of 7,800 infants aged 4–8 weeks tested for HIV, indicating HIV exposure. This was higher among infants of adult mothers (47.4%) compared to adolescent mothers (17.9%, p<0.0001). The MTCT rate at 4–8 weeks of age was significantly higher amongst infants of adolescent mothers compared to adult mothers (35/325 [10.8%] vs. 185/2,800 [6.1%], OR 1.7, 95% CI 1.2–2.4). Conclusion Despite high levels of antenatal clinic attendance among pregnant adolescents in KwaZulu-Natal, the MTCT risk is higher among infants of HIV-infected adolescent mothers compared to adult mothers. Access to adolescent-friendly family planning and PMTCT services should be prioritised for this vulnerable group. PMID:24073215

Peer mentorship program on HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents: an evidence based practice

PubMed Central

Nabunya, Proscovia; Ssewamala, Fred M.; Mukasa, Miriam N.; Byansi, William; Nattabi, Jennifer

2015-01-01

Adolescents and young adults in sub-Saharan Africa (SSA) are particularly vulnerable to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) infection. Adolescents orphaned as a direct result of HIV/AIDS are at an elevated risk of acquiring HIV/AIDS and other sexually transmitted infections. However, limited empirical evidence exists on HIV knowledge and prevention programs, especially those designed to address HIV information gaps among adolescents. This study evaluates the effect of a peer mentorship program provided in addition to other supportive services on HIV/AIDS knowledge, beliefs, and prevention attitudes, among school-going orphaned adolescents in southern Uganda. We utilize data from the Bridges to the Future Study, a 5-year longitudinal randomized experimental study funded by the National Institute of Child Health and Human Development. Out of the 1410 adolescents enrolled in the study (average age = 12.7 at study initiation), 855 of them participated in a nine-session, curriculum based peer mentorship program. We analyzed data collected at baseline and 12-months post intervention initiation. The results from bivariate and regression analysis indicate that, controlling for socioeconomic characteristics, adolescents who participated in a peer mentorship program were more likely than non-participants to report increased scores on HIV/AIDS knowledge(b = .86, 95%CI = .47 – 1.3, p ≤ .001); better scores on desired HIV/AIDS-related beliefs (b = .29, 95%CI = .06 – .52, p ≤ .01); and better scores on HIV/AIDS prevention attitudes (b = .76, 95%CI = .16 – 1.4, p ≤ .01). Overall, the study findings point to the potential role a of peer mentorship program in promoting the much-desired HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents. Future programs and policies that support AIDS-orphaned adolescents in sub-Saharan Africa should consider incorporating peer mentoring programs that provide correct, age, and culturally appropriate HIV information to help protect orphaned adolescents and reduce the risk of HIV infections. PMID:27042195

HIV testing among at-risk adolescents and young adults: a prospective analysis of a community sample.

PubMed

Tolou-Shams, Marina; Payne, Nanetta; Houck, Christopher; Pugatch, David; Beausoleil, Nancy; Brown, Larry K

2007-12-01

Little is known about predictors of human immunodeficiency virus (HIV) testing among sexually active adolescents, who account for a large proportion of new HIV infections. This study sought to determine predictors of HIV testing among a large community-based sample of adolescents in three cities who had recent unprotected sexual intercourse. Sexually active adolescents (N = 1222) completed baseline and 3-month assessments of sexual behavior, substance use and HIV testing behaviors as part of a larger, multi-site, brief HIV prevention program. Approximately half of the adolescents reported having previously been tested for HIV, and of those one third were tested in the next 3 months without a specific intervention. Adolescents who received HIV testing were more likely at baseline to have ever been tested, to have a STI diagnosis, to have not used substances during sex and to have been assertive about condom use with a partner. Health care models encouraging more widespread, universal testing may be an important public health initiative to curb the spread of HIV. Regular HIV screenings provide an opportunity to enhance awareness of behavioral risk and HIV status, as well as provide opportunities for early detection and care.

Sexual behavior of female adolescents on the spread of HIV/AIDS and other STDs in Carriacou.

PubMed

Patrice-Coy, Celestine; Johnson, Emmanuel Janagan; Boodram, Cheryl Ann Sarita

2016-09-01

This article explores information relating to female adolescents knowledge, attitudes, and behaviors toward human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) in Carriacou. The authors aimed at finding out whether adolescent females in Carriacou receive adequate information about HIV and other STDs. Where did students receive most of their information about HIV/STDs and whether the knowledge has influenced their sexual behaviors? Furthermore, this study focused on how female adolescents feel toward people living with HIV/STDs.Focus group method was employed with 2 age groups of female adolescent students. Content analysis was carried out by the researcher to analyze the data. Themes were developed using coding and thematic analysis.The findings revealed that female adolescents were highly aware of HIV/STDs-related facts. They were knowledgeable and have received adequate information about HIV/STDs.

African American adolescent perceptions of vulnerability and resilience to HIV.

PubMed

Glenn, Betty L; Wilson, Kathleen P

2008-07-01

HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.

Community perspectives on the ethical issues surrounding adolescent HIV vaccine trials in South Africa.

PubMed

Jaspan, Heather B; Soka, Nosiphiwo F; Strode, Ann E; Mathews, Catherine; Mark, Daniella; Flisher, Alan J; Wood, Robin; Bekker, Linda-Gail

2008-10-23

Adolescents globally are at high risk for HIV acquisition and are the targets of HIV prevention interventions such as HIV vaccines. In order to understand stakeholders' attitudes towards the ethical issues of adolescent involvement in HIV vaccine trials, we conducted focus group discussions with key members of a semi-urban, informal Cape Town community with high HIV prevalence in which HIV vaccine trials are taking place. Themes were identified from focus group transcripts by four researchers, and included necessity of guardian consent, age of independent consent, and confidentiality of in-trial medical results. In general, ethical adolescent HIV vaccine trials will be feasible in this community.

Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Recommendations of the Panel on Clinical Practices for Treatment of HIV.

PubMed

Dybul, Mark; Fauci, Anthony S; Bartlett, John G; Kaplan, Jonathan E; Pau, Alice K

2002-05-17

The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for clinical management of HIV-infected adults and adolescents (CDC. Report of the NIH Panel To Define Principles of Therapy of HIV Infection and Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR 1998;47[RR-5]:1-41). This report, which updates the 1998 guidelines, addresses 1) using testing for plasma HIV ribonucleic acid levels (i.e., viral load) and CD4+ T cell count; 2) using testing for antiretroviral drug resistance; 3) considerations for when to initiate therapy; 4) adherence to antiretroviral therapy; 5) considerations for therapy among patients with advanced disease; 6) therapy-related adverse events; 7) interruption of therapy; 8) considerations for changing therapy and available therapeutic options; 9) treatment for acute HIV infection; 10) considerations for antiretroviral therapy among adolescents; 11) considerations for antiretroviral therapy among pregnant women; and 12) concerns related to transmission of HIV to others. Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance because of nonadherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic decisions is critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy among asymptomatic patients require analysis of real and potential risks and benefits. Treatment should be offered to persons who have <350 CD4+ T cells/mm3 or plasma HIV ribonucleic acid (RNA) levels of >55,000 copies/mL (by b-deoxyribonucleic acid [bDNA] or reverse transcriptase-polymerase chain reaction [RT-PCR] assays). The recommendation to treat asymptomatic patients should be based on the willingness and readiness of the person to begin therapy; the degree of existing immunodeficiency as determined by the CD4+ T cell count; the risk for disease progression as determined by the CD4+ T cell count and level of plasma HIV RNA; the potential benefits and risks of initiating therapy in an asymptomatic person; and the likelihood, after counseling and education, of adherence to the prescribed treatment regimen. Treatment goals should be maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality. Results of therapy are evaluated through plasma HIV RNA levels, which are expected to indicate a 1.0 log10 decrease at 2-8 weeks and no detectable virus (<50 copies/mL) at 4-6 months after treatment initiation. Failure of therapy at 4-6 months might be ascribed to nonadherence, inadequate potency of drugs or suboptimal levels of antiretroviral agents, viral resistance, and other factors that are poorly understood. Patients whose therapy fails in spite of a high level of adherence to the regimen should have their regimen changed; this change should be guided by a thorough drug treatment history and the results of drug-resistance testing. Because of limitations in the available alternative antiretroviral regimens that have documented efficacy, optimal changes in therapy might be difficult to achieve for patients in whom the preferred regimen has failed. These decisions are further confounded by problems with adherence, toxicity, and resistance. For certain patients, participating in a clinical trial with or without access to new drugs or using a regimen that might not achieve complete suppression of viral replication might be preferable. Because concepts regarding HIV management are evolving rapidly, readers should check regularly for additional information and updates at the HIV/AIDS Treatment Information Service website (http://www.hivatis.org).

Delayed-type hypersensitivity skin test responses to PPD and other antigens among BCG-vaccinated HIV-1-infected and healthy children and adolescents.

PubMed

Costa, Natalia Moriya Xavierda; Albuquerque, Maly de; Lins, Janaína Bacelar Acioli; Alvares-Junior, João Teixeira; Stefani, Mariane Martins de Araújo

2011-10-01

Among HIV-1-infected patients, CD4+ T cell counts are well-established markers of cell-mediated immunity. Delayed-type hypersensitivity (DTH) skin tests can be used to evaluate in vivo cell-mediated immunity to common antigens. DTH responses to tuberculin purified protein derivative (PPD), sporotrichin, trichophytin, candidin and streptokinase/streptodornase antigens were assessed. Thirty-six HIV-1-infected children/adolescents and 56 age- and sex-matched HIV-1/HIV-2-seronegative participants were tested. All participants had a BCG scar. Fisher's exact test was used to evaluate significant differences between groups (p<0.05). The main characteristics of the HIV-1 patients were as follows: median age 8.1 years; 20/36 were males; 35 were vertical transmission cases; 34 were AIDS cases under antiretroviral therapy; median viral load = 3.04 log10 copies/ml; median CD4+ T cell count = 701 cells/μl. A total of 25% (9/36) and 87.5% (49/56) of HIV-1-infected and healthy participants, respectively, displayed DTH reactivity to at least one antigen (p<0.001). Among HIV-1-infected participants, reactivity to candidin predominated (8/36, 22.2%), while PPD positivity prevailed among healthy participants (40/56, 71.4%). PPD reactivity in the HIV-1-positive group was 8.3% (p<0.01). The median PPD induration was 2.5mm (range: 2-5mm) in the HIV-1 group and 6.0 mm among healthy participants (range: 3-15 mm). There was no correlation between PPD positivity and age. No correlation between CD4+ T cell counts and DTH reactivity was observed among HIV-1-infected patients. DTH skin test responses, including PPD reactivity, were significantly lower among HIV-1-infected participants compared to healthy controls, which likely reflects advanced disease and T cell depletion.

Conspiracy beliefs and knowledge about HIV origins among adolescents in Soweto, South Africa.

PubMed

Hogg, Robert; Nkala, Busisiwe; Dietrich, Janan; Collins, Alexandra; Closson, Kalysha; Cui, Zishan; Kanters, Steve; Chia, Jason; Barhafuma, Bernard; Palmer, Alexis; Kaida, Angela; Gray, Glenda; Miller, Cari

2017-01-01

We examined adolescents' knowledge regarding the origin of HIV/AIDS and correlates of beliefs surrounding conspiracy theories in Soweto, South Africa. Now, a decade post-AIDS denialism, South Africa has the largest antiretroviral therapy roll-out worldwide. However, conspiracy theories stemming from past AIDS denialism may impact HIV prevention and treatment efforts. Study participants were recruited through the Kganya Motsha Adolescent Health Centre and the Perinatal HIV Research Unit's Botsha Bophelo Adolescent Health Study (BBAHS). Adolescents were eligible to participate if aged 14-19 years and living in Soweto. We calculated the proportion of adolescents who correctly believed that HIV originated from non-human primates, and used contingency table analysis and logistic regression modeling to describe correlates associated with accurate knowledge and beliefs in conspiracy theories. Of 830 adolescents, 168 (20.2%) participants correctly identified HIV as originating from chimpanzees and one third (n = 71, 8.6%) believed in a conspiracy theory about the origins of HIV, including that it originated from the US government (2.3%), the pharmaceutical industry (2.2%), a vaccine (2.1%), space (1.5%), and a scientist (0.6%). Participants who were more likely to correctly identify the origin of HIV were older, men, and unemployed. Participants who were men, unemployed or students, and who had a parent or close relative who had died of HIV, were more likely to believe in a conspiracy theory regarding the origins of HIV. Adolescents living in Soweto did not have high levels of accurate knowledge regarding the origins of HIV/AIDS and conspiracy beliefs were present among a small minority of participants. Accurate knowledge of the origins of HIV and debunking myths are important for improving uptake of HIV prevention tools in this population.

Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa

PubMed Central

Toska, Elona; Gittings, Lesley; Hodes, Rebecca; Cluver, Lucie D.; Govender, Kaymarlin; Chademana, KE; Gutiérrez, Vincent Evans

2017-01-01

Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with behavioural and social interventions to alleviate the socio-structural determinants of HIV infection. There is growing evidence that social protection has the potential to reduce the risk of HIV infection among children and adolescents. This research combined expert consultations with a rigorous review of academic and policy literature on the effectiveness of social protection for HIV prevention among children and adolescents, including prevention for those already HIV-positive. The study had three goals: (i) assess the evidence on the effectiveness of social protection for HIV prevention, (ii) consider key challenges to implementing social protection programmes that promote HIV prevention, and (iii) identify critical research gaps in social protection and HIV prevention, in Eastern and Southern Africa. Causal pathways of inequality, poverty, gender and HIV risk require flexible and responsive social protection mechanisms. Results confirmed that HIV-inclusive child- and adolescent-sensitive social protection has the potential to interrupt risk pathways to HIV infection and foster resilience. In particular, empirical evidence (literature and expert feedback) detailed the effectiveness of combination social protection particularly cash/in-kind components combined with ‘care’ and ‘capability’ among children and adolescents. Social protection programmes should be dynamic and flexible, and take into account age, gender, HIV-related stigma, and context, including cultural norms, which offer opportunities to improve programmatic coverage, reach, and uptake. Effective HIV prevention also requires integrated social protection policies, developed through strong national government ownership and leadership. Future research should explore which combinations of social protection work for sub-groups of children and adolescents, particularly those living with HIV. PMID:27399042

Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa.

PubMed

Toska, Elona; Gittings, Lesley; Hodes, Rebecca; Cluver, Lucie D; Govender, Kaymarlin; Chademana, K Emma; Gutiérrez, Vincent Evans

2016-07-01

Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with behavioural and social interventions to alleviate the socio-structural determinants of HIV infection. There is growing evidence that social protection has the potential to reduce the risk of HIV infection among children and adolescents. This research combined expert consultations with a rigorous review of academic and policy literature on the effectiveness of social protection for HIV prevention among children and adolescents, including prevention for those already HIV-positive. The study had three goals: (i) assess the evidence on the effectiveness of social protection for HIV prevention, (ii) consider key challenges to implementing social protection programmes that promote HIV prevention, and (iii) identify critical research gaps in social protection and HIV prevention, in Eastern and Southern Africa. Causal pathways of inequality, poverty, gender and HIV risk require flexible and responsive social protection mechanisms. Results confirmed that HIV-inclusive child-and adolescent-sensitive social protection has the potential to interrupt risk pathways to HIV infection and foster resilience. In particular, empirical evidence (literature and expert feedback) detailed the effectiveness of combination social protection particularly cash/in-kind components combined with "care" and "capability" among children and adolescents. Social protection programmes should be dynamic and flexible, and consider age, gender, HIV-related stigma, and context, including cultural norms, which offer opportunities to improve programmatic coverage, reach and uptake. Effective HIV prevention also requires integrated social protection policies, developed through strong national government ownership and leadership. Future research should explore which combinations of social protection work for sub-groups of children and adolescents, particularly those living with HIV.

Transitional probability-based model for HPV clearance in HIV-1-positive adolescent females.

PubMed

Kravchenko, Julia; Akushevich, Igor; Sudenga, Staci L; Wilson, Craig M; Levitan, Emily B; Shrestha, Sadeep

2012-01-01

HIV-1-positive patients clear the human papillomavirus (HPV) infection less frequently than HIV-1-negative. Datasets for estimating HPV clearance probability often have irregular measurements of HPV status and risk factors. A new transitional probability-based model for estimation of probability of HPV clearance was developed to fully incorporate information on HIV-1-related clinical data, such as CD4 counts, HIV-1 viral load (VL), highly active antiretroviral therapy (HAART), and risk factors (measured quarterly), and HPV infection status (measured at 6-month intervals). Data from 266 HIV-1-positive and 134 at-risk HIV-1-negative adolescent females from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort were used in this study. First, the associations were evaluated using the Cox proportional hazard model, and the variables that demonstrated significant effects on HPV clearance were included in transitional probability models. The new model established the efficacy of CD4 cell counts as a main clearance predictor for all type-specific HPV phylogenetic groups. The 3-month probability of HPV clearance in HIV-1-infected patients significantly increased with increasing CD4 counts for HPV16/16-like (p<0.001), HPV18/18-like (p<0.001), HPV56/56-like (p = 0.05), and low-risk HPV (p<0.001) phylogenetic groups, with the lowest probability found for HPV16/16-like infections (21.60±1.81% at CD4 level 200 cells/mm(3), p<0.05; and 28.03±1.47% at CD4 level 500 cells/mm(3)). HIV-1 VL was a significant predictor for clearance of low-risk HPV infections (p<0.05). HAART (with protease inhibitor) was significant predictor of probability of HPV16 clearance (p<0.05). HPV16/16-like and HPV18/18-like groups showed heterogeneity (p<0.05) in terms of how CD4 counts, HIV VL, and HAART affected probability of clearance of each HPV infection. This new model predicts the 3-month probability of HPV infection clearance based on CD4 cell counts and other HIV-1-related clinical measurements.

Self-Esteem Enhancing Reasons for Having Sex and the Sexual Behaviors of African American Adolescents

ERIC Educational Resources Information Center

Robinson, Melissa L.; Holmbeck, Grayson N.; Paikoff, Roberta

2007-01-01

A sample of 146 African American adolescents living in impoverished neighborhoods with high HIV rates participated in the Chicago HIV Prevention and Adolescent Mental Health Project (CHAMP), a longitudinal study of adolescent HIV risk exposure. The current study examined self-reported reasons why African American adolescents may participate in…

The Moderating Effect of Marijuana Use on the Relationship between Delinquent Behavior and HIV Risk among Adolescents in Foster Care

PubMed Central

Auslander, Wendy F.; Thompson, Ronald G.; Gerke, Donald R.

2014-01-01

Adolescents in foster care experience mental health and substance use problems that place them at risk for HIV, yet the exact nature of the relationship remains unclear. This study examined the co-occurring influences of mental health problems and substance use on HIV risk and determined whether substance use moderated the effect of mental health problems on HIV risk behaviors among adolescents in foster care. Regression analyses of cross-sectional data collected through structured interviews with 334 adolescents, aged 15–18 years, determined which mental health problems and substances increased HIV risk behaviors. Adolescents with delinquency and anxiety/depression engaged in significantly more HIV risk behaviors than their counterparts, controlling for race, gender, and type of childhood abuse. Further, any marijuana use significantly moderated the effects of delinquent behaviors on HIV risk, differentially increasing HIV risk among those who engaged in delinquent behaviors. PMID:25214818

HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in adolescents: a cross-sectional questionnaire survey.

PubMed

Lee, Yi-Hui; Salman, Ali; Fitzpatrick, Joyce J

2009-05-01

High incidence rates of HIV/AIDS infections among youth draw attention to the need for emphasizing the reduction of risky sexual behavior, a major contributor to the spread of HIV/AIDS. Few researchers have examined the relationship between self-efficacy for HIV/AIDS preventions, depressive symptoms, and adolescent risky sexual behavior. This insufficient understanding limits nurses' ability to provide effective programs for reducing adolescents' risky sexual behaviors. This study was conducted to investigate the relationships among HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in Taiwanese adolescents. A cross-sectional, correlational study. Seven vocational high schools located in a metropolitan area in southern Taiwan. A convenience sample of 16-18-year-old vocational high school Taiwanese adolescents (n=734) participated in this study. Several self-administrated questionnaires, including HIV/AIDS Preventive Self-efficacy scale, the Center for Epidemiological Studies-Depression scale, Safe Sex Behavior Questionnaire, and a form for demographic data, were used to collect data. Taiwanese adolescents who had higher HIV/AIDS preventive self-efficacy scores had less overall risky sexual behavior. Adolescents who had less depressive symptoms had higher HIV/AIDS preventive self-efficacy. More depressive symptoms were correlated to more risky sexual behavior. Improving Taiwanese adolescents' HIV/AIDS preventive self-efficacy could be useful to reduce risky sexual behaviors in this population. Results of this study may assist nurses in understanding factors related to adolescents HIV/AIDS related risky sexual behavior and its' preventions. However, future longitudinal studies are needed to clarify whether depressive symptoms is a major influential factor that might interfere with the effectiveness of HIV/AIDS prevention programs.

Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15-24 Years - Seven African Countries, 2015-2017.

PubMed

Brown, Kristin; Williams, Daniel B; Kinchen, Steve; Saito, Suzue; Radin, Elizabeth; Patel, Hetal; Low, Andrea; Delgado, Stephen; Mugurungi, Owen; Musuka, Godfrey; Tippett Barr, Beth A; Nwankwo-Igomu, E Amaka; Ruangtragool, Leala; Hakim, Avi J; Kalua, Thokozani; Nyirenda, Rose; Chipungu, Gertrude; Auld, Andrew; Kim, Evelyn; Payne, Danielle; Wadonda-Kabondo, Nellie; West, Christine; Brennan, Elizabeth; Deutsch, Beth; Worku, Anteneh; Jonnalagadda, Sasi; Mulenga, Lloyd B; Dzekedzeke, Kumbutso; Barradas, Danielle T; Cai, Haotian; Gupta, Sundeep; Kamocha, Stanley; Riggs, Margaret A; Sachathep, Karampreet; Kirungi, Wilford; Musinguzi, Joshua; Opio, Alex; Biraro, Sam; Bancroft, Elizabeth; Galbraith, Jennifer; Kiyingi, Herbert; Farahani, Mansoor; Hladik, Wolfgang; Nyangoma, Edith; Ginindza, Choice; Masangane, Zandile; Mhlanga, Fortune; Mnisi, Zandile; Munyaradzi, Pasipamire; Zwane, Amos; Burke, Sean; Kayigamba, Felix B; Nuwagaba-Biribonwoha, Harriet; Sahabo, Ruben; Ao, Trong T; Draghi, Chiara; Ryan, Caroline; Philip, Neena M; Mosha, Fausta; Mulokozi, Aroldia; Ntigiti, Phausta; Ramadhani, Angela A; Somi, Geoffrey R; Makafu, Cecilia; Mugisha, Veronicah; Zelothe, Julius; Lavilla, Kayla; Lowrance, David W; Mdodo, Rennatus; Gummerson, Elizabeth; Stupp, Paul; Thin, Kyaw; Frederix, Koen; Davia, Stefania; Schwitters, Amee M; McCracken, Stephen D; Duong, Yen T; Hoos, David; Parekh, Bharat; Justman, Jessica E; Voetsch, Andrew C

2018-01-12

In 2016, an estimated 1.5 million females aged 15-24 years were living with human immunodeficiency virus (HIV) infection in Eastern and Southern Africa, where the prevalence of HIV infection among adolescent girls and young women (3.4%) is more than double that for males in the same age range (1.6%) (1). Progress was assessed toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2020 targets for adolescent girls and young women in sub-Saharan Africa (90% of those with HIV infection aware of their status, 90% of HIV-infected persons aware of their status on antiretroviral treatment [ART], and 90% of those on treatment virally suppressed [HIV viral load <1,000 HIV RNA copies/mL]) (2) using data from recent Population-based HIV Impact Assessment (PHIA) surveys in seven countries. The national prevalence of HIV infection in adolescent girls and young women aged 15-24 years, the percentage who were aware of their status, and among those persons who were aware, the percentage who had achieved viral suppression were calculated. The target for viral suppression among all persons with HIV infection is 73% (the product of 90% x 90% x 90%). Among all seven countries, the prevalence of HIV infection among adolescent girls and young women was 3.6%; among those in this group, 46.3% reported being aware of their HIV-positive status, and 45.0% were virally suppressed. Sustained efforts by national HIV and public health programs to diagnose HIV infection in adolescent girls and young women as early as possible to ensure rapid initiation of ART should help achieve epidemic control among adolescent girls and young women.

Guidelines for using antiretroviral agents among HIV-infected adults and adolescents.

PubMed

Dybul, Mark; Fauci, Anthony S; Bartlett, John G; Kaplan, Jonathan E; Pau, Alice K

2002-09-03

The availability of an increasing number of antiretroviral agents and the rapid evolution of new information have introduced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for clinical management of HIV-infected adults and adolescents (CDC. Report of the NIH Panel To Define Principles of Therapy of HIV Infection and Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR. 1998;47[RR-5]:1-41). This report, which updates the 1998 guidelines, addresses 1) using testing for plasma HIV ribonucleic acid levels (i.e., viral load) and CD4+ T cell count; 2) using testing for antiretroviral drug resistance; 3) considerations for when to initiate therapy; 4) adherence to antiretroviral therapy; 5) considerations for therapy among patients with advanced disease; 6) therapy-related adverse events; 7) interruption of therapy; 8) considerations for changing therapy and available therapeutic options; 9) treatment for acute HIV infection; 10) considerations for antiretroviral therapy among adolescents; 11) considerations for antiretroviral therapy among pregnant women; and 12) concerns related to transmission of HIV to others. Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance because of nonadherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic decisions are critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy among asymptomatic patients require analysis of real and potential risks and benefits. In general, treatment should be offered to persons who have <350 CD4+ T cells/mm3 or plasma HIV ribonucleic acid (RNA) levels of >55,000 copies/mL (by b-deoxyribonucleic acid [bDNA] or reverse transcriptase-polymerase chain reaction [RT-PCR] assays). The recommendation to treat asymptomatic patients should be based on the willingness and readiness of the person to begin therapy; the degree of existing immunodeficiency as determined by the CD4+ T cell count; the risk for disease progression as determined by the CD4+ T cell count and level of plasma HIV RNA; the potential benefits and risks of initiating therapy in an asymptomatic person; and the likelihood, after counseling and education, of adherence to the prescribed treatment regimen. Treatment goals should be maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality. Results of therapy are evaluated through plasma HIV RNA levels, which are expected to indicate a 1.0 log10 decrease at 2-8 weeks and no detectable virus (<50 copies/mL) at 4-6 months after treatment initiation. Failure of therapy at 4-6 months might be ascribed to nonadherence, inadequate potency of drugs or suboptimal levels of antiretroviral agents, viral resistance, and other factors that are poorly understood. Patients whose therapy fails in spite of a high level of adherence to the regimen should have their regimen changed; this change should be guided by a thorough drug treatment history and the results of drug-resistance testing. Because of limitations in the available alternative antiretroviral regimens that have documented efficacy, optimal changes in therapy might be difficult to achieve for patients in whom the preferred regimen has failed. These decisions are further confounded by problems with adherence, toxicity, and resistance. For certain patients, participating in a clinical trial with or without access to new drugs or using a regimen that might not achieve complete suppression of viral replicatioing a regimen that might not achieve complete suppression of viral replication might be preferable. Because concepts regarding HIV management are evolving rapidly, readers should check regularly for additional information and updates at the HIV/AIDS Treatment Information Service website ( http://www.hivatis.org ).

Equity of child and adolescent treatment, continuity of care and mortality, according to age and gender among enrollees in a large HIV programme in Tanzania.

PubMed

Chaudhury, Sumona; Hertzmark, Ellen; Muya, Aisa; Sando, David; Ulenga, Nzovu; Machumi, Lameck; Spiegelman, Donna; Fawzi, Wafaie W

2018-02-01

Global scale up of anti-retroviral therapy (ART) has led to expansion of HIV treatment and prevention across sub-Saharan Africa. However, age and gender-specific disparities persist leading to failures in fulfillment of Sustainability Development Goals, including SDG3 (achieving healthy lives and wellbeing for all, at all ages) and SDG5 (gender equality). We assessed ART initiation and adherence, loss to follow-up, all-cause death and early death, according to SDG3 and SDG5 indicators among a cohort of HIV-infected children and adolescents enrolled in care in Dar-es-Salaam, Tanzania METHODS: SDG3 indicators included young (<5 years) and older paediatric children (5 to <10 years), early adolescent (10 to <15 years) and late adolescent (15 to <20 years) age group divisions and the SDG5 indicator was gender. Associations of age group and gender with ART initiation, loss to follow-up and all-cause death, were analysed using Cox proportional hazards regression and with adherence, using generalized estimating equations (GEE) with the Poisson distribution. Associations of age group and gender with early death were analysed, using log-Poisson regression with empirical variance. A total of 18,315 enrollees with at least one clinic visit were included in this cohort study. Of these 7238 (40%) were young paediatric , 4169 (23%) older paediatric, 2922 (16%) early adolescent and 3986 (22%) late adolescent patients at enrolment. Just over half of paediatric and early adolescents and around four fifths of the late adolescents were female. Young paediatric patients were at greater risk of early death, being almost twice as likely to die within 90 days. Males were at greater risk of early death once initiated on ART (HR 1.35, 95% CI 1.09, 1.66)), while females in late adolescence were at greatest risk of late death (HR 2.44 [1.60, 3.74] <0.01). Late adolescents demonstrated greater non-engagement in care (RR 1.21 (95% CI 1.16, 1.26)). Among both males and females, early paediatric and late adolescent groups experienced significantly greater loss to follow-up. These findings highlight equity concerns critical to the fulfillment of SDG3 and SDG5 within services for children and adolescents living with HIV in sub-Saharan Africa. Young paediatric and late adolescent age groups were at increased risk of late diagnosis, early death, delayed treatment initiation and loss of continuity of care. Males were more likely to die earlier. Special attention to SDG3 and SDG5 disparities for children and adolescents living with HIV will be critical for fulfillment of the 2030 SDG agenda. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Perceptions and Experiences about Self-Disclosure of HIV Status among Adolescents with Perinatal Acquired HIV in Poor-Resourced Communities in South Africa.

PubMed

Madiba, Sphiwe; Mokgatle, Mathildah

2016-01-01

Background. There is limited research on the disclosure experiences of adolescents with perinatal acquired HIV (PAH). The study explores how adolescents with PAH experience living with HIV and examined their perceptions and experiences regarding disclosure and onward self-disclosure to friends and sexual partners. Methods. Thematic analysis was used to analyze in-depth interviews conducted with 37 adolescents. Findings. Adolescents received disclosure about their status at mean age of 12 years. They perceived disclosure as necessary and appreciated the truthful communication they received. Adolescents have learned to accept and live with HIV, and they desired to be healthy and normal like other people. After receiving disclosure, they found their treatment meaningful, and they adhered to medication. However, they also expressed a strong message that their HIV status was truly their secret and that self-disclosure to others will take the feeling of being normal away from them because they will be treated differently. Conclusion. Adolescents maintained secrecy in order to be accepted by their peers but also to protect themselves from stigma and isolation. Given that adolescents want to be informed of their HIV status but desire controlling self-disclosure of their HIV status, these should form the basis for development of disclosure interventions.

Importance of Self-Motivation and Social Support in Medication Adherence in HIV-Infected Adolescents in the United Kingdom and Ireland: A Multicentre HYPNet Study.

PubMed

Kim, Sung-Hee; McDonald, Susan; Kim, Samuel; Foster, Caroline; Fidler, Sarah

2015-06-01

Adolescents are a vulnerable population, not only to the acquisition of HIV, but also to poor adherence to antiretroviral therapy (ART) associated with disease progression and a increased risk of onward viral transmission. The aim of the study was to examine the factors that aid or act as barriers to adherence in a UK population of adolescents and young adults receiving ART. A cross-sectional survey was completed of 138 adolescents (12-24 years) across 14 clinical and community sites in the UK and Ireland. Analysis of results was undertaken using Chi-square testing in SPSS. Of the 138 patients, 48% were female, and 52% were born outside of the UK. Fifty-two of the 138 (43%) reported being on ART for at least 8 years. More than a third of the patients have ever interrupted treatment since initiating ART. One hundred four of the 138 (75%) patients self-reported being >85% adherent to medication for 7 day recall. Self-motivation (e.g., having a routine, specific goal) was cited as being most helpful in medication compliance (33%), followed by reminders by friends and family (25%), with 20% identifing no specific factor. Only 15% chose interventions such as an adherence diary or mobile phone reminders as helpful factors, and 1% chose healthcare professional input such as home visits. This study highlights the importance of self-motivation and social support in medication adherence in an HIV-infected adolescent population, in preference to healthcare professional input. Education and motivational strategies may confer the biggest impact on sustained ART adherence amongst this vulnerable group.

Psychosocial profile of HIV-infected adolescents in a Southern US urban cohort.

PubMed

Kadivar, H; Garvie, P A; Sinnock, C; Heston, J D; Flynn, P M

2006-08-01

We undertook a retrospective medical chart review of HIV-infected adolescents referred to a Southern US urban comprehensive adolescent HIV clinic between 1992 and 2003 to describe the psychosocial profile of adolescents infected with HIV via high-risk behaviours.Ninety-one adolescents (59 females, 32 males, 95% African-American, median age 17 years) were identified. Common reasons for initial HIV testing included routine prenatal screening (20%), clinical symptoms suggestive of HIV (20%), and recognized risk-related behaviours (20%). Findings included a history of unstable housing in the previous year (27%), running away (29%), knowing someone with HIV (36%), parental substance abuse (reported by youth, 46%), parental abandonment/neglect (30%), high substance use rates (marijuana 33%, tobacco 27%), current/prior STDs (60%), and involvement with the juvenile justice system or incarceration (41%). Sexual abuse/assault was reported by 41%. Previous depression was reported in 15% with approximately half reporting prior hospitalization. An additional 12% of the cohort had current clinical depressive symptoms. We conclude that infections with HIV via high-risk behaviours during adolescence occur in youth with multiple psychosocial stressors. Targeted prevention efforts to reduce these underlying stressors may decrease new adolescent infection. HIV-infected youth are best served in a comprehensive care environment with immediate access to medical care, social work, and psychology/psychiatry services.

When a relationship is imperative, will young women knowingly place their sexual health at risk? A sample of African American adolescent girls in the juvenile justice system.

PubMed

Raiford, Jerris L; Seth, Puja; Fasula, Amy M; DiClemente, Ralph J

2017-08-01

HIV and other sexually transmissible infections (HIV/STIs) are significant contributors to adolescent girls' morbidity in the US. Risks for HIV/STIs are increased among adolescent girls involved in the juvenile justice system, and African American adolescent girls comprise nearly 50% of adolescent girls in detention centres. Although HIV prevention programs focus on HIV/STI knowledge, increased knowledge may not be sufficient to reduce sexual risk. The present study examined the interactive effects of HIV/STI knowledge and the importance of being in a relationship (a relationship imperative) on sexual risk behaviours in a sample of detained African American adolescent girls. In all, 188 African American adolescent girls, 13-17 years of age, were recruited from a short-term detention facility in Atlanta, Georgia, and completed assessments on sexual risk behaviours, relationship characteristics, HIV/STI knowledge and several psychosocial risk factors. When girls endorsed a relationship imperative, higher HIV/STI knowledge was associated with low partner communication self-efficacy, inconsistent condom use and unprotected sex, when controlling for demographics and self-esteem. Young girls with high HIV/STI knowledge may have placed themselves at risk for HIV/STIs given the importance and value they place on being in a relationship. Contextual factors should be considered when developing interventions.

Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa.

PubMed

Williams, Shannon; Renju, Jenny; Ghilardi, Ludovica; Wringe, Alison

2017-09-15

Observational studies have shown considerable attrition among adolescents living with HIV across the "cascade" of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents' engagement in HIV care. Stigma was the most salient factor impeding adolescents' interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. Adolescents' initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as "test and treat" policies are scaled up.

Meeting the goal of concurrent adolescent and adult licensure of HIV prevention and treatment strategies.

PubMed

Hume, Michelle; Lewis, Linda L; Nelson, Robert M

2017-12-01

The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties of drugs in adolescents are expected to be similar to those in adults. Finally, adolescents enrolled in therapeutic HIV prevention and treatment research can be considered adults, based on US Food and Drug Administration (FDA) regulations and the appropriate application of state law. The FDA permits local jurisdictions to apply state and local HIV/sexually transmitted infection minor treatment laws so that adolescents who are HIV-positive or at risk of contracting HIV may be enrolled in therapeutic or prevention trials without obtaining parental permission. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A pressing need to respond to the needs and sexual and reproductive health problems of adolescent girls living with HIV in low- and middle-income countries.

PubMed

Chandra-Mouli, Venkatraman; Armstrong, Alice; Amin, Avni; Ferguson, Jane

2015-01-01

This commentary provides the rationale and makes a call for greater investment and effort to meet the sexual and reproductive health (SRH) problems of adolescent girls living with HIV in low- and middle-income countries (LMIC). Adolescent girls in LMIC are at a greater risk of acquiring HIV infection than their male peers. They also face a number of other serious SRH problems--early pregnancy, pregnancy- and childbirth-related complications, unsafe abortions, sexual abuse and intimate partner violence and sexually transmitted infections. While many LMIC have made notable progress in preventing HIV in children and adults and in improving the access of these population groups to HIV treatment and care, adolescents in general and adolescent girls in particular have not received the same effort and investment. Much more needs to be done to implement proven approaches to prevent new HIV infections in adolescent girls in LMIC and to meet the needs of those living with HIV.

[Cryptococcus neoformans meningitis in children and adolescents infected with HIV].

PubMed

Quian, Jorge; Gutiérrez, Stella; González, Virginia; Sánchez, Mercedes; Abayian, Marina; Baccino, Fernando

2012-10-01

Three cases of meningitis due to criptococcus in children infected with HIV are reported. All patients had severe immunodeficiency. The first case occurred before antiretroviral therapy. The second case had poor adherence to treatment. The third case is a teenager with prolonged fever, who did not have a clear source of transmission of HIV and was immunodeficient at the time of diagnosis. Examination of cerebrospinal fluid with India ink dye was essential for making the diagnosis in all three cases. The disease course was adequate in all three patients despite flucytosine not being available.

Maternal Substance Use and HIV Status: Adolescent Risk and Resilience

ERIC Educational Resources Information Center

Leonard, Noelle R.; Gwadz, Marya Viorst; Cleland, Charles M.; Vekaria, Pooja C.; Ferns, Bill

2008-01-01

We examined the risk and protective factors and mental health problems of 105 low SES, urban adolescents whose mothers were coping with alcohol abuse and other drug problems. Approximately half of the mothers were also HIV-infected. As hypothesized, there were few differences between adolescents of HIV-infected and HIV-uninfected mothers in…

Risk Assessment for Human Immunodeficiency Virus among Pregnant Hispanic Adolescents.

ERIC Educational Resources Information Center

Berger, David K.; And Others

1993-01-01

Assessed human immunodeficiency virus (HIV) risk status of pregnant Hispanic adolescents in New York City. One-third of 87 adolescents were identified as being at increased risk for HIV infection. Sexual risk-taking behavior was most common factor that increased HIV risk. Birthplace and nationality were significantly associated with HIV risk…

Renal function in HIV-infected children and adolescents treated with tenofovir disoproxil fumarate and protease inhibitors.

PubMed

Pontrelli, Giuseppe; Cotugno, Nicola; Amodio, Donato; Zangari, Paola; Tchidjou, Hyppolite K; Baldassari, Stefania; Palma, Paolo; Bernardi, Stefania

2012-01-23

Kidney disease is an important complication in HIV infected people, and this may be related to infection or antiretroviral therapy (ART). Our aim is to assess renal function in HIV infected paediatric patients, who may be particularly affected and are likely to take ART for longer than adults, and investigate the long term role of Tenofovir Disoproxil Fumarate (TDF) alone or co-administered with Ritonavir-boosted Protease Inhibitors (PI). Serum creatinine, phosphate and potassium levels, with estimated Glomerular Filtration Rate (eGFR), had been prospectively evaluated for 2 years in a cohort of HIV infected children and adolescents (age 9-18) on ART, and data analyzed according to the exposure to TDF or simultaneous TDF and PI. Forty-nine patients were studied (57% female, mean age 14). Sixty-three percent were treated with ART containing TDF (Group A), and 37% without TDF (Group B); 47% with concomitant use of TDF and PI (Group C) and 53% without this combination (Group D). The groups didn't differ for age, gender or ethnicity. The median creatinine increased in the entire cohort and in all the groups analyzed; eGFR decreased from 143.6 mL/min/1.73 m2 at baseline to 128.9 after 2 years (p = 0.006) in the entire cohort. Three patients presented a mild eGFR reduction, all were on TDF+PI. Phosphatemia decreased significantly in the entire cohort (p = 0.0003) and in TDF+PI group (p = 0.0128) after 2 years. Five patients (10%) developed hypophosphatemia (Division of Acquired Immune Deficiency AE grade 1 or 2), and four of them were on TDF+PI. Renal function decrease and hypophosphatemia occur over time in HIV infected children and adolescents on ART. The association with co-administration of TDF and PI appears weak, and further studies are warranted.

Adolescent Health-Risk Sexual Behaviors: Effects of a Drug Abuse Intervention

PubMed Central

Ozechowski, Timothy J.; Waldron, Holly B.; Davis, Betsy; Turner, Charles W.; Brody, Janet L.; Barrera, Manuel

2011-01-01

Adolescents who abuse substances are more likely to engage in health-risking sexual behavior (HRSB) and are at particularly high risk for HIV/AIDS. Thus, substance abuse treatment presents a prime opportunity to target HIV-risk behaviors. The present study evaluated a one-session HIV-risk intervention embedded in a controlled clinical trial for drug-abusing adolescents. The trial was conducted in New Mexico and Oregon with Hispanic and Anglo adolescents. Youths were randomly assigned to individual cognitive behavior therapy (CBT) or to an integrated behavioral and family therapy (IBFT) condition, involving individual and family sessions. The HIV-specific intervention was not associated with change. IBFT and CBT were both efficacious in reducing HIV-risk behaviors from intake to the 18-month follow-up for high-risk adolescents. For low-risk adolescents, CBT (versus IBFT) was more efficacious in suppressing HRSB. These data suggest that drug abuse treatments can have both preventative and intervention effects for adolescents, depending on their relative HIV-risk. PMID:21833690

Bone health in HIV-infected children and adolescents.

PubMed

Eckard, Allison R; Mora, Stefano

2016-05-01

Chronic HIV infection and exposure to antiretroviral therapy compromises bone health in children and adolescents, potentially impacting their long-term quality of life. Thus, the purpose of this article is to review the most recent literature on this topic in HIV-infected children and adolescents. Recent studies continue to demonstrate bone abnormalities in HIV-infected children and adolescents, whether HIV is acquired perinatally or during adolescence. Researchers have employed new modalities, both high tech and those that can be utilized in resource-limited settings, to better assess bone health. New data suggest that this population may also be experiencing an increase incidence of fractures, and they may not acquire the same peak bone mass as their HIV-uninfected counterparts. Reassuringly, however, in-utero tenofovir exposure does not appear to have a significant impact on bone health in HIV-exposed, uninfected infants. HIV-infected children and adolescents are exposed to HIV and antiretroviral therapy for many decades starting early in life and during the most critical time for skeletal growth and bone mass accrual. Recent findings underscore the need for further research on bone in this population. Longitudinal studies are especially needed to evaluate long-term risk of osteoporosis and fracture.

Mania Symptoms and HIV-Risk Behavior among Adolescents in Mental Health Treatment

ERIC Educational Resources Information Center

Stewart, Angela J.; Theodore-Oklota, Christina; Hadley, Wendy; Brown, Larry K.; Donenberg, Geri; DiClemente, Ralph

2012-01-01

This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, "M" age = 14.9 years) who received mental…

Knowledge and perceptions of sexual and reproductive health and HIV among perinatally HIV-infected adolescents in rural China.

PubMed

Mu, Weiwei; Zhao, Yan; Khoshnood, Kaveh; Cheng, Yuewu; Sun, Xin; Liu, Xia; Xu, Wenqing; Wang, Shuiwang; Ma, Ye; Zhang, Fujie

2015-01-01

Due to the success of highly active antiretroviral therapy, more children infected with HIV perinatally are living to adolescence. This brings new challenges on sexual and reproductive health (SRH) needs and psychosocial support specific to adolescents. To improve such efforts on long-term care of this vulnerable population, we assessed SRH and HIV knowledge and perceptions among perinatally HIV-infected adolescents (PHIVA). This descriptive cross-sectional study was conducted between July and September 2013 in a rural HIV clinic. A structured questionnaire focusing on SRH and HIV was administered to 124 PHIVA attending quarterly medical visit. Multivariable logistic regression was used to detect associated factors with knowledge acquisition. Among participants, 79% had never discussed puberty development or sexuality with parents. Over 50% had never heard of condoms and 20% reported not having any informational source of SRH and HIV knowledge. Only 5% correctly answered all questions regarding HIV knowledge and pregnancy, with 18% correctly answered questions regarding contraception. Adolescents older than age of 15 and who had been disclosed of HIV status were more likely to acquire correct knowledge of SRH and HIV. Most PHIVA did not report having access to comprehensive information on SRH and HIV, in part because of the early death of caretakers or unfavorable family status. Further integration of SRH services with HIV treatment programs is needed to provide comprehensive care for adolescents and prepare them for the transition to adult care.

Conspiracy beliefs and knowledge about HIV origins among adolescents in Soweto, South Africa

PubMed Central

Nkala, Busisiwe; Dietrich, Janan; Collins, Alexandra; Closson, Kalysha; Cui, Zishan; Kanters, Steve; Chia, Jason; Barhafuma, Bernard; Palmer, Alexis; Kaida, Angela; Gray, Glenda; Miller, Cari

2017-01-01

Purpose We examined adolescents’ knowledge regarding the origin of HIV/AIDS and correlates of beliefs surrounding conspiracy theories in Soweto, South Africa. Now, a decade post-AIDS denialism, South Africa has the largest antiretroviral therapy roll-out worldwide. However, conspiracy theories stemming from past AIDS denialism may impact HIV prevention and treatment efforts. Methods Study participants were recruited through the Kganya Motsha Adolescent Health Centre and the Perinatal HIV Research Unit’s Botsha Bophelo Adolescent Health Study (BBAHS). Adolescents were eligible to participate if aged 14–19 years and living in Soweto. We calculated the proportion of adolescents who correctly believed that HIV originated from non-human primates, and used contingency table analysis and logistic regression modeling to describe correlates associated with accurate knowledge and beliefs in conspiracy theories. Results Of 830 adolescents, 168 (20.2%) participants correctly identified HIV as originating from chimpanzees and one third (n = 71, 8.6%) believed in a conspiracy theory about the origins of HIV, including that it originated from the US government (2.3%), the pharmaceutical industry (2.2%), a vaccine (2.1%), space (1.5%), and a scientist (0.6%). Participants who were more likely to correctly identify the origin of HIV were older, men, and unemployed. Participants who were men, unemployed or students, and who had a parent or close relative who had died of HIV, were more likely to believe in a conspiracy theory regarding the origins of HIV. Conclusions Adolescents living in Soweto did not have high levels of accurate knowledge regarding the origins of HIV/AIDS and conspiracy beliefs were present among a small minority of participants. Accurate knowledge of the origins of HIV and debunking myths are important for improving uptake of HIV prevention tools in this population. PMID:28151937

Etravirine in treatment-experienced, HIV-1-infected children and adolescents: 48-week safety, efficacy and resistance analysis of the phase II PIANO study.

PubMed

Tudor-Williams, G; Cahn, P; Chokephaibulkit, K; Fourie, J; Karatzios, C; Dincq, S; Opsomer, M; Kakuda, T N; Nijs, S; Tambuyzer, L; Tomaka, F L

2014-10-01

PIANO (Paediatric study of Intelence As an NNRTI Option; TMC125-C213; NCT00665847) assessed the safety/tolerability, antiviral activity and pharmacokinetics of etravirine plus an optimized background regimen (OBR) in treatment-experienced, HIV-1-infected children (≥ 6 to < 12 years) and adolescents (≥ 12 to < 18 years) over 48 weeks. In a phase II, open-label, single-arm study, 101 treatment-experienced patients (41 children; 60 adolescents) with screening viral load (VL) ≥ 500 HIV-1 RNA copies/mL received etravirine 5.2 mg/kg (maximum dose 200 mg) twice a day (bid) plus OBR. Sixty-seven per cent of patients had previously used efavirenz or nevirapine. At week 48, the most common treatment-related grade ≥ 2 adverse event (AE) was rash (13%); 12% experienced grade 3 AEs. Only two grade 4 AEs occurred (both thrombocytopaenia, not etravirine related). At week 48, 56% of patients (68% children; 48% adolescents) achieved a virological response (VL<50 copies/mL; intent-to-treat, noncompleter=failure). Factors predictive of response were adherence > 95%, male sex, low baseline etravirine weighted genotypic score and high etravirine trough concentration (C0h ). Seventy-six patients (75%) completed the trial; most discontinuations occurred because of protocol noncompliance or AEs (8% each). Sixty-five per cent of patients were > 95% adherent by questionnaire and 39% by pill count. Forty-one patients experienced virological failure (VF; time-to-loss-of-virological-response non-VF-censored algorithm) (29 nonresponders; 12 rebounders). Of 30 patients with VF with paired baseline/endpoint genotypes, 18 (60%) developed nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations, most commonly Y181C. Mean etravirine area under the plasma concentration-time curve over 12 h (AUC0-12h ; 5216 ng h/mL) and C0h (346 ng/mL) were comparable to adult target values. Results with etravirine 5.2 mg/kg bid (with OBR) in this treatment-experienced paediatric population and etravirine 200 mg bid in treatment-experienced adults were comparable. Etravirine is an NNRTI option for treatment-experienced paediatric patients. © 2014 British HIV Association.

Adolescent lives matter: preventing HIV in adolescents

PubMed Central

Pettifor, Audrey; Stoner, Marie; Pike, Carey; Bekker, Linda-Gail

2018-01-01

Purpose of review Many of the almost 2 million HIV infections that occurred globally in the last year occurred among adolescents and young people, particularly those from East and Southern Africa and within key populations. Global HIV epidemic control will require that new infections among these youth populations be curtailed. This review examines the most effective prevention approaches to reach these adolescent populations in the next 5 years. Recent findings Adolescents are in transition and are developmentally unique. They have specific needs and challenges, which if not addressed will result in less than successful interventions. Tailored, layered, combination prevention packages that take into account specific adolescent needs and involve biomedical, behavioural and structural components are recommended. These packages should be designed for and with the meaningful input of adolescents, and involve their peers in their implementation and execution. Where possible, age-appropriate health and social interventions that go beyond HIV should be bundled and offered in a variety of community-based venues that are already acceptable to and frequented by adolescents. Summary It is urgent that we reach adolescents globally with the most effective HIV prevention approaches. HIV prevention investment in this population has immediate and longer-term benefits. PMID:29528850

"Let's talk about sex": a qualitative study of Rwandan adolescents' views on sex and HIV.

PubMed

Van Nuil, Jennifer Ilo; Mutwa, Philippe; Asiimwe-Kateera, Brenda; Kestelyn, Evelyne; Vyankandondera, Joseph; Pool, Robert; Ruhirimbura, John; Kanakuze, Chantal; Reiss, Peter; Geelen, Sibyl P M; van de Wijgert, Janneke H; Boer, Kimberly R

2014-01-01

This qualitative study explored the views and experiences of adolescents with perinatally acquired HIV in Kigali, Rwanda, regarding sex, love, marriage, children and hope for the future. The study enrolled 42 adolescents who had received combination antiretroviral therapy for at least 12 months, and a selection of their primary caregivers. Study methods included 3 multiple day workshops consisting of role-playing and focus group discussions (FGDs) with adolescents, 8 in-depth interviews with adolescents, and one FGD with caregivers. The adolescents reported experiencing similar sexual needs and dilemmas as most other adolescents, but with an added layer of complexity due to fears related to HIV transmission and/or rejection by partners. They desired more advice from their parents/caregivers on these topics. Although they struggled with aspects of sex, love, marriage and having children, most agreed that they would find love, be married and have children in the future. The two most discussed HIV-related anxieties were how and when to disclose to a (potential) sex/marriage partner and whether to have children. However, most adolescents felt that they had a right to love and be loved, and were aware of prevention-of-mother-to-child-transmission (PMTCT) options in Rwanda. Adolescents generally spoke about their future role in society in a positive manner. Strengthening the life skills of HIV-positive adolescents, especially around HIV disclosure and reduction of HIV transmission, as well as the support skills of parents/caregivers, may not only reduce onward HIV transmission but also improve quality of life by reducing anxiety.

A Prospective Study of the Onset of Sexual Behavior and Sexual Risk in Youth Perinatally Infected With HIV

PubMed Central

Bauermeister, José A.; Elkington, Katherine S.; Robbins, Reuben N.; Kang, Ezer; Mellins, Claude A.

2011-01-01

Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), we compared the rate of sexual onset during adolescence across four youth-caregiver combinations: PHIV+ youth with HIV+ caregivers (12%); PHIV+ youth with HIV− caregivers (27%); HIV− youth with HIV+ caregivers (34%); and HIV− youth with HIV-caregivers (27%). Youth with HIV− caregivers were more likely than other youth-caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. We discuss our findings by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence. PMID:21797715

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda.

PubMed

Nalukenge, W; Martin, F; Seeley, J; Kinyanda, E

2018-05-02

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5-17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5-11 years) and adolescents (12-17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28-69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem  and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.

Psychosocial outcomes in a cohort of perinatally HIV-infected adolescents in Western Jamaica.

PubMed

Evans-Gilbert, Tracy; Kasimbie, Kazie; Reid, Gail; Williams, Shelly Ann

2018-02-05

Background Psychosocial factors interact with adolescent development and affect the ability of HIV-infected adolescents to cope with and adhere to treatment. Aim To evaluate psychosocial outcomes in perinatally HIV-infected adolescents (PHIVAs) in Western Jamaica after psychosocial intervention. Methods The Bright Futures Paediatric Symptom Checklist (BF-PSC) was used for psychological screening of PHIVAs in Western Jamaica. Referred patients were evaluated using the Youth version of the Columbia Impairment Scale (CIS). Demographic, laboratory and clinical data obtained between July 2014 and June 2016 were evaluated retrospectively and outcomes were reviewed before and after psychosocial intervention. Results Sixty PHIVAs were enrolled and 36 (60%) had a positive BF-PSC score that necessitated referral. The BF-PSC correctly identified 89% of patients with impaired psychosocial assessment by CIS scores. Referred patients were less likely to adhere to treatment, to be virologically suppressed or to have a CD4+ count of >500 cells/μl, and were more likely to be in the late teenage group or to be of orphan status. After intervention, the prevalence of viral suppression increased and median viral load decreased. A difference in mean CD4+ cell count was detected before but not after intervention in teenage and orphan groups. Conclusions The BF-PSC identified at-risk PHIVAs with impaired psychosocial functioning. Increased vulnerability was noted in orphans and older teenagers. Psychosocial interventions (including family therapy) reduced psychosocial impairment and improved virological suppression. Mental health intervention should be instituted to facilitate improved clinical outcomes, autonomy of care and transition to adult care.

Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study.

PubMed

Augustemak de Lima, Luiz Rodrigo; Petroski, Edio Luiz; Moreno, Yara Maria Franco; Silva, Diego Augusto Santos; Trindade, Erasmo Benício de Moraes Santos; Carvalho, Aroldo Prohmann de; Back, Isabela de Carlos

2018-01-01

HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8-15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL-1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL-1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL-1, p< 0.001), CRP (1.6 vs. 1.0 mg.L-1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL-1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL-1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL-1, p< 0.001) compared to controls. Systolic blood pressure (β = 0.006, p = 0.004) and TNF-α (β = -0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (β = -0.186, p = 0.008), trunk body fat (β = -0.011, p = 0.006), glucose (β = 0.005, p = 0.046), and IL-6 (β = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.

Association between HIV status and depressive symptoms among children and adolescents in the Southern Highlands Zone, Tanzania: A case-control study.

PubMed

Lwidiko, Abraham; Kibusi, Stephen Matthew; Nyundo, Azan; Mpondo, Bonaventura C T

2018-01-01

Children and adolescents continue to have HIV/AIDS in southern Saharan Africa. Scaling up of HIV services has significantly improved access to ARV and consequently improved on morbidity and mortality related to HIV/AIDS including opportunistic infection. Despite the above efforts, non-communicable conditions including mental disorders such as depression have been observed to contribute to the burden of disabilities about which little is documented. This study, therefore, aimed to determine the magnitude of depressive symptoms and the associated factors among HIV-infected children and adolescents. The study was a matched case-control design involving 300 cases of HIV-infected children matched by age and sex against 600 uninfected controls. Systematic sampling technique was used to select the cases while multistage sampling technique was employed to identify villages/ streets purposive and sampling technique was employed to obtain participants from households. The overall prevalence of depressive symptoms among the cohort of 900 participants was found to be 12.9%, with 27% of HIV-infected and 5.8% of HIV-uninfected children and adolescents screened positive for depressive symptoms. Multiple logistic regression revealed that being HIV-infected (AOR 1.96(1.11-3.45)), residing in a rural setting (AOR 0.61(0.39-0.96)) and history of childhood deprivation (AOR 4.76 (2.79-8.13)) were significantly associated with depressive symptoms. HIV infected adolescents are more affected by depression compared to non-infected counterparts. Childhood deprivation was significantly associated with presence of depressive symptoms. Integration of mental health evaluation and treatment into the HIV care provided for adolescents can be beneficial. More studies to delineate factors associated with depressed adolescents with HIV may add value to the body of knowledge and overall improvement of care.

Family-Based Processes Associated with Adolescent Distress, Substance Use and Risky Sexual Behavior in Families Affected by Maternal HIV

ERIC Educational Resources Information Center

Lester, Patricia; Stein, Judith A.; Bursch, Brenda; Rice, Eric; Green, Sara; Penniman, Typhanye; Rotheram-Borus, Mary Jane

2010-01-01

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother-adolescent (ages 12-21) dyads (N = 264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth…

Kganya Motsha Adolescent Centre: a model for adolescent friendly HIV management and reproductive health for adolescents in Soweto, South Africa.

PubMed

Nkala, Busisiwe; Khunwane, Mamakiri; Dietrich, Janan; Otwombe, Kennedy; Sekoane, Itumeleng; Sonqishe, Bulelwa; Gray, Glenda

2015-01-01

This paper reports on Kganya Motsha Adolescent Centre, an adolescent program specifically established to provide voluntary counseling and testing as well as management of HIV-positive young people in Soweto, South Africa. A retrospective cross-sectional analysis, using clinic records of young people accessing services from 2008 to 2012, was conducted. Of the 11,522 who tested, 7689 (67%) were females. The total number of HIV infections was 410, with an HIV prevalence of 3.6% (95% CI 3.2-3.9%). More females (332, 4% vs. 72, 2%; p < 0.0001) were HIV-infected than males. Of those testing HIV positive, 109 (26.5%) had a median CD4 cell count of 491 (IQR 345-686) cells/mm(3). Only 12/410 individuals (2.9%) were eligible for antiretroviral treatment and 10 (2.4%) of those successfully received treatment. The program observed that young people testing HIV positive would not return for follow up blood specimens or confirmatory results. Future programs should consider innovative ways of retaining adolescents in care to reduce potential HIV transmissions that could lead to deteriorating health.

Maternal HIV, substance use role modeling, and adolescent girls' alcohol use.

PubMed

Cederbaum, Julie A; Guerrero, Erick G; Barman-Adhikari, Anamika; Vincent, Carol A

2015-01-01

Parental role modeling has a major influence on adolescent alcohol use. Our study examined maternal factors associated with daughters' alcohol use among inner-city racial minority adolescents of HIV-infected and HIV-uninfected mothers. A nonprobability sample of 176 mothers (37% with HIV) and their adolescent daughters completed self-administered surveys. Between- and within-group analyses were conducted using hierarchical multivariate logistic regressions. Findings showed that in the full sample, difficulty talking with daughters about alcohol was positively associated with alcohol use among daughters, whereas maternal report of importance of religion was negatively associated with alcohol use among daughters. Within-group analysis of participants by maternal HIV status revealed that maternal beliefs that drinking alcohol in front of their daughters was normative were associated with higher odds of adolescent alcohol use in households with HIV-infected mothers. These preliminary findings highlight the potential increased vulnerability of racial minority adolescent girls living in households with HIV-infected mothers. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

A pressing need to respond to the needs and sexual and reproductive health problems of adolescent girls living with HIV in low- and middle-income countries

PubMed Central

Chandra-Mouli, Venkatraman; Armstrong, Alice; Amin, Avni; Ferguson, Jane

2015-01-01

Introduction This commentary provides the rationale and makes a call for greater investment and effort to meet the sexual and reproductive health (SRH) problems of adolescent girls living with HIV in low- and middle-income countries (LMIC). Discussion Adolescent girls in LMIC are at a greater risk of acquiring HIV infection than their male peers. They also face a number of other serious SRH problems – early pregnancy, pregnancy- and childbirth-related complications, unsafe abortions, sexual abuse and intimate partner violence and sexually transmitted infections. While many LMIC have made notable progress in preventing HIV in children and adults and in improving the access of these population groups to HIV treatment and care, adolescents in general and adolescent girls in particular have not received the same effort and investment. Conclusions Much more needs to be done to implement proven approaches to prevent new HIV infections in adolescent girls in LMIC and to meet the needs of those living with HIV. PMID:26643463

Mental health among adolescents living with HIV in Namibia: the role of poverty, orphanhood and social support.

PubMed

Gentz, Shelene G; Calonge-Romano, Isabel; Martínez-Arias, Rosario; Zeng, Chengbo; Ruiz-Casares, Mónica

2018-05-30

The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV.

Exploring the Context of Trafficking and Adolescent Sex Industry Involvement in Tijuana, Mexico: Consequences for HIV Risk and Prevention

PubMed Central

Goldenberg, Shira M.; Silverman, Jay G.; Engstrom, David; Bojorquez-Chapela, Ietza; Usita, Paula; Rolón, María Luisa; Strathdee, Steffanie A.

2015-01-01

Coerced and adolescent sex industry involvement are linked to serious health and social consequences, including enhanced risk of HIV infection. Using ethnographic fieldwork, including interviews with 30 female sex workers with a history of coerced or adolescent sex industry involvement, we describe contextual factors influencing vulnerability to coerced and adolescent sex industry entry and their impacts on HIV risk and prevention. Early gender-based violence and economic vulnerabilities perpetuated subsequent vulnerability to coercion and adolescent sex exchange, while HIV risk mitigation capacities improved with increased age, control over working conditions, and experience. Structural interventions addressing gender-based violence, economic factors, and HIV prevention among all females who exchange sex are needed. PMID:25648946

Exploring the context of trafficking and adolescent sex industry involvement in Tijuana, Mexico: consequences for HIV risk and prevention.

PubMed

Goldenberg, Shira M; Silverman, Jay G; Engstrom, David; Bojorquez-Chapela, Ietza; Usita, Paula; Rolón, María Luisa; Strathdee, Steffanie A

2015-04-01

Coerced and adolescent sex industry involvement are linked to serious health and social consequences, including enhanced risk of HIV infection. Using ethnographic fieldwork, including interviews with 30 female sex workers with a history of coerced or adolescent sex industry involvement, we describe contextual factors influencing vulnerability to coerced and adolescent sex industry entry and their impacts on HIV risk and prevention. Early gender-based violence and economic vulnerability perpetuated vulnerability to coercion and adolescent sex exchange, while HIV risk mitigation capacities improved with increased age, control over working conditions, and experience. Structural interventions addressing gender-based violence, economic factors, and HIV prevention among all females who exchange sex are needed. © The Author(s) 2015.

Assessment of comprehensive HIV/AIDS knowledge level among in-school adolescents in eastern Ethiopia.

PubMed

Oljira, Lemessa; Berhane, Yemane; Worku, Alemayehu

2013-03-20

In Ethiopia, more adolescents are in school today than ever before; however, there are no studies that have assessed their comprehensive knowledge of HIV/AIDS. Thus, this study tried to assess the level of this knowledge and the factors associated with it among in-school adolescents in eastern Ethiopia. A cross-sectional school-based study was conducted using a facilitator-guided self-administered questionnaire. The respondents were students attending regular school in 14 high schools located in 14 different districts in eastern Ethiopia. The proportion of in-school adolescents with comprehensive HIV/AIDS knowledge was computed and compared by sex. The factors that were associated with the comprehensive HIV/AIDS knowledge were assessed using bivariate and multivariable logistic regression. Only about one in four, 677 (24.5%), in-school adolescents have comprehensive HIV/AIDS knowledge. The knowledge was better among in-school adolescents from families with a relatively middle or high wealth index (adjusted OR [95% CI]=1.39 [1.03-1.87] and 1.75 [1.24-2.48], respectively), who got HIV/AIDS information mainly from friends or mass media (adjusted OR [95% CI]=1.63 [1.17-2.27] and 1.55 [1.14-2.11], respectively) and who received education on HIV/AIDS and sexual matters at school (adjusted OR [95% CI]=1.59 [1.22-2.08]). The females were less likely to have comprehensive HIV/AIDS knowledge compared to males (adjusted OR and [95% CI]=0.60 [0.49-0.75]). In general, only about a quarter of in-school adolescents had comprehensive HIV/AIDS knowledge. Although the female adolescents are highly vulnerable to HIV infection and its effects, they were by far less likely to have comprehensive HIV/AIDS knowledge. HIV/AIDS information, education and communication activities need to be intensified in high schools.

HIV-related chronic lung disease in adolescents: are we prepared for the future?

PubMed

Goussard, Pierre; Gie, Robert P

2017-12-01

Chronic lung diseases (CLD) are the most chronic disease occurring in adolescents living with human immunodeficiency virus (ALHIV). In ALHIV who received antiretroviral therapy (ART) late in childhood, bronchiectasis, bronchiolitis obliterans and interstitial pneumonitis are common. In adolescents who received ART early in life the spectrum of CLD has changed with asthma and chronic obstructive pulmonary disease being common. Areas covered: The aim of this paper was to review CLD in ALHIV. We conducted a literature review of electronic databases focusing on CLD that were common prior to the introduction of ART (1996-2004), the present situation where ART is widely available (2005 to 2016), and articles which aided us speculating on the impact of HIV-related CLD in adolescents transitioning to adult HIV-clinics. Amongst the approximately 2.1 million adolescents living with HIV, CLD commonly occurs. Awareness of the CLD amongst ALHIV needs to be raised to ensure that disease appropriate treatment is available to these vulnerable adolescents. Expert commentary: As adolescents' transition from pediatric HIV-clinics to adult HIV-clinics the evidence shows that adolescents might not receive optimal care if adult pulmonologists are not aware of the CLD that commonly occur in ALHIV.

An Exploratory Study of Spirituality in HIV Infected Adolescents and their Families: FAmily CEntered Advance Care Planning and Medication Adherence

PubMed Central

Lyon, Maureen E.; Garvie, Patricia A.; Kao, Ellin; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J.; McCarter, Robert

2010-01-01

Purpose To explore the impact of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence in HIV+ adolescents and their surrogate decision-makers. Methods A sample of HIV+ adolescents (n=40) and their surrogates, age 21 or older, (n=40) was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents’ spirituality was assessed at baseline and 3 months post-intervention, using the FACIT-SP-4-EX, as was the belief that HIV is a punishment from God. Results Control adolescents increased faith and meaning/purpose more so than FACE adolescents (p=0.02). At baseline more behaviorally (16%) vs. perinatally (8%) infected adolescents believed HIV was a punishment from God, but not at 3-months post-intervention. Adolescents endorsing HIV was a punishment scored lower on spirituality (p=.05) and adherence to HAART (p= .04). Surrogates were more spiritual than adolescents (p=<.0001). Conclusion Providing family support in a friendly, facilitated, environment enhanced adolescents’ spirituality. Facilitated family conversations had an especially positive effect on behaviorally infected adolescents’ medication adherence and spiritual beliefs. PMID:21575826

Male adolescent sexual and reproductive health care.

PubMed

Marcell, Arik V; Wibbelsman, Charles; Seigel, Warren M

2011-12-01

Male adolescents' sexual and reproductive health needs often go unmet in the primary care setting. This report discusses specific issues related to male adolescents' sexual and reproductive health care in the context of primary care, including pubertal and sexual development, sexual behavior, consequences of sexual behavior, and methods of preventing sexually transmitted infections (including HIV) and pregnancy. Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and delivering appropriate vaccinations. Pediatricians should provide these services to male adolescent patients in a confidential and culturally appropriate manner, promote healthy sexual relationships and responsibility, and involve parents in age-appropriate discussions about sexual health with their sons.

A Multimodal Behavioral Intervention to Impact Adherence and Risk Behavior among Perinatally and Behaviorally HIV-Infected Youth: Description, Delivery, and Receptivity of Adolescent Impact

ERIC Educational Resources Information Center

Chandwani, Sulachni; Abramowitz, Susan; Koenig, Linda J.; Barnes, William; D'Angelo, Lawrence

2011-01-01

Secondary prevention programs are needed to help HIV-positive youth reduce risk behavior and improve adherence to HIV medications. This article provides an overview of Adolescent Impact, a secondary HIV prevention intervention, including its description, delivery, and receptivity among the two unique groups of participants. Adolescent Impact, a…

Pharmacokinetics and Pharmacokinetic/Pharmacodynamic Relationships of Etravirine in HIV-1-Infected, Treatment-Experienced Children and Adolescents in PIANO.

PubMed

Kakuda, Thomas N; Brochot, Anne; Green, Bruce; Nijs, Steven; Vis, Peter; Opsomer, Magda; Tomaka, Frank L; Hoetelmans, Richard M W

2016-11-01

PIANO (NCT00665847) investigated etravirine pharmacokinetics, efficacy, and safety in children and adolescents. Treatment-experienced, HIV-1-infected patients (≥6 to <18 years) received etravirine 5.2 mg/kg twice daily (maximum 200 mg twice daily) plus background antiretrovirals. A population pharmacokinetic model was developed, and etravirine C 0h and AUC 0-12h were estimated. Relationships among intrinsic/extrinsic factors and etravirine pharmacokinetics and pharmacokinetics with pharmacodynamics were assessed. The best model describing etravirine pharmacokinetics consisted of a single compartment with sequential zero- and first-order absorption following a lag time. Interindividual variability terms were included on clearance (CL/F) and the first-order input rate constant (KA). The final model estimates (coefficient of variation, %) for CL/F and KA were 46.3 (11) L/h and 1.07 (34) h -1 , respectively. Overall, median (range) estimated etravirine C 0h and AUC 0-12h were 287 (2-2276) ng/mL and 4560 (62-28,865) ng · h/mL, respectively. Exposure was slightly lower in adolescents vs children. Sex and adherence did not affect etravirine pharmacokinetics. Factors significantly affecting etravirine exposure were body weight (higher with lower weight), race (lower in Asians than in white or black patients), and the use of certain HIV protease inhibitors. Virologic response (<50 copies/mL at week 48) was lower in the lowest etravirine AUC 0-12h quartile vs the upper 3 quartiles (41% vs 67% to 76%). Rash occurred more frequently in the highest quartile than in the lower 3 quartiles (52% versus 8% to 20%). Etravirine 5.2 mg/kg twice daily in treatment-experienced, HIV-1-infected children and adolescents provides comparable exposure to that in adults receiving etravirine 200 mg twice daily and is the recommended dose for children and adolescents. © 2016, The American College of Clinical Pharmacology.

Impact of Clinical Parameters in the Intrahost Evolution of HIV-1 Subtype B in Pediatric Patients: A Machine Learning Approach

PubMed Central

Rojas Sánchez, Patricia; Cobos, Alberto; Navaro, Marisa; Ramos, José Tomas; Pagán, Israel

2017-01-01

Abstract Determining the factors modulating the genetic diversity of HIV-1 populations is essential to understand viral evolution. This study analyzes the relative importance of clinical factors in the intrahost HIV-1 subtype B (HIV-1B) evolution and in the fixation of drug resistance mutations (DRM) during longitudinal pediatric HIV-1 infection. We recovered 162 partial HIV-1B pol sequences (from 3 to 24 per patient) from 24 perinatally infected patients from the Madrid Cohort of HIV-1 infected children and adolescents in a time interval ranging from 2.2 to 20.3 years. We applied machine learning classification methods to analyze the relative importance of 28 clinical/epidemiological/virological factors in the HIV-1B evolution to predict HIV-1B genetic diversity (d), nonsynonymous and synonymous mutations (dN, dS) and DRM presence. Most of the 24 HIV-1B infected pediatric patients were Spanish (91.7%), diagnosed before 2000 (83.3%), and all were antiretroviral therapy experienced. They had from 0.3 to 18.8 years of HIV-1 exposure at sampling time. Most sequences presented DRM. The best-predictor variables for HIV-1B evolutionary parameters were the age of HIV-1 diagnosis for d, the age at first antiretroviral treatment for dN and the year of HIV-1 diagnosis for ds. The year of infection (birth year) and year of sampling seemed to be relevant for fixation of both DRM at large and, considering drug families, to protease inhibitors (PI). This study identifies, for the first time using machine learning, the factors affecting more HIV-1B pol evolution and those affecting DRM fixation in HIV-1B infected pediatric patients. PMID:29044435

Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: a qualitative investigation.

PubMed

Petersen, I; Bhana, A; Myeza, N; Alicea, S; John, S; Holst, H; McKay, M; Mellins, C

2010-08-01

While the roll-out of antiretroviral therapy in South Africa should lead to a reduction in mother to child transmission, mortality and orphaning, it will also be accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease. Adolescence is a particularly vulnerable period for HIV-infected people in relation to mental health problems and engagement in high-risk behaviours, including non-compliance with medical treatment. The goal of this qualitative study was to develop an understanding of the psychosocial challenges as well as protective influences promoting socio-emotional coping in HIV+ adolescents in order to inform mental health promotion and HIV prevention programming for this population in South Africa. In-depth qualitative interviews were conducted with HIV+ adolescents (25) and caregivers of HIV+ children (15) at a large HIV/AIDS Clinic in South Africa. Data were analysed thematically using NVivo8 software. Psycho-social challenges for adolescents included dealing with loss of biological parents in the case of orphans; coming to terms with their HIV+ status including identity difficulties; external stigma and discrimination; and disclosure difficulties. For caregivers, disclosure and lack of financial, family and social support emerged as key challenges. Medication, HIV information, a future orientation and social support was identified as important for coping and general well-being of adolescents, with financial and social support emerging as key for promoting supportive caregiving contexts. While HIV+ adolescents in South Africa experience similar concerns to those in high-income countries, socio-emotional coping may be compromised by increased levels of loss due to the late roll-out of ARVS and challenges to caregiving contexts including poverty, stigma and minimally supported foster care arrangements. There is a need for mental health promotion programmes for adolescents to adopt an ecological approach, strengthening protective influences at the individual, interpersonal, community and policy levels.

'Everyone has a secret they keep close to their hearts': challenges faced by adolescents living with HIV infection at the Kenyan coast.

PubMed

Abubakar, Amina; Van de Vijver, Fons J R; Fischer, Ronald; Hassan, Amin S; K Gona, Joseph; Dzombo, Judith Tumaini; Bomu, Grace; Katana, Khamis; Newton, Charles R

2016-02-29

The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast. A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants) took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software. We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring. In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges.

Barriers and facilitators to antiretroviral therapy adherence among Peruvian adolescents living with HIV: A qualitative study

PubMed Central

Wong, Milagros; Muñoz, Maribel; Valle, Emiliano; Leon, Segundo R.; Díaz Perez, Dayana; Kolevic, Lenka; Franke, Molly

2018-01-01

AIDS deaths among adolescents are increasing globally. This qualitative study investigated the barriers and facilitators to cART adherence among Peruvian adolescents living with HIV. Guided by a social ecological model, we analyzed transcripts from 24 psychosocial support groups for HIV-positive adolescents aged 13–17 years and 15 individual, in-depth interviews with cART providers and caregivers to identify the barriers and facilitators to cART adherence at the individual, family/caregiver and hospital levels. Most barriers and facilitators to cART adherence clustered at the individual and family/caregiver levels, centering on support provided to adolescents; history of declining health due to suboptimal cART adherence; side effects from antiretroviral drugs; and cART misinformation. Interventions to support adolescent HIV cART adherence should begin at the individual and family/caregiver levels and include an educational component. No adolescent living with HIV should die from AIDS in an era of accessible cART. PMID:29447226

Sexual risk behavior and STI health literacy among ethnic minority adolescent women.

PubMed

Dimmitt Champion, Jane; Harlin, Badia; Collins, Jennifer L

2013-11-01

Although information is available for prevention of sexually transmitted infection (STI/HIV), adolescents continue to engage in high risk sexual behavior particularly ethnic minority adolescent women with histories of STI or abuse. A description therefore of STI/HIV knowledge and sexual risk behavior among these women is indicated for modification of prevention efforts for sexual health promotion. African-American (n=94) and Mexican-American (n=465) adolescent women 14-18 years of age were included in the study. Assessments of sexual risk behavior and STI/HIV knowledge among these adolescent women described Mexican-American women as at higher risk of STI, pregnancy, substance use and abuse with lower levels of STI/HIV knowledge, previous HIV testing and perceptions of risk than African-American women. A focus on Mexican-American adolescent women with histories of STI and abuse is indicated for translation of community-based health promotion interventions for amelioration of potential adverse sexual health outcomes among ethnic minority adolescent women. © 2013.

Comparison of adolescents' HIV/AIDS knowledge and self-efficacy across two cultures.

PubMed

Mahat, Ganga; Scoloveno, Mary Ann; Ayres, Cynthia

2014-01-01

This study examines the effectiveness of a HIV/AIDS peer education program, Teens for AIDS Prevention (TAP) in two cultures. A convenience sample of 287 (American and Nepalese) 9th grade students participated in the study. It was found that HIV/AIDS knowledge scores were significantly higher among American adolescents than their Nepalese counterparts only at pre-intervention. American adolescents had significantly higher self-efficacy scores than Nepalese adolescents both at pre-intervention and post-intervention. Adolescent peer education programs could be used to improve adolescent HIV/AIDS knowledge and self-efficacy for limiting sexual risk behavior; however for the educational programs to be effective, it is pertinent that the program is culturally appropriate to the target population.

Emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda.

PubMed

Musisi, S; Kinyanda, E

2009-01-01

To investigate the emotional and behavioral problems of HIV sero-positive adolescents. A cross-sectional descriptive study. A specialised HIV/AIDS Health Care Centre, the Mildmay Centre, in Kampala, Uganda. Eighty two HIV sero-positive adolescents were consecutively enrolled for the study. Over half (55.6%) of the subjects were females. They were mostly (88.9%) under the age of 15 years, orphans (97.6%) and stayed with non-parental relatives (68.3%). Almost two thirds (60.9%) of them were in the HIV/AIDS clinical disease stage III or IV and were not on ARVs drugs. Forty two (51.2%) of the subjects had significant psychological distress (SRQ-25 scores > or = 6) and 14 (17.1%) had attempted suicide within the last 12 months. Their specific psychiatric disorders, made using ICD-10 criteria, were: Anxiety 45.6%, depression 40.8%, somatisation 18.0%, seizures 8.4%, mania 1.2% and HIV-associated progressive encephalopathy 4.8%. HIV/AIDS infection in adolescence was associated with considerable psychological problems and the presence of major psychiatric disorders. With the current increasing availability of effective antiretroviral therapy, many of these children are surviving into adolescence, thus calling for the development of adolescent friendly HIV medical and psychological support and treatment services in developing countries such as Uganda.

Psychological Stressors and Coping Strategies Used by Adolescents Living with and Not Living with Hiv Infection in Nigeria.

PubMed

Folayan, Morenike O; Cáceres, Carlos F; Sam-Agudu, Nadia A; Odetoyinbo, Morolake; Stockman, Jamila K; Harrison, Abigail

2017-09-01

Little is known about stressful triggers and coping strategies of Nigerian adolescents and whether or not, and how, HIV infection modulates these sources of stress and coping. This study evaluated differences in stressors and coping strategies among Nigerian adolescents based on HIV status. We analysed the data of six hundred 10-19 year old adolescents recruited through a population-based survey from 12 States of Nigeria who self-reported their HIV status. Data on stressors and coping strategies were retrieved by self-report from participants, using a validated structured questionnaire. We compared results between adolescents with and without HIV with respect to identification of specific life events as stressors, and use of specific coping strategies to manage stress. Logistic regression analysis adjusted for age and sex. Adolescents living with HIV (ALHIV) had significantly increased odds of identifying 'having to visit the hospital regularly' (AOR: 5.85; 95 % CI: 2.11-16.20; P = 0.001), and 'having to take drugs regularly' (AOR: 9.70; 95 % CI: 4.13-22.81; P < 0.001) as stressors; and 'Seeking social support' (AOR: 3.14; 95 % CI: 1.99-4.93; p < 0.001) and 'using mental disengagement' (OR: 1.64; 95 % CI: 0.49-1.84; p = 0.001) as coping strategies. Adolescents not living with HIV had significantly increased odds of identifying 'argument with a friend or family member' as a stressor (AOR: 6.59; 95 % CI: 3.62-11.98; P < 0.001). Life events related to adolescents' HIV positive status were significant stressors for ALHIV. Providing targeted psychosocial support could help reduce the impact of such HIV status-related stressors on ALHIV.

Short Communication: Phylogenetic Evidence of HIV-1 Transmission Between Adult and Adolescent Men Who Have Sex with Men.

PubMed

Wolf, Elizabeth; Herbeck, Joshua T; Van Rompaey, Stephen; Kitahata, Mari; Thomas, Katherine; Pepper, Gregory; Frenkel, Lisa

2017-04-01

HIV-1 incidence among youth, especially men who have sex with men (MSM), is increasing in the United States. We aimed to better understand the patterns of adolescent HIV-1 acquisition, to help guide future prevention interventions. We conducted a study combining epidemiologic and HIV-1 pol sequence data from a retrospective cohort of HIV-infected adults and adolescents in Seattle, WA between 2000 and 2013. Adolescents were defined as 13-24 years of age at the time of first HIV-1 care. Maximum-likelihood phylogenetic trees were reconstructed to identify putative viral transmission clusters of two or more individuals, followed by multivariable regression tests of associations between clustering and demographic and clinical parameters. The dataset included 3,102 sequences from 1,953 individuals; 72 putative transmission clusters were identified, representing 168 individuals (8.6%). MSM and MSM/intravenous drug use (IDU) were positively associated with clustering, with aOR 3.18 (95% CI: 1.34-7.55) and 2.59 (95% CI: 1.04-6.49), respectively. African American race was negatively associated with clustering (aOR 0.54 95% CI: 0.32-0.91). Twenty-five clusters contained one adolescent and five clusters contained two adolescents. Other individuals who clustered with adolescents were predominantly male (95%), white (85%), and either MSM (66%) or MSM/IDU (16%), with a greater mean age (34 years vs. 22 years; p < .01). In this Seattle cohort, HIV-1 transmission linkages were identified between white male adolescents and older MSM adults. Interventions aimed at age-discrepant pairs may reduce HIV-1 infections in adolescent males.

HIV status disclosure to perinatally-infected adolescents in Zimbabwe: a qualitative study of adolescent and healthcare worker perspectives.

PubMed

Kidia, Khameer K; Mupambireyi, Zivai; Cluver, Lucie; Ndhlovu, Chiratidzo E; Borok, Margaret; Ferrand, Rashida A

2014-01-01

Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process. In-depth interviews were conducted with 31 (14 male, 17 female) perinatally-infected adolescents aged 16-20 at an HIV clinic in Harare, Zimbabwe, and focused on adolescents' experiences of disclosure. In addition, 15 (1 male, 14 female) healthcare workers participated in two focus groups that were centred on healthcare workers' practices surrounding disclosure in the clinic. Purposive sampling was used to recruit participants. A coding frame was developed and major themes were extracted using grounded theory methods. Healthcare workers encouraged caregivers to initiate disclosure in the home environment. However, many adolescents preferred disclosure to take place in the presence of healthcare workers at the clinic because it gave them access to accurate information as well as an environment that made test results seem more credible. Adolescents learned more specific information about living with an HIV-positive status and the meaning of that status from shared experiences among peers at the clinic. HIV-status disclosure to adolescents is distinct from disclosure to younger children and requires tailored, age-appropriate guidelines. Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent. The study also highlights the value of peer support among adolescents, which could help reduce the burden of psychosocial care on caregivers and healthcare workers.

Opportunity Knocks: HIV Prevention in Primary Care.

PubMed

Thrun, Mark W

2014-06-01

Expansions in health care coverage, a comprehensive framework for HIV prevention and care, electronic medical records, and novel HIV prevention modalities create a current opportunity to change the trajectory of the HIV epidemic in the United States. HIV is increasingly disproportionately found in populations historically at higher risk, including gay men and other men who have sex with men, transgender women, injection drug users, and persons of color. This underscores the need for providers to identify persons at higher risk for HIV and assure the provision of screening and prevention services. In turn, universal screening for HIV-testing every adolescent and adult at least once in their lifetime-will increasingly be necessary to find the infrequent cases of HIV in lower risk populations. In both these domains, primary care providers will play a unique role in complementing traditional providers of HIV prevention and care services by increasing the proportion of their patients who have been screened for HIV, opening dialogues around sexual health, including asking about sexual orientation and gender identity, and prescribing antivirals as pre- and postexposure prophylaxis for their non-HIV-infected patients. Primary care providers must understand and embrace their importance along the HIV prevention and care continuum.

Perinatally acquired HIV infection accelerates epigenetic aging in South African adolescents.

PubMed

Horvath, Steve; Phillips, Nicole; Heany, Sarah J; Kobor, Michael S; Lin, David Ts; Myer, Landon; Zar, Heather J; Stein, Dan J; Levine, Andrew J; Hoare, Jacqueline

2018-05-08

Recent studies demonstrate that infection with the Human Immunodeficiency Virus-1 (HIV) is associated with accelerated aging effects in adults according to a highly accurate epigenetic biomarker of aging known as epigenetic clock. However, it not yet known whether epigenetic age acceleration occurs as early as adolescence in perinatally HIV-infected (PHIV+) youth. Observational study of PHIV and HIV-uninfected adolescents enrolled in the Cape Town Adolescent Antiretroviral Cohort (CTAAC) Study. The Illumina EPIC array was used to generate blood DNA methylation data from 204 PHIV and 44 age-matched, uninfected (HIV-) adolescents aged 9 to 12 years old. The epigenetic clock software and method was used to estimate two measures of epigenetic age acceleration. Each participant completed a comprehensive neuropsychological test battery upon enrolment to CTAAC. HIV is associated with biologically older blood in PHIV+ adolescents according to both measures of epigenetic age acceleration. One of the measures, extrinsic epigenetic age acceleration, is negatively correlated with measures of cognitive functioning (executive functioning, working memory, processing speed). Overall, our results indicate that epigenetic age acceleration in blood can be observed in PHIV+ adolescents and that these epigenetic changes accompany poorer cognitive functioning.

Case Study: Delirium in an Adolescent Girl with Human Immunodeficiency Virus-Associated Dementia

ERIC Educational Resources Information Center

Scharko, Alexander M.; Baker, Eva H.; Kothari, Priti; Khattak, Hina; Lancaster, Duniya

2006-01-01

Delirium and human immunodeficiency virus (HIV)-associated dementia are well recognized neuropsychiatric consequences of HIV infection in adults. Almost nothing is known regarding the management of delirium in HIV-infected children and adolescents. HIV-related progressive encephalopathy is thought to represent the pediatric form of HIV-associated…

Cystatin C: A Marker for Inflammation and Renal Function Among HIV-infected Children and Adolescents.

PubMed

Deyà-Martínez, Àngela; Fortuny, Clàudia; Soler-Palacín, Pere; Neth, Olaf; Sánchez, Emília; Martín-Nalda, Andrea; Falcón-Neyra, Lola; Vila, Anna; Valls, Anna; Noguera-Julian, Antoni

2016-02-01

Renal disease is a leading cause of morbidity in HIV-infected adults in the highly active antiretroviral therapy (HAART) era. Cystatin C has been proposed as a more sensitive marker of renal function, but it may be affected by ongoing inflammation. We aimed to study the cystatin C levels in a cohort of HIV-infected pediatric patients at 3 Spanish centers. This is a multicenter cross-sectional observational study. Renal function was assessed by means of first morning urine protein/creatinine and albumin/creatinine ratios and creatinine-estimated glomerular filtration rates (GFRs), together with the following inflammation markers: cystatin C, reactive C protein, β-2-microglobulin and 25(OH)-vitamin D levels. A control group of healthy children and adolescents was used. Eighty-three patients (51 females, median age: 13.3 years; 32 males, median age: 13.6 years) and 44 controls (24 females, median age: 12.2 years; 20 males, median age: 10.9 years) were included. Among the former, mean CD4 cell count was 860/mm, 29(35%) patients had a previous AIDS diagnosis, 73(88%) were on HAART and HIV viremia was undetectable in 61(73%). No differences in cystatin C levels were observed between the 2 groups. In HIV-infected patients, cystatin C levels correlated with GFR (r = -0.27; P = 0.01), age at first HAART (r = -0.21; P = 0.05), and β-2-microglobulin (r = 0.569; P < 0.01). In multivariate analysis, lower GFR (P = 0.014) and higher β-2-microglobulin levels (P = 0.001) remained as independent risk factors for higher cystatin C values. Cystatin C values were associated with GFR and β-2-microglobulin. Cystatin C may be useful as a marker of renal function in HIV-infected pediatric patients, independently of ongoing inflammation or viremia.

Community intervention improves knowledge of HIV status of adolescents in Zambia: findings from HPTN 071-PopART for youth study

PubMed Central

Shanaube, Kwame; Schaap, Ab; Chaila, Mwate Joseph; Floyd, Sian; Mackworth-Young, Constance; Hoddinott, Graeme; Hayes, Richard; Fidler, Sarah; Ayles, Helen

2017-01-01

Objective: To determine the uptake of home-based HIV counselling and testing (HCT) in four communities of the HPTN 071 (PopART) trial in Zambia among adolescents aged 15–19 years and explore factors associated with HCT uptake. Design: The PopART for youth study is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa which aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment, among young people. The study is nested within the HPTN 071 (PopART) trial. Methods: Using a door-to-door approach that includes systematically revisiting households, all adolescents enumerated were offered participation in the intervention and verbal consent was obtained. Data were analysed from October 2015 to September 2016. Results: Among 15 456 enumerated adolescents, 11 175 (72.3%) accepted the intervention. HCT uptake was 80.6% (8707/10 809) and was similar by sex. Adolescents that knew their HIV-positive status increased almost three-fold, from 75 to 210. Following visits from community HIV care providers, knowledge of HIV status increased from 27.6% (3007/10 884) to 88.5% (9636/10 884). HCT uptake was associated with community, age, duration since previous HIV test; other household members accepting HCT, having an HIV-positive household member, circumcision, and being symptomatic for STIs. Conclusion: Through a home-based approach of offering a combination HIV prevention package, the proportion of adolescents who knew their HIV status increased from ∼28 to 89% among those that accepted the intervention. Delivering a community-level door-to-door combination, HIV prevention package is acceptable to many adolescents and can be effective if done in combination with targeted testing. PMID:28665880

Digital gaming for HIV prevention with young adolescents.

PubMed

Enah, Comfort; Moneyham, Linda; Vance, David E; Childs, Gwendolyn

2013-01-01

The search for intervention strategies appropriate for young adolescents has recently led to the use of digital games. Digital gaming interventions are promising because they may be developmentally appropriate for adolescent populations. The gaming approach also capitalizes on an inherent interest to adolescents and circumvents traditional barriers to access to prevention interventions faced in some geographical areas. Notwithstanding, research on gaming in HIV prevention is quite limited. In this review article, we examine the need for contextually relevant HIV prevention interventions among young adolescents. From this, we provide a theoretical framework for exploring contextually relevant HIV risk factors and a foundation for gathering and using input from the target population to adapt an existing game or to create a developmentally appropriate and contextually relevant HIV prevention game. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Attitudes and beliefs regarding depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

PubMed Central

Brawner, Bridgette M.

2012-01-01

Individuals’ attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purpose of this study was to elucidate attitudes and beliefs about depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semi-structured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e. loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females. PMID:23164403

"My mother told me that I should not": a qualitative study exploring the restrictions placed on adolescent girls living with HIV in Zambia.

PubMed

Mackworth-Young, Constance Rs; Bond, Virginia; Wringe, Alison; Konayuma, Katongo; Clay, Sue; Chiiya, Chipo; Chonta, Mutale; Sievwright, Kirsty; Stangl, Anne L

2017-12-01

Adolescent girls in sub-Saharan Africa are disproportionately affected by HIV due to a range of social and structural factors. As they transition to adulthood, they are recipients of increasing blame for HIV infection and 'improper' sex, as well as increasing scrutiny, restrictions and surveillance. This study used a qualitative and participatory approach to explore the messaging and restrictions imposed on adolescent girls living with HIV in Zambia. Thirty-four in-depth interviews and four participatory workshops were carried out with 24 adolescent girls aged 15 to 19 years old living with HIV in Lusaka, Zambia. Key themes explored included experiences living with HIV, finding out about HIV status, disclosure, experiences with antiretroviral treatment, and support needs. Data were organized, coded and analysed using a grounded theory approach to thematic analysis. This analysis uses data on participants' experiences of living with HIV and their interactions with their parents, guardians and healthcare providers. Family and healthcare providers, partly in a quest to protect both the health of adolescent girls living with HIV and also to protect them from blaming discourse, imposed restrictions on their behaviour around three main topics: don't disclose your HIV status, don't have sex, and don't miss your medicines. These restrictions were often delivered using tactics of fear, and usually disconnected from other options. Participants responded to these messages in several ways, including internalizing the messages, changing their behaviour either to comply with or resist the restrictions, by remaining silent and anxious when restrictions were broken, and developing concerns around their own health and sexual and reproductive aspirations. Participants also sometimes experiencing stigma when restrictions could not be maintained. Restrictive messages were delivered to adolescent girls living with HIV through the broader social discourses of stigma, religion, and global and local narratives about HIV. Programmes aiming to support adolescent girls living with HIV need to work together with parents and healthcare providers to reflect on the impact of sanctioning messages, and to encourage more enabling and empowering messaging for adolescent girls living with HIV. © 2017 Zambart. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

A Human Immunodeficiency Virus Posttest Video to Increase Condom Use Among Adolescent Emergency Department Patients

PubMed Central

Calderon, Yvette; Cowan, Ethan; Leu, Cheng-Shiun; Brusalis, Christopher; Rhee, John Y.; Nickerson, Jillian; Leider, Jason; Bauman, Laurie J.

2013-01-01

Purpose To compare the effectiveness of a theory-based HIV educational video tool with in-person HIV counseling in promoting safer sex behaviors among adolescent patients of an urban Emergency Department (ED). Methods This was a randomized controlled trial taking place in the Emergency Department of Jacobi Medical Center in the Bronx, New York. A total of 203 stable, sexually active patients aged 15–21 years completed pre-intervention and postintervention measures. Participants were randomized to the intervention video series (102 participants), a theory-based, youth-friendly human immunodeficiency virus (HIV) educational video, or an in-person HIV counseling session with a trained HIV counselor (101 participants). Participants completed pre-intervention and postintervention measures on the primary outcomes: condom intention, outcome expectancy, and self-efficacy. Results Participants in the video group improved condom use intention (adjusted differential mean improvement [ADMI] = .98 units; confidence interval [CI], .20–1.77; Holm adjusted p = .028), condom self-efficacy outcome (ADMI = .26 units; CI, .04–.48; Holm adjusted p = .019), and condom outcome expectancy scores (ADMI = .15 units; CI, .07–.23; Holm adjusted p < .001) significantly more than those in the counselor group, adjusting for stage of change. The intervention helped participants progress to the next level of readiness or maintain their positive behavior, and did not differ by age, gender, or race. Conclusions A theory-based, youth-friendly video can be a valid means to provide posttest HIV education and prevention messages within an urban emergency department. The theory-based prevention messages can improve teenagers’ condom intentions, condom self-efficacy, and condom outcome expectancies immediately after the intervention. PMID:23582525

The challenges of timely and safe HIV disclosure among perinatally HIV-infected adolescents in sub-Saharan Africa.

PubMed

Dahourou, Désiré; Raynaud, Jean-Philippe; Leroy, Valériane

2018-05-01

Improved access to antiretroviral therapy has resulted in an emerging population of adolescents living with HIV (ALHIV) mainly in sub-Saharan Africa. Full disclosure of an HIV diagnosis includes naming HIV/AIDS and is an important step in coping with HIV. We reviewed the recent trends in the rates of children/adolescents who have been informed of their HIV infection according to age groups, the barriers and the evaluated interventions aimed at improving the HIV disclosure process to ALHIV in sub-Saharan Africa. Literature shows that HIV disclosure remains challenging in sub-Saharan Africa. Although full HIV disclosure rates have increased recently, this is still insufficient and occurs at a late age (median 13 years). Individual disclosure is the main practice but group sessions involving adolescent peers also exist. The practice of the disclosure is often complex, because of multiple barriers related to caregivers (fear of the parents of the breaking of the family secrecy, feelings of guilt) and to healthcare workers (lack of training, excess workload). The development and evaluation of research interventions adapted to sociocultural contexts to support timely and safe HIV disclosure to ALHIV is urgently needed to reach the 90-90-90 UNAIDS targets.

Predicting the Onset of Sexual and Drug Risk Behaviors in HIV-Negative Youths with HIV-Positive Mothers: The Role of Contextual, Self-Regulation, and Social-Interaction Factors

ERIC Educational Resources Information Center

Mellins, Claude A.; Dolezal, Curtis; Brackis-Cott, Elizabeth; Nicholson, Ouzama; Warne, Patricia; Meyer-Bahlburg, Heino F. L.

2007-01-01

HIV-negative, inner-city adolescents with HIV-infected parents are considered to be at high risk for acquiring HIV themselves. Using a modified theory of health behavior, this study examined the effects of maternal HIV infection and psychosocial variables on the onset of sexual and drug risk behavior in 144 HIV-negative adolescents with and…

Validity of Self-reported Sexual Behavior Among Adolescents: Where Do We Go from Here?

PubMed

DiClemente, Ralph J

2016-01-01

Adolescents have high rates of sexually transmitted infections (STIs). Adolescents consuming alcohol and using drugs have markedly greater HIV/STI risk and are a priority population for intervention. Accurate measurement of sexual risk behavior is critical for understanding individual's risk for HIV/STI, transmission dynamics of HIV/STI, and evaluating the efficacy of interventions designed reduce HIV/STI risk. However, significant challenges to accurately measuring adolescents' self-reported sexual behavior are well-documented. Recent advances in microbiology, such as the use of less invasive specimen collection for DNA assays, can assist researchers in more accurately measuring adolescents' sexual risk behavior. However, the majority of studies of adolescents' sexual risk rely solely on self-reported behavior; therefore, methods to improve the validity of adolescents' self-reported sexual behavior are needed. In addition, integrating biologic measures to complement self-reported measures are recommended, when appropriate and feasible.

Incident anal human papillomavirus and human papillomavirus-related sequelae in HIV-infected versus HIV-uninfected adolescents in the United States.

PubMed

Mullins, Tanya L Kowalczyk; Wilson, Craig M; Rudy, Bret J; Sucharew, Heidi; Kahn, Jessica A

2013-09-01

Little is known about the incidence of anal human papillomavirus (HPV) infection and related sequelae, as well as factors associated with these outcomes, among adolescents who are HIV infected versus HIV uninfected but at risk. We analyzed the data from a multisite US study, the Reaching for Excellence in Adolescent Care and Health Project. Adolescents aged 12 to 18 years who were behaviorally HIV infected (n = 319) or HIV uninfected but at risk (n = 177) were recruited. Incidence rates for anal HPV, high-risk anal HPV, anogenital warts, and anal dysplasia were calculated using Poisson modeling. Factors associated with these outcomes were examined using Cox proportional hazards modeling. Mean age at entry was 16.8 years; mean (SD) follow-up time for detection of anal HPV was 22.4 (10.8) months. Most participants (76%) were female; 70% were black non-Hispanic. HIV-infected (vs. HIV-uninfected) women had a significantly higher incidence of anal HPV (30 vs. 14 per 100 person-years; P = 0.002), high-risk anal HPV (12 vs. 5.3 per 100 person-years; P = 0.04), and anogenital warts (6.7 vs. 1.6 per 100 person-years; P = 0.002) but not anal dysplasia. Although incidence rates were higher for these outcomes among HIV-infected versus HIV-uninfected men, the differences were not statistically significant. Among women, factors associated with anal HPV and related sequelae differed by HIV status and included biological, behavioral, and HIV-related factors. No factors were associated with outcomes in men. HIV-infected versus HIV-uninfected adolescent women had higher rates of anal HPV and anogenital warts. Because HIV-infected youth are at increased risk of these outcomes, enhanced HPV prevention efforts such as vaccination are warranted for this group.

Reducing HIV-related risk and mental health problems through a client-centred psychosocial intervention for vulnerable adolescents in Addis Ababa, Ethiopia.

PubMed

Jani, Nrupa; Vu, Lung; Kay, Lynnette; Habtamu, Kassahun; Kalibala, Samuel

2016-01-01

Ethiopia is experiencing an increasingly urban HIV epidemic, alongside a rise in urban adolescent migration. Adolescent migrants are often confronted by unique social challenges, including living in a difficult environment, abuse and mental health problems. These issues can increase adolescents' vulnerability to HIV and compromise their capacity to protect themselves and others from HIV. We piloted and assessed the effects of a targeted psychosocial intervention to reduce mental health problems and improve HIV-related outcomes among migrant adolescents in Addis Ababa. A pre- and post-comparison design was used in a cohort of 576 female and 154 male migrant adolescents aged 15 to 18 years in Addis Ababa receiving services from two service delivery organizations, Biruh Tesfa and Retrak. We implemented a three-month client-centred, counsellor-delivered psychosocial intervention, based on findings from formative research among the same target population, to address participants' increased vulnerability to HIV. The intervention package comprised individual, group and creative arts therapy counselling sessions. Key outcome indicators included anxiety, depression, aggressive behaviour, attention problems, social problems, knowledge of HIV, safer sex practices and use of sexual health services. Longitudinal data analysis (McNemar test and random effects regression) was used to assess changes over time in key indicators by gender. For females, aggressive behaviour decreased by 60% (adjusted odds ratio (AOR): 0.4 (0.25 to 0.65)) and any mental health problem decreased by 50% (AOR: 0.5 (0.36 to 0.81)) from baseline to end line. In addition, knowledge of HIV increased by 60% (AOR: 1.6 (1.08 to 2.47)), knowledge of a place to test for HIV increased by 70% (AOR: 1.7 (1.12 to 2.51)) and HIV testing increased by 80% (AOR: 1.8 (1.13 to 2.97)). For males, HIV knowledge increased by 110% (AOR: 2.1 (1.1 to 3.94)), knowledge of a place to test for HIV increased by 290% (AOR: 3.9 (1.02 to 14.9)), HIV testing increased by 630% (AOR: 7.3 (2.6 to 20.7)) and use of sexual health services increased by 220% (AOR: 3.2 (1.62 to 6.27)). We did not find any significant reduction in mental health problems among male adolescents. Our findings suggest that a psychosocial intervention was associated with increased knowledge and uptake of HIV and sexual health services among both male and female migrant adolescents and with reduced mental health problems among female adolescents. Mental health problems varied significantly for male and female adolescents, suggesting that future interventions should be tailored to address their different needs and would benefit from intensive follow-up efforts.

HIV/Aids in South Africa: A Review of Sexual Behavior among Adolescents

ERIC Educational Resources Information Center

Hartell, Cycil George

2005-01-01

South Africa has a fast-growing HIV/AIDS rate, with the highest prevalence among young people (15 to 24 years), especially females. This paper is a comprehensive analytical review of available research concerning the sexual behavior of adolescents in South Africa. It offers insight into HIV infection among adolescents and provides an important…

The Perception of Family Conflict by Parents Living with HIV/AIDS and Their Adolescent Children

ERIC Educational Resources Information Center

Li, Li; Jiang, Luohua; Lord, Lynwood; Rotheram-Borus, Mary Jane

2007-01-01

This study explores discrepancies in perceiving family conflict between HIV-infected parents and their adolescent children aged 12 to 22. A representative sample of 382 adolescent children and their HIV+ parents were recruited and assessed over 4 years. Relationships between discrepancies in perception and family demographics and the impact of…

Risky sexual behaviors of adolescents in rural Malawi: evidence from focus groups.

PubMed

Dancy, Barbara L; Kaponda, Chrissie P N; Kachingwe, Sitingawawo I; Norr, Kathleen F

2006-07-01

Little is known about rural Malawian adolescents' perceptions of their sexual behavior and what would constitute an effective HIV risk-reduction program. This study explored the perceptions of Malawain adolescents using qualitative description research with focus groups. A purposive sample of 144 adolescents, ranging from 10 to 19 years of age was obtained. Subjects were then placed in focus groups separated by gender Qualitative content analysis revealed that adolescents were at risk for HIV based on the select behaviors These included early sexual debut, multiple partners, non-use of condoms and among girls older partners These adolescents acknowledged peer pressure and lack of parental supervision as factors that perpetuated these behaviors and identified two components of HIV prevention programs. For example, parental involvement and support for sexual abstinence were among the issues discussed. It is essential that HIV risk-reduction programs create ways of involving parents and of enhancing adolescents' HIV risk-reduction skills by helping them to change peer norms and to develop negotiation and assertiveness skills to in order to resist peer pressure.

Adolescent Adjustment Before and After HIV-Related Parental Death.

ERIC Educational Resources Information Center

Rotheram-Borus, Mary Jane; Weiss, Robert; Alber, Susan; Lester, Patricia

2005-01-01

The impact of HIV-related parental death on 414 adolescents was examined over a period of 6 years. The adjustment of bereaved adolescents was compared over 4 time periods relative to parental death and was also compared with the adjustment of nonbereaved adolescents. Bereaved adolescents had significantly more emotional distress, negative life…

HIV-infected adolescents have low adherence to antiretroviral therapy: a cross-sectional study in Addis Ababa, Ethiopia.

PubMed

Firdu, Naod; Enquselassie, Fikre; Jerene, Degu

2017-01-01

For antiretroviral therapy (ART) to work effectively, adherence is very crucial. However, most studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents. Using a cross-sectional study design, we interviewed 273 HIV-infected adolescents receiving ART from three hospitals in Addis Ababa. We used a structured questionnaire to measure adherence levels using patient self-reports. Bivariate and multivariate methods were used for analysis. We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%) of the participants were girls. Their mean age was 15.4 years (SD± 1.75). The self-reported adherence rate of the respondents was 79.1% (216/273). On bivariate analysis, variables like WHO clinical stage, being on Cotrimoxazole Prophylactic Therapy (CPT), marital and living status of the parent, whether parent was on ART or not and having special instructions for ART medications were associated with optimum adherence. However of those, only WHO stage IV (adjusted OR, 12.874 95% CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 95% CI, 0.124-0.97) and adolescents with widowed parent (adjusted OR, 0.087 with 95% CI, 0.021-0.359) were found to be significantly associated with optimum ART adherence. The level of self-reported ART adherence among HIV-infected adolescents at the three hospitals was below the recommended threshold. Though earlier presentation of adolescents to care should be encouraged, more targeted adherence support should be planned for those who present at an early stage of their illness.

Family-Based Processes Associated with Adolescent Distress, Substance Use and Risky Sexual Behavior in Families Affected by Maternal HIV

PubMed Central

Lester, Patricia; Stein, Judith A.; Bursch, Brenda; Rice, Eric; Green, Sara; Penniman, Typhanye; Rotheram-Borus, Mary Jane

2014-01-01

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother–adolescent (ages 12–21) dyads (N=264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth aggressive conflict style, maternal bonding, maternal role reversal expectations, and overall family functioning. Results of structural equation modeling indicated that youth aggressive conflict resolution style was strongly associated with adolescent distress, substance use, and risky sexual behavior. In HIV-affected families, youth less frequently reported using an aggressive conflict resolution style and more frequently reported positive maternal bonds; their mothers reported less positive family functioning than control families. Finally, maternal distress indirectly affected adolescent distress and risk behavior via youth aggressive conflict resolution style. PMID:20419574

Family-based processes associated with adolescent distress, substance use and risky sexual behavior in families affected by maternal HIV.

PubMed

Lester, Patricia; Stein, Judith A; Bursch, Brenda; Rice, Eric; Green, Sara; Penniman, Typhanye; Rotheram-Borus, Mary Jane

2010-01-01

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother-adolescent (ages 12-21) dyads (N = 264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth aggressive conflict style, maternal bonding, maternal role reversal expectations, and overall family functioning. Results of structural equation modeling indicated that youth aggressive conflict resolution style was strongly associated with adolescent distress, substance use, and risky sexual behavior. In HIV-affected families, youth less frequently reported using an aggressive conflict resolution style and more frequently reported positive maternal bonds; their mothers reported less positive family functioning than control families. Finally, maternal distress indirectly affected adolescent distress and risk behavior via youth aggressive conflict resolution style.

Adolescents, sex and injecting drug use: risks for HIV infection.

PubMed

Barnard, M; McKeganey, N

1990-01-01

In this paper we present data on the HIV-related risks for adolescents growing up in an area where injecting drug use is prevalent and HIV infection has been identified among local injecting drug users. We report on young peoples' knowledge, attitudes and perceptions of drug use and injectors; HIV and AIDS; sex, safer sex and condom use. These adolescents had an extensive and practically oriented knowledge of illicit drugs and drug injectors. The majority of adolescents contacted had an unsophisticated but approximate understanding of HIV transmission dynamics and how to guard against infection. Our data suggest that many adolescents find issues relating to sex awkward, embarrassing and difficult subjects for discussion. In a final section we consider some of the policy implications of our work focussing in particular on the prevention of injecting, the promotion of condom use, and the necessity of avoiding a focus upon risk groups.

Determinants of HIV testing and receipt of test results among adolescent girls in Nigeria: the role of assets and decision-making.

PubMed

Iwelunmor, Juliet; Blackstone, Sarah; Jennings, Larissa; Converse, Donaldson; Ehiri, John; Curley, Jami

2018-04-09

Purpose Many adolescent girls in Nigeria do not test for HIV despite being at high risk. While the influence of psychosocial factors on HIV testing has been examined, there is less evidence regarding the impact of assets and control of assets on HIV testing. This study investigated the protective effects of specific adolescent girls' assets on decision-making regarding HIV testing. Methods Cross-sectional data from the 2013 Nigeria Demographic and Health Survey was analyzed. The main outcome variables were self-reports of having been tested for HIV and knowledge of a place that offers HIV testing. Binary logistic regression was used with employment, education, wealth index, home ownership, land ownership and decision making as potential predictors. Demographic characteristics were controlled in the analysis. Results Age [odds ratio (OR = 1.49)], employment (OR = 3.38), education (OR = 3.16), wealth index (OR = 1.33) and decision making (OR = 3.16) were positively associated with HIV testing. Age (OR = 1.20), employment (OR = 1.33), education (OR = 1.38), wealth (OR = 1.64), land ownership (OR = 1.42), and decision making (OR = 1.26) were positively associated with knowledge of an HIV testing location. Conclusion Our findings suggest that assets play an important role with HIV testing decisions for adolescent girls. Further research to elucidate the specific asset-based needs of adolescent girls will be needed to enhance decisions surrounding uptake of HIV testing and receipt of test results in Nigeria.

The Usability and Acceptability of an Adolescent mHealth HIV/STI and Drug Abuse Preventive Intervention in Primary Care.

PubMed

Cordova, David; Alers-Rojas, Francheska; Lua, Frania Mendoza; Bauermeister, Jose; Nurenberg, Rachel; Ovadje, Lauretta; Fessler, Kathryn; Delva, Jorge; Salas-Wright, Christopher P; Council, Youth Leadership

2018-01-01

Human Immunodeficiency Virus (HIV)/sexually transmitted infection (STI) risk behaviors among adolescents remain significant public health concerns. Shifts in policy and advances in technology provide opportunities for researchers and clinicians to deliver and evaluate mobile-health (mHealth) prevention programs in primary care, however, research is limited. This study assessed the usability and acceptability of Storytelling 4 Empowerment-a mHealth HIV/STI and drug abuse preventive intervention app-among adolescents in primary care. Informed by principles of community-based participatory research, we recruited a purposive sample of 30 adolescents from a youth-centered community health care clinic in Southeast Michigan. The study sample is primarily African American and female. Adolescents who participated in the Storytelling 4 Empowerment intervention assessed its usability and acceptability, and self-reported their HIV/STI risk behaviors. We used a multiple-methods approach. Adolescents reported high acceptability of the content, process, and format of Storytelling 4 Empowerment, as evidenced by qualitative data and mean scores from the Session Evaluation Form for the HIV/STI and Alcohol/Drug content, overall Storytelling 4 Empowerment intervention, and Client Satisfaction Questionnaire-8. Findings indicate that Storytelling 4 Empowerment is acceptable among adolescents in primary care. A next step is to examine the effect of Storytelling 4 Empowerment on adolescent sexual risk and drug use behaviors and HIV/STI testing.

Leptospirosis and Human Immunodeficiency Virus Co-Infection Among Febrile Inpatients in Northern Tanzania

PubMed Central

Biggs, Holly M.; Galloway, Renee L.; Bui, Duy M.; Morrissey, Annie B.; Maro, Venance P.

2013-01-01

Abstract Background Leptospirosis and human immunodeficiency virus (HIV) infection are prevalent in many areas, including northern Tanzania, yet little is known about their interaction. Methods We enrolled febrile inpatients at two hospitals in Moshi, Tanzania, over 1 year and performed HIV antibody testing and the microscopic agglutination test (MAT) for leptospirosis. Confirmed leptospirosis was defined as ≥four-fold rise in MAT titer between acute and convalescent serum samples, and probable leptospirosis was defined as any reciprocal MAT titer ≥800. Results Confirmed or probable leptospirosis was found in 70 (8.4%) of 831 participants with at least one serum sample tested. At total of 823 (99.0%) of 831 participants had HIV testing performed, and 203 (24.7%) were HIV infected. Among HIV-infected participants, 9 (4.4%) of 203 had confirmed or probable leptospirosis, whereas among HIV-uninfected participants 61 (9.8%) of 620 had leptospirosis. Leptospirosis was less prevalent among HIV-infected as compared to HIV-uninfected participants [odds ratio (OR) 0.43, p=0.019]. Among those with leptospirosis, HIV-infected patients more commonly presented with features of severe sepsis syndrome than HIV-uninfected patients, but differences were not statistically significant. Among HIV-infected patients, severe immunosuppression was not significantly different between those with and without leptospirosis (p=0.476). Among HIV-infected adolescents and adults, median CD4 percent and median CD4 count were higher among those with leptospirosis as compared to those with other etiologies of febrile illness, but differences in CD4 count did not reach statistical significance (p=0.015 and p=0.089, respectively). Conclusions Among febrile inpatients in northern Tanzania, leptospirosis was not more prevalent among HIV-infected patients. Although some indicators of leptospirosis severity were more common among HIV-infected patients, a statistically significant difference was not demonstrated. Among HIV-infected patients, those with leptospirosis were not more immunosuppressed relative to those with other etiologies of febrile illness. PMID:23663165

School, Supervision and Adolescent-Sensitive Clinic Care: Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South Africa.

PubMed

Toska, Elona; Cluver, Lucie D; Boyes, Mark E; Isaacsohn, Maya; Hodes, Rebecca; Sherr, Lorraine

2017-09-01

Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine 'cash/cash-in-kind' and 'care' provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33-0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33-0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25-0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 % reported unprotected sex; with 1-2 provisions 13-38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls.

Prevention of HIV in Adolescent Girls and Young Women: Key to an AIDS-Free Generation.

PubMed

Abdool Karim, Quarraisha; Baxter, Cheryl; Birx, Deborah

2017-05-01

The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) has ensured that more infants in high-HIV burden countries survive childhood HIV-free. Although equal numbers of boy and girl children have survived to age 10, a gender divergence starts to emerge as they enter adolescence. Up to 3 times as many young women aged 15-24 years in eastern and southern Africa are living with HIV compared with their male peers. Further, more adolescent girls and young women are sick and/or dying from AIDS-related or HIV-related complications during pregnancy and in the postpartum period, underscoring the importance of strengthening HIV treatment and prevention services for this group. Failure to prevent HIV in adolescent girls and young women and keep them alive will reverse the infant HIV prevention and survival gains made under the Global Plan. The promising global declines in HIV infection in young women need to be strengthened to realize the goals of an AIDS-free generation. The DREAMS initiative of the United States President's Emergency Plan for AIDS Relief (PEPFAR), which specifically addresses adolescent girls and young women at highest risk of HIV acquisition, brings new hope for meeting the prevention and care needs of this important and vulnerable population through political commitment, leadership, financial and human resource investments, advocacy efforts, and a focus on the highest priority settings. Importantly, to achieve the goal of keeping mothers alive, we have to place more emphasis on access to sexual and reproductive health services that (1) include HIV prevention and treatment services for adolescent girls and young women; (2) increase male/paternal responsibility in mother and infant health; and (3) ensure a supportive social environment that enables young women to grow up into young adults who are free to graduate from high school and plan their pregnancies, ultimately entering adulthood safe, healthy, and free from HIV.

Coping with an HIV infection. A multicenter qualitative survey on HIV positive adolescents' perceptions of their disease, therapeutic adherence and treatment.

PubMed

Michaud, Pierre-André; Suris, Joan-Carles; Thomas, Ralph; Gnehm, Hanspeter E; Cheseaux, Jean-Jacques

2010-05-01

HIV-positive adolescents face a number of challenges in dealing with their disease and its treatment. In this qualitative study, twenty-nine HIV-positive adolescents aged 13 to 20 years (22 girls), who live in Switzerland, were asked, in a semi-structured interview (duration of 40-110 minutes), to describe their perceptions and experiences with the disease itself and with therapeutic adherence. While younger adolescents most often thought of their disease as fate, older adolescents usually knew that they had received it through vertical transmission, although the topic appeared to be particularly difficult to discuss for those living with their HIV-positive mothers. Based on their attending physician's assessment, 18 subjects were judged highly adherent, 4 fairly and 7 poorly adherent. High adherence appeared linked with adequate psychological adjustment and effective coping mechanisms, as well as with the discussion and adoption of explicit medication-taking strategies. The setting and organisation of health care teams should allow for ongoing discussions with HIV-positive adolescents that focus on their perceptions of their disease, how they cope with it and with the treatment, and how they could improve their adherence.

‘Let Us Protect Our Future’ a culturally congruent evidenced-based HIV/STD risk-reduction intervention for young South African adolescents

PubMed Central

Jemmott, L. S.; Jemmott, J. B.; Ngwane, Z.; Icard, L.; O’Leary, A.; Gueits, L.; Brawner, B.

2014-01-01

One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15–24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the ‘Let Us Protect Our Future!’ HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed. PMID:23962491

HIV and AIDS among adolescents who use drugs: opportunities for drug policy reform within the sustainable development agenda.

PubMed

Tinasti, Khalid

2018-02-01

The international community's commitment to halve by 2015 the HIV transmission among people who inject drugs has not only been largely missed, instead new HIV infections have increased by 30%. Moreover, drug injection remains one of the drivers of new HIV infections due to punitive responses and lack of harm reduction resourcing. In the midst of this situation, adolescents are a forgotten component of the global response to illegal drugs and their link with HIV infection. The Sustainable Development Goals (SDGs) present an opportunity to achieve the global objective of ending AIDS among adolescents who use drugs, by addressing the structural vulnerabilities they face be they economic, social, criminal, health-related or environmental. The implementation of the SDGs presents an opportunity to address the horizontal nature of drug policy and to efficiently address the drugs-adolescents-HIV risk nexus. Adolescent-focused drug policies are linked to goals 1, 3, 4, 10, 16 and 17. Goals 3 and 16 are the most relevant; the targets of the latter link to the criminalization of drug use and punitive policy environments and their impact on adolescents' health and HIV transmission risks. Moreover, it presents an opportunity to include adolescent needs that are missing in the three drug control conventions (1961, 1971 and 1988), and link them with the provisions of the Convention on the Rights of the Child (1989). Finally, the six principles to deliver on sustainable development are also an opportunity to divert adolescents who use drugs away from criminalization and punitive environments in which their vulnerability to HIV is greater. Addressing HIV among adolescents who use drugs is an extremely complex policy issue depending on different sets of binding and non-binding commitments, interventions and stakeholders. The complexity requires a horizontal response provided by the SDGs framework, starting with the collection of disaggregated data on this specific subgroup. Ending AIDS among adolescents who use drugs requires the implementation of national drugs and HIV plans based on the multi-sectoral approach and the transformative nature of the SDGs, to provide a comprehensive response to the epidemic among this key affected subgroup. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

“At our age, we would like to do things the way we want:” a qualitative study of adolescent HIV testing services in Kenya

PubMed Central

Wilson, Kate S.; Beima-Sofie, Kristin M.; Moraa, Helen; Wagner, Anjuli D.; Mugo, Cyrus; Mutiti, Peter M.; Wamalwa, Dalton; Bukusi, David; John-Stewart, Grace C.; Slyker, Jennifer A.; Kohler, Pamela K.; O’Malley, Gabrielle

2017-01-01

Objectives: Adolescents in Africa have low HIV testing rates. Better understanding of adolescent, provider, and caregiver experiences in high-burden countries such as Kenya could improve adolescent HIV testing programs. Design: We conducted 16 qualitative interviews with HIV-positive and HIV-negative adolescents (13–18 years) and six focus group discussions with Healthcare workers (HCWs) and caregivers of adolescents in Nairobi, Kenya. Methods: Semi-structured interviews and focus groups were recorded and transcribed. Analysis employed a modified constant comparative approach to triangulate findings and identify themes influencing testing experiences and practices. Results: All groups identified that supportive interactions during testing were essential to the adolescent's positive testing experience. HCWs were a primary source of support during testing. HCWs who acted respectful and informed helped adolescents accept results, link to care, or return for repeat testing, whereas HCWs who acted dismissive or judgmental discouraged adolescent testing. Caregivers universally supported adolescent testing, including testing with the adolescent to demonstrate support. Caregivers relied on HCWs to inform and encourage adolescents. Although peers played less significant roles during testing, all groups agreed that school-based outreach could increase peer demand and counteract stigma. All groups recognized tensions around adolescent autonomy in the absence of clear consent guidelines. Adolescents valued support people during testing but wanted autonomy over testing and disclosure decisions. HCWs felt pressured to defer consent to caregivers. Caregivers wanted to know results regardless of adolescents’ wishes. Conclusion: Findings indicate that strengthening HCW, caregiver, and peer capacities to support adolescents while respecting their autonomy may facilitate attaining ‘90-90-90’ targets for adolescents. PMID:28665879

Association between parent-adolescent communication about sex-related topics and HIV testing, United States. 2006-2013.

PubMed

Balaji, Alexandra B; Oraka, Emeka; Fasula, Amy M; Jayne, Paula E; Carry, Monique G; Raiford, Jerris L

2017-03-01

Adolescents need information about sex-related topics in order to reduce risk behavior and engage in healthy sexual decision-making. Parents have the potential to be an important source of this information. Using the 2006-2010 and 2011-2013 National Survey of Family Growth, we examined associations between parent-adolescent communication before age 18 about sex-related topics and HIV testing among respondents aged 18-24 that ever had sexual intercourse (women = 3893; men = 3359). Analyses showed that for both men and women, discussing how to prevent HIV/AIDS and how to use a condom with a parent before age 18 were positively associated with HIV testing. Among women only, discussions about methods of birth control, where to get birth control, and STDs were positively associated with HIV testing. Developing strategies and interventions to facilitate parent-adolescent communication about sex-related topics, particularly HIV prevention and condom use, may be important to increase HIV testing among young women and men.

Adolescent decision making about participation in a hypothetical HIV vaccine trial.

PubMed

Alexander, Andreia B; Ott, Mary A; Lally, Michelle A; Sniecinski, Kevin; Baker, Alyne; Zimet, Gregory D

2015-03-10

The purpose of this study was to examine the process of adolescent decision-making about participation in an HIV vaccine clinical trial, comparing it to adult models of informed consent with attention to developmental differences. As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16-19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their decision making process when deciding whether or not to enroll in and HIV vaccine trial. An ethnographic content analysis approach was utilized. Twelve concepts related to adolescents' decision-making about participation in an HIV vaccine trial were identified and mapped onto Appelbaum and Grisso's four components of decision making capacity including understanding of vaccines and how they work, the purpose of the study, trial procedures, and perceived trial risks and benefits, an appreciation of their own situation, the discussion and weighing of risks and benefits, discussing the need to consult with others about participation, motivations for participation, and their choice to participate. The results of this study suggest that most adolescents at high risk for HIV demonstrate the key abilities needed to make meaningful decisions about HIV vaccine clinical trial participation. Published by Elsevier Ltd.

Who accepts a rapid HIV antibody test? The role of race/ethnicity and HIV risk behavior among community adolescents.

PubMed

Swenson, Rebecca R; Hadley, Wendy S; Houck, Christopher D; Dance, S Kwame; Brown, Larry K

2011-05-01

Centers for Disease Control and Prevention guidelines recommend routine human immunodeficiency virus (HIV) screening in health care settings for all individuals aged 13-64 years; however, overall testing rates among adolescents still continue to remain low. This study examined factors related to the acceptance of HIV testing among an at-risk sample of ethnically/racially diverse community adolescents. Adolescents aged 15-21 (N = 81) years were recruited from community-based youth organizations to complete HIV risk assessment surveys. After the completion of the survey, participants were offered a free OraQuick rapid HIV antibody test. More than half (53.1%) of the participants accepted the test, with the black population being more likely to accept testing as compared to Latinos (75% vs. 39%). After controlling for race/ethnicity, significant predictors of test acceptance included history of sexual intercourse (OR = 5.43), having only one sexual partner in the past 3 months (OR = 4.88), not always using a condom with a serious partner (OR = 3.94), and not using a condom during last sexual encounter (OR = 4.75). Given that many adolescents are willing to know their HIV status, policies that support free or low-cost routine testing may lead to higher rates of case identification among youth. However, approaches must be developed to increase test acceptance among Latino adolescents and teenagers with multiple sexual partners. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: a qualitative study.

PubMed

Mutumba, Massy; Bauermeister, José A; Musiime, Victor; Byaruhanga, Judith; Francis, Kiweewa; Snow, Rachel C; Tsai, Alexander C

2015-02-01

Although more than 90% of youth perinatally infected with HIV live in sub-Saharan Africa, little is known about the psychosocial factors that impact their wellbeing, or how these youth cope with these challenges. The purpose of this study was to identify the psychosocial challenges and coping strategies among perinatal HIV-infected adolescents in Uganda. In-depth interviews were conducted with a purposive sample of 38 HIV-infected adolescents aged 12-19 years at a large HIV treatment center in Kampala. Data were analyzed thematically to identify themes and domains related to stressors and specific coping strategies. Psychosocial challenges included stigma/discrimination, relationship challenges such as HIV status disclosure, and medication difficulties. Coping strategies included medication adherence, concealment or limited disclosure of HIV status, treatment optimism, social support, rationalizing, social comparison, spirituality/religiosity, avoidance, and distraction. Age and gender differences also emerged: younger participants generally lacked specific coping strategies; compared to females, male adolescents reported greater use of avoidance/distraction techniques. Findings underscore the need to address stigma within homes and schools, and to equip adolescents with the comprehensive knowledge and skills to address their varied challenges.

The Experience of Sexual Risk Communication in African American Families Living with HIV

ERIC Educational Resources Information Center

Cederbaum, Julie A.

2012-01-01

Mother-daughter communication plays an influential role in adolescent development. The impact of maternal HIV infection on family communication is not clear. This study explores how living with HIV impacts sexual risk communication between mothers and daughters and whether maternal HIV status influences adolescent choices about engagement in HIV…

Differences in sexual behaviour and sexual practices of adolescents in Nigeria based on sex and self-reported HIV status.

PubMed

Folayan, Morenike O; Odetoyinbo, Morolake; Brown, Brandon; Harrison, Abigail

2014-12-06

Sexual behaviour and sexual practices affect the risk for acquisition and transmission of HIV infection. This study tries to identify differences in sexual behaviour (condom use with non-marital partners, multiple sexual partnerships transactional sex and age mixing in sexual relationships), sexual practices (oral, anal and vagina sex), and forced sexual initiation based on sex and HIV status of adolescents in Nigeria. Face to face interviewer-administered questionnaires were used to collect information from a nationally representative sample of 10-19 years old adolescents residing in Nigeria. Data included information on age of sexual debut, sexual behaviour and sexual practices. Association between HIV status, sex, sexual behaviour and sexual practices, and predictors of use of condoms during the last vaginal sexual intercourse were determined. More self-reported HIV positive than HIV negative females had experienced forced sexual initiation (p = 0.008). Significantly more female than male adolescents had engaged in transactional sex (p < 0.001) and had sex with partners who were older than them by 10 years or more (p < 0.001). Vaginal (95.2%), oral (26.6%) and anal (7.8%) sex were practiced by male and females irrespective of HIV status. More females reported oral sex (p = 0.001). Being a female (p = 0.001), having genital itching in the last 12 months (p = 0.04)and having engaged in anal sex in the last 12 months (p = 0.009) reduced the odds of using a condom at last vaginal intercourse. Having a HIV positive or negative status did not significantly increase the odds of using a condom at last vaginal intercourse. Differences in sexual behaviour and sexual practices of adolescents was observed based on sex and not on HIV status. History of forced sex initiation however differed by HIV status. Tailored interventions for male and female adolescents are required to reduce their risk of HIV infection. Tailored interventions are also required for adolescents living with HIV to improve their sexual and reproductive health.

Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents.

PubMed

Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine

2016-01-01

Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can "cash plus care" social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=-0.08, p<0.002 between structural deprivation and psychosocial problems, and B=-0.07, p<0.001 between psychosocial problems and HIV risk behaviour). Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches.

Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents

PubMed Central

Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine

2016-01-01

Introduction Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. Methods This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Results Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=−0.08, p<0.002 between structural deprivation and psychosocial problems, and B=−0.07, p<0.001 between psychosocial problems and HIV risk behaviour). Conclusions Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches. PMID:27086838

Adolescent pre-exposure prophylaxis for HIV prevention: current perspectives

PubMed Central

Machado, Daisy Maria; de Sant’Anna Carvalho, Alexandre Machado; Riera, Rachel

2017-01-01

Adolescents are a critical population that is disproportionately impacted by the HIV epidemic. More than 2 million adolescents between the age group of 10 and 19 years are living with HIV, and millions are at risk of infection. HIV risks are considerably higher among girls, especially in high-prevalence settings such as eastern and southern Africa. In addition to girls, there are other vulnerable adolescent subgroups, such as teenagers, who use intravenous (IV) drugs, gay and bisexual boys, transgender youth, male sex workers, and people who fall into more than one of these categories. Pre-exposure prophylaxis (PrEP) is a new intervention for people at high risk for acquiring HIV, with an estimated HIV incidence of >3%. Recent data from trials show evidence of the efficacy of PrEP as a powerful HIV prevention tool in high-risk populations, including men who have sex with men, HIV-1-serodiscordant heterosexual couples, and IV drug users. The reported efficacy in those trials of the daily use of oral tenofovir, alone or in combination with emtricitabine, to prevent HIV infection ranged from 44% to 75% and was heavily dependent on adherence. Despite the proven efficacy of PrEP in adult trials, concerns remain about its feasibility in real-life scenarios due to stigma, cost, and limited clinician experience with PrEP delivery. Recent studies are attempting to expand the inquiry into the efficacy of such HIV prophylaxis approaches in adolescent populations, but there are still many gaps in knowledge, and no country has yet approved it for use with adolescents. The aim of this review was to identify and summarize the evidence from studies on PrEP for adolescents. We have compiled and reviewed published studies focusing on safety, feasibility, adherence to therapeutics, self-perception, and legal issues related to PrEP in people aged between 10 and 24 years. PMID:29238237

Children and Adolescents with HIV Disease: Implications for School Counselors.

ERIC Educational Resources Information Center

Cobia, Debra C.; Carney, Jamie S.; Waggoner, Irene M.

1998-01-01

Describes policies and procedures initiated in the school environment concerning students with Human Immunodeficiency Virus (HIV). Discusses interventions for school personnel, parents, and students. Assessment and counseling children and adolescents with HIV are also discussed. (MKA)

Reducing HIV-related risk and mental health problems through a client-centred psychosocial intervention for vulnerable adolescents in Addis Ababa, Ethiopia

PubMed Central

Jani, Nrupa; Vu, Lung; Kay, Lynnette; Habtamu, Kassahun; Kalibala, Samuel

2016-01-01

Introduction Ethiopia is experiencing an increasingly urban HIV epidemic, alongside a rise in urban adolescent migration. Adolescent migrants are often confronted by unique social challenges, including living in a difficult environment, abuse and mental health problems. These issues can increase adolescents’ vulnerability to HIV and compromise their capacity to protect themselves and others from HIV. We piloted and assessed the effects of a targeted psychosocial intervention to reduce mental health problems and improve HIV-related outcomes among migrant adolescents in Addis Ababa. Methods A pre- and post-comparison design was used in a cohort of 576 female and 154 male migrant adolescents aged 15 to 18 years in Addis Ababa receiving services from two service delivery organizations, Biruh Tesfa and Retrak. We implemented a three-month client-centred, counsellor-delivered psychosocial intervention, based on findings from formative research among the same target population, to address participants’ increased vulnerability to HIV. The intervention package comprised individual, group and creative arts therapy counselling sessions. Key outcome indicators included anxiety, depression, aggressive behaviour, attention problems, social problems, knowledge of HIV, safer sex practices and use of sexual health services. Longitudinal data analysis (McNemar test and random effects regression) was used to assess changes over time in key indicators by gender. Results For females, aggressive behaviour decreased by 60% (adjusted odds ratio (AOR): 0.4 (0.25 to 0.65)) and any mental health problem decreased by 50% (AOR: 0.5 (0.36 to 0.81)) from baseline to end line. In addition, knowledge of HIV increased by 60% (AOR: 1.6 (1.08 to 2.47)), knowledge of a place to test for HIV increased by 70% (AOR: 1.7 (1.12 to 2.51)) and HIV testing increased by 80% (AOR: 1.8 (1.13 to 2.97)). For males, HIV knowledge increased by 110% (AOR: 2.1 (1.1 to 3.94)), knowledge of a place to test for HIV increased by 290% (AOR: 3.9 (1.02 to 14.9)), HIV testing increased by 630% (AOR: 7.3 (2.6 to 20.7)) and use of sexual health services increased by 220% (AOR: 3.2 (1.62 to 6.27)). We did not find any significant reduction in mental health problems among male adolescents. Conclusions Our findings suggest that a psychosocial intervention was associated with increased knowledge and uptake of HIV and sexual health services among both male and female migrant adolescents and with reduced mental health problems among female adolescents. Mental health problems varied significantly for male and female adolescents, suggesting that future interventions should be tailored to address their different needs and would benefit from intensive follow-up efforts. PMID:27443267

Risk and protection for HIV/AIDS in African-American, Hispanic, and White adolescents.

PubMed

Bartlett, Robin; Buck, Raymond; Shattell, Mona M

2008-07-01

African-Americans and Hispanics are disproportionately affected by HIV/AIDS in the United States. HIV infection is often acquired during adolescence, a time when risky sexual behaviors are at their peak. This study explored relationships among selected risk factors, protective factors, and risky sexual behaviors among African-American, Hispanic, and White adolescents, from a sample of adolescents from the National Longitudinal Study of Adolescent Health. African-Americans and Hispanics were more likely to have sexual intercourse without the use of birth control than were Whites. African-Americans were more likely to have sexual behavior with multiple sexual partners than either Hispanics or Whites were, and African-Americans had higher self-esteem than did Hispanics and Whites. In order to develop culturally sensitive, effective interventions to prevent HIV/AIDS in adolescents, racial differences in risk and protective factors must be examined.

Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa.

PubMed

Cluver, Lucie D; Orkin, F Mark; Boyes, Mark E; Sherr, Lorraine

2014-07-01

It is not known whether cumulative 'cash plus care' interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIV-risk behaviour and whether social protection provision of 'cash' or integrated 'cash plus care' reduces HIV-risk behaviour. A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention). Three thousand five hundred and fifteen 10-18 year-olds (56.7% girls) were interviewed in South Africa between 2009-2010 and 2011-2012. All homes with a resident adolescent were sampled, within randomly selected census areas in two urban and two rural districts in two provinces. Measures included potential environmental risks (e.g. parental HIV/AIDS, poverty), social protection: receipt of cash/food support (e.g. child grants, school feeding), care (e.g. positive parenting) and HIV-risk behaviours (e.g. unprotected sex). Analyses used logistic regression. Cash alone was associated with reduced HIV risk for girls [odds ratio (OR) 0.63; 95% confidence interval (95% CI) 0.44-0.91, P = 0.02] but not for boys. Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes (girls OR 0.55; 95% CI 0.35-0.85, P = 0.007; boys OR 0.50; 95% CI 0.31-0.82, P = 0.005), compared with no support and controlling for confounders. Follow-up HIV-risk behaviour was reduced from 41 to 15% for girls and from 42 to 17% for boys. Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour, but were less likely to access integrated social protection. Integrated cash plus care reduces male and female adolescent HIV-risk behaviours. Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa.

Teens in the Twenty-First Century Still Prefer People over Machines: Importance of Intervention Delivery Style in Adolescent HIV/STD Prevention

ERIC Educational Resources Information Center

Pendleton, Sara M.; Stanton, Bonita; Cottrell, Lesley A.; Marshall, Sharon; Pack, Robert; Burns, James; Gibson, Catherine; Wu, Ying; Li, Xiaoming; Cole, Matthew

2007-01-01

Purpose: To assess and compare youth satisfaction with two delivery approaches to a HIV/STD risk reduction intervention targeting adolescents: an on-site, face-to-face (FTF) approach versus a long distance interactive televised (DIT) approach. Methods: A convenience sample of 571 rural adolescents ages 12-16 years who participated in an HIV/STD…

Adolescents and the right to health: eliminating age-related barriers to HIV/AIDS services in Rwanda.

PubMed

Binagwaho, Agnes; Fuller, Arlan; Kerry, Vanessa; Dougherty, Sarah; Agbonyitor, Mawuena; Wagner, Claire; Nzayizera, Rodrigue; Farmer, Paul

2012-01-01

Under international, regional, and domestic law, adolescents are entitled to measures ensuring the highest attainable standard of health. For HIV/AIDS, this is essential as adolescents lack many social and economic protections and are disproportionately vulnerable to the effects of the disease. In many countries, legal protections do not always ensure access to health care for adolescents, including for HIV/AIDS prevention, treatment, and care. Using Rwanda as an example, this article identifies gaps, policy barriers, and inconsistencies in legal protection that can create age-related barriers to HIV/AIDS services and care. One of the most pressing challenges is defining an age of majority for access to prevention measures, such as condoms, testing and treatment, and social support. Occasionally drawing on examples of existing and proposed laws in other African countries, Rwanda and other countries may strengthen their commitment to adolescents' rights and eliminate barriers to prevention, family planning, testing and disclosure, treatment, and support. Among the improvements, Rwanda and other countries must align its age of consent with the actual behavior of adolescents and ensure privacy to adolescents regarding family planning, HIV testing, disclosure, care, and treatment.

Polymorphisms and resistance mutations in the protease and reverse transcriptase genes of HIV-1 F subtype Romanian strains.

PubMed

Paraschiv, Simona; Otelea, Dan; Dinu, Magdalena; Maxim, Daniela; Tinischi, Mihaela

2007-03-01

To evaluate the prevalence of resistance mutations in the genome of HIV-1 F subtype strains isolated from Romanian antiretroviral (ARV) treatment-naïve patients and to assess the phylogenetic relatedness of these strains with other HIV-1 strains. Twenty-nine HIV-1 strains isolated from treatment-naïve adolescents (n=15) and adults (n=14) were included in this study. Resistance genotyping was performed by using Big Dye Terminator chemistry provided by the ViroSeq Genotyping System. The sequences of the protease and reverse transcriptase genes were aligned (ClustalW) and a phylogenetic tree was built (MEGA 3 software). For subtyping purposes, all the nucleotide sequences were submitted to the Stanford database. All the studied strains were found to harbor accessory mutations in the protease gene. The most frequent mutation was M36I (29 of 29 strains), followed by L63T, K20R, and L10V. The number of polymorphisms associated with protease inhibitor resistance was different for the two age groups. Intraphylogenetic divergence was greater for adults than for adolescents infected in childhood. All the strains were found to belong to the F1 subtype. The phylogenetic analysis revealed that Romanian strains clustered together, but distinctly from F1 HIV-1 strains isolated in other parts of the world (Brazil, Finland, and Belgium). Protease secondary mutations are present with high frequency in the HIV-1 F subtype strains isolated from Romanian ARV treatment-naïve patients, but no major resistance mutations were found.

HIV-infected adolescents with hemophilia: adaptation and coping. The Hemophilia Behavioral Intervention Evaluation Project.

PubMed

Brown, L K; Schultz, J R; Gragg, R A

1995-09-01

It is estimated that 70% of individuals with factor VIII deficiency hemophilia who received blood products before 1985 are infected with human immunodeficiency virus (HIV). The goal of the current study was to assess how adolescents with hemophilia cope with reminders of their HIV status, because adaptation is likely to have implications for these individuals' quality of life and adherence to safer sex recommendations. Participants included 297 HIV-positive adolescents with hemophilia who were recruited from 11 sites across the United States. Adolescents reported on the use and effectiveness of strategies for coping with reminders of their HIV status. A significant degree of distress was reported in response to such reminders, with anger being the most commonly reported emotion. Although a wide variety of coping strategies had been tried, participants reported using resignation (80.9%), self-calming (78.8%), and distraction (76.4%) most frequently in their attempts to cope with reminders of HIV. Self-blame (3.6%), engaging in risky behaviors (22.2%), thinking about sex (25.4%), and drug/alcohol use (29.1%) were used least. These adolescents tended to rate more active cognitive and behavioral coping strategies (eg, cognitive restructuring, seeking social support, physical activity) as most effective, whereas passive strategies (eg, wishful thinking, blaming others) were reported to be least helpful. Those individuals who reported being distressed by reminders of HIV endorsed most of the coping strategies significantly more often than the nondistressed group, although ineffective strategies were commonly chosen. Sexually active adolescents were more likely than their abstinent peers to cope by thinking about sex, engaging in risky behaviors, or using alcohol and drugs. In this population of adolescents who have known their serostatus for several years, distress about everyday reminders of HIV appears to be associated with ineffective coping strategies.

The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes.

PubMed

Slogrove, Amy L; Sohn, Annette H

2018-05-01

The aim of this study was to summarize recent evidence on the global epidemiology of adolescents (age 10-19 years) living with HIV (ALHIV), the burden of HIV on the health of adolescents and HIV-associated mortality. In 2016, there were an estimated 2.1 million (uncertainty bound 1.4-2.7 million) ALHIV; 770 000 younger (age 10-14 years) and 1.03 million older (age 15-19 years) ALHIV, 84% living in sub-Saharan Africa. The population of ALHIV is increasing, as more peri/postnatally infected ALHIV survive into older ages; an estimated 35% of older female ALHIV were peri/postnatally infected, compared with 57% of older male ALHIV. Although the numbers of younger ALHIV deaths are declining, deaths among older ALHIV have remained static since peaking in 2012. In 2015, HIV-associated mortality was the eighth leading cause of adolescent death globally and the fourth leading cause in African low and middle-income countries. Needed investments into characterizing and improving adolescent HIV-related health outcomes include strengthening systems for nationally and globally disaggregated data by age, sex and mode of infection; collecting more granular data within routine programmes to identify structural, social and mental health challenges to accessing testing and care; and prioritizing viral load monitoring and adolescent-focused differentiated models of care.

Perceptions of risk to HIV infection among adolescents in Uganda: are they related to sexual behaviour?

PubMed

Kibombo, Richard; Neema, Stella; Ahmed, Fatima H

2007-12-01

Uganda has been hailed as a success story in the fight against HIV that has seen a reversal in prevalence from a peak of 15% in 1991 to about 6.5% currently Since 1992, the largest and most consistent declines in HIV have occurred among the 15-19-year-olds. While many studies have examined how key behavior changes (Abstinence, Be faithful and Condom use) have contributed to the decline in HIV prevalence, few have studied the relationship between sexual behaviors and risk perception. Using data from the 2004 National Survey of Adolescents, multivariate logistic regression models were fitted to examine the strength of the association between risky sexual behavior and perceived risk among 12-19-year-old adolescents in Uganda. After controlling for other correlates of sexual behavior such as age, education, residence, region and marital status, the findings indicate highly significant positive association between perceived risk and risky sexual behavior among males but not females. The findings reveal that, regardless of their current sexual behavior, most female adolescents in Uganda feel at great risk of HIV infection. The findings also show that adolescents with broken marriages are much more vulnerable to high risk sexual behaviors than other categories of adolescents. These results further emphasize the need for a holistic approach in addressing the social, economic and contextual factors that continue to put many adolescents at risk of HIV infection.

Legal Barriers to Adolescent Participation in Research About HIV and Other Sexually Transmitted Infections

PubMed Central

Moore, Quianta L.; Paul, Mary E.; McGuire, Amy L.

2016-01-01

Whether adolescents can participate in clinical trials of pharmacologic therapies for HIV prevention, such as preexposure prophylaxis, without parental permission hinges on state minor consent laws. Very few of these laws explicitly authorize adolescents to consent to preventive services for HIV and other sexually transmitted infections. Unclear state laws may lead to research cessation. We have summarized legal, ethical, and policy considerations related to adolescents’ participation in HIV and sexually transmitted infection prevention research in the United States, and we have explored strategies for facilitating adolescents’ access. PMID:26562103

Developing a Measure of Stigma by Association with African American Adolescents Whose Mothers Have HIV

ERIC Educational Resources Information Center

Mason, Sally; Berger, Barbara; Ferrans, Carol Estwing; Sultzman, Vickey; Fendrich, Michael

2010-01-01

Objectives: African American urban adolescents are one of the fastest growing groups of children affected by their mother's HIV status. These children experience HIV stigma by association with their HIV-positive mothers. Stigma may contribute to adverse outcomes for these teens. Methods: The authors describe a multistage process of scale…

Risk for HIV Infection among Adolescents in the Border City of Tijuana, Mexico

ERIC Educational Resources Information Center

Martinez-Donate, Ana P.; Blumberg, Elaine J.; Hovell, Melbourne F.; Sipan, Carol L.; Zellner, Jennifer A.; Hughes, Suzanne

2004-01-01

Previous studies have suggested high rates of HIV infection and other sexually transmitted infections in theU.S.-Mexico border region. However, no information is available on the risk for HIV infection among Mexican adolescents living in this geographic area. This study examines the prevalence of HIV risk practices and psychosocial correlates…

HIV/AIDS Researchers Interaction with Schoolteachers: A Key to Combat AIDS among Brazilian Adolescents

ERIC Educational Resources Information Center

Kashima, Simone; de Castro, Fabiola Attie; de Castro Amarante, Maria Fernanda; Barbieri, Marisa Ramos; Covas, Dimas Tadeu

2008-01-01

Considering the fact that information on HIV/AIDS is a strategy for disease control, this project was planned to provide comprehensive information about HIV infection and AIDS to schoolteachers and their students. Previous analysis of adolescent students' knowledge of HIV/AIDS showed that they still have doubts about transmission, diagnosis, and…

A Longitudinal Study of Adolescents with Perinatally or Transfusion Acquired HIV Infection: Sexual Knowledge, Risk Reduction Self-efficacy and Sexual Behavior

PubMed Central

Wiener, Lori S.; Battles, Haven B.; Wood, Lauren V.

2008-01-01

As HIV-positive children are surviving to adolescence and beyond, understanding their HIV knowledge and sexual behavior is critical. Forty HIV+ adolescents/young adults were interviewed twice, approximately 21 months apart (mean age 16.6 and 18.3 years, respectively). Data on demographics, safer sex knowledge, sexual risk behaviors, risk reduction self-efficacy, and Tanner stage were collected. Twenty-eight percent of HIV+ youth at Time 1 and 41% at Time 2 reported being sexually active. HIV transmission/safer sex knowledge was low, increased with age, and both self-efficacy for and actual condom use was relatively high. Secondary prevention messages should be incorporated into routine medical settings. PMID:17028994

[Psychosocial aspects in a cohort of vertically transmitted human immunodeficiency virus-infected adolescents].

PubMed

García-Navarro, Cristina; García, Isabel; Medín, Gabriela; Ramos-Amador, José Tomás; Navarro-Gómez, Marisa; Mellado-Peña, M José; Gómez, M I de José; Cortés, Marisol; Zamora Crespo, Berta; Muñoz-Fernandez, M Angeles; Gamero, Daniel Blázquez; González-Tomé, M Isabel

2014-12-01

Thanks to advances in antiretroviral treatment, children with HIV infections through vertical transmission have improved their life expectancy. However, new challenges have emerged. We propose this study in order to determine the psychosocial aspects and knowledge of infections in a cohort of adolescents with vertically transmitted HIV infections. Patients with vertically-acquired HIV infection between 12 and 19 years old were included. Data were obtained through semi-structured interviews and a Strengths and Difficulties Questionnaire for emotional and behavioral disorders screening. We evaluated 96 patients (58% females) with a median age of 15 years (11-19.1) and a median age at diagnosis of 1.70 years (0-12.2). The median CD4 count was 626cells/mm(3) (132-998), and the viral load was<50cp/ml in 72% of patients. Among them, 90% attended school and 60% repeated at least one course. Although 81% of them knew of their diagnosis, only 30% understood their disease, with 18.2% having discussed it with friends. Six unwanted pregnancies occurred during the study period. Strengths and Difficulties Questionnaire showed hyperactivity risk in 33%. A high percentage of adolescents show difficulties in several areas (disease knowledge, peer relationship, school failure...) that can have an impact on their adult lives. Further studies are needed to evaluate their origin and development in depth, as well as interventions to modify this situation. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Identifying community risk factors for HIV among South African adolescents with mental health problems: a qualitative study of parental perceptions.

PubMed

Kagee, Ashraf; Donenberg, Geri; Davids, Alicia; Vermaak, Redwaan; Simbayi, Leickness; Ward, Catherine; Naidoo, Pamela; Mthembu, Jacky

2014-01-01

High risk sexual behaviour, alcohol and drug use, and mental health problems combine to yield high levels of HIV-risk behaviour among adolescents with mental health problems. In South Africa, little research has been conducted on parental perspectives of HIV-risk among this population. We conducted a series of focus group discussions with 28 mothers of adolescents receiving services at two mental health clinics in South Africa to identify, from their perspectives, the key community problems facing their children. Participants indicated that HIV remained a serious threat to their adolescent children's well-being, in addition to substance abuse, early sexual debut, and teenage pregnancy. These social problems were mentioned as external to their household dynamics, and thus seemingly beyond the purview of the parent-adolescent relationship. These data have implications for the design of family-based interventions to ameliorate the factors associated with HIV-risk among youth receiving mental health services.

Effectiveness of a School HIV/AIDS Prevention Program for Spanish Adolescents

ERIC Educational Resources Information Center

Espada, Jose P.; Orgiles, Mireia; Morales, Alexandra; Ballester, Rafael; Huedo-Medina, Tania B.

2012-01-01

Due to a lack of controlled studies on HIV prevention interventions among Spanish adolescents, COMPAS, a five-session behavioral intervention, was developed and tested on Spanish adolescents aged 15-18. Participants included 827 adolescents from central, east and north Spain. Six hundred and seven students (M = 15.71 years) received the…

Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention.

PubMed

Closson, Kalysha; Dietrich, Janan Janine; Nkala, Busi; Musuku, Addy; Cui, Zishan; Chia, Jason; Gray, Glenda; Lachowsky, Nathan J; Hogg, Robert S; Miller, Cari L; Kaida, Angela

2016-11-25

Youth trauma exposure is associated with syndemic HIV risk. We measured lifetime prevalence, type, and correlates of trauma experience by gender among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. Using data from the Botsha Bophelo Adolescent Health Survey (BBAHS), prevalence of "ever" experiencing a traumatic event among adolescents (aged 14-19) was assessed using a modified Traumatic Event Screening Inventory-Child (TESI-C) scale (19 items, study alpha = 0.63). We assessed self-reported number of potentially traumatic events (PTEs) experienced overall and by gender. Gender-stratified multivariable logistic regression models assessed independent correlates of 'high PTE score' (≥7 PTEs). Overall, 767/830 (92%) participants were included (58% adolescent women). Nearly all (99.7%) reported experiencing at least one PTE. Median PTE was 7 [Q1,Q3: 5-9], with no gender differences (p = 0.19). Adolescent men reported more violent PTEs (e.g., "seen an act of violence in the community") whereas women reported more non-violent HIV/AIDS-related PTEs (e.g., "family member or someone close died of HIV/AIDS"). High PTE score was independently associated with high food insecurity among adolescent men and women (aOR = 2.63, 95%CI = 1.36-5.09; aOR = 2.57, 95%CI = 1.55-4.26, respectively). For men, high PTE score was also associated with older age (aOR = 1.40/year, 95%CI = 1.21-1.63); and recently moving to Soweto (aOR = 2.78, 95%CI = 1.14-6.76). Among women, high PTE score was associated with depression using the CES-D scale (aOR = 2.00, 95%CI = 1.31-3.03,) and inconsistent condom use vs. no sexual experience (aOR = 2.69, 95%CI = 1.66-4.37). Nearly all adolescents in this study experienced trauma, with gendered differences in PTE types and correlates, but not prevalence. Exposure to PTEs were distributed along social and gendered axes. Among adolescent women, associations with depression and inconsistent condom use suggest pathways for HIV risk. HIV prevention interventions targeting adolescents must address the syndemics of trauma and HIV through the scale-up of gender-transformative, youth-centred, trauma-informed integrated HIV and mental health services.

The VUKA Family Program: Piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa

PubMed Central

Bhana, Arvin; Mellins, Claude Ann; Petersen, Inge; Alicea, Stacey; Myeza, Nonhlahla; Holst, Helga; Abrams, Elaine; John, Sally; Chhagan, Meera; Nestadt, Danielle F; Leu, Cheng-Shiun; McKay, Mary

2013-01-01

An increasing number of adolescents born with HIV in South Africa are on antiretroviral treatment and have to confront complex issues related to coping with a chronic, stigmatizing and transmittable illness. Very few evidence-based mental health and health promotion programs for this population exist in South Africa. This study builds on a previous collaboratively designed and developmentally-timed family-based intervention for early adolescents (CHAMP). The study uses community-based participatory approach as part of formative research to evaluate a pilot randomized control trial at two hospitals. The paper reports on the development, feasibility and acceptability of the VUKA family-based program and its short-term impact on a range of psychosocial variables for HIV+ pre-adolescents and their caregivers. A ten session intervention of approximately 3 months duration was delivered to 65 pre-adolescents aged 10-13 years and their families. VUKA participants were noted to improve on all dimensions, including mental health, youth behaviour, HIV treatment knowledge, stigma, communication and adherence to medication. VUKA shows promise as a family-based mental and HIV prevention program for HIV+ pre-adolescents and which could be delivered by trained lay staff. PMID:23767772

Arrest history as an indicator of adolescent/young adult substance use and HIV risk.

PubMed

Tolou-Shams, Marina; Brown, Larry K; Gordon, Glenn; Fernandez, Isabel

2007-04-17

Juvenile offenders are particularly at risk for HIV because of their substantially high rates of risk behaviors, high rates of substance use disorders and psychopathology. Most studies have focused on risk behaviors among incarcerated youth. This study sought to determine if an arrest history could serve as a marker for HIV risk and substance abuse among a community-based sample of high-risk adolescents and young adults. Adolescents (N=1400; mean age=18 years) who participated in a larger multi-site HIV prevention program in three states (GA, FL and RI) provided baseline data on sexual risk, substance use, attitudes and mental health history. Participants were grouped as arrestees (N=404) and non-arrestees (N=996) based on self-reported arrest history. Juvenile arrestees reported more alcohol and drug use, substance use during sex, unprotected sex acts, STI diagnoses, suicide attempts and psychiatric hospitalizations than non-arrestees. Having an arrest history may serve as a marker for adolescent HIV risk and substance abuse. Effectively screening adolescents for legal history and responding to the psychosocial and health needs of these high-risk adolescents could increase necessary engagement in substance use and mental health treatment, reduce HIV risk in the community, and reduce costs to the legal, medical and mental health systems.

Assessing the effects of a complementary parent intervention and prior exposure to a preadolescent program of HIV risk reduction for mid-adolescents.

PubMed

Stanton, Bonita; Wang, Bo; Deveaux, Lynette; Lunn, Sonja; Rolle, Glenda; Li, Xiaoming; Braithwaite, Nanika; Dinaj-Koci, Veronica; Marshall, Sharon; Gomez, Perry

2015-03-01

We (1) evaluated the impact of an evidence-based HIV prevention program with and without a parent component among mid-adolescents living in the Caribbean and (2) determined the effect of prior receipt of a related intervention during preadolescence on intervention response. A randomized, controlled 4-cell trial of a 10-session, theory-based HIV prevention intervention involving 2564 Bahamian grade-10 youths (some of whom had received a comparable intervention in grade 6) was conducted (2008-2011). Randomization occurred at the level of the classroom with follow-up at 6, 12, and 18 months after intervention. The 3 experimental conditions all included the youths' curriculum and either a youth-parent intervention emphasizing adolescent-parent communication, a parent-only goal-setting intervention, or no parent intervention. An intervention delivered to mid-adolescents in combination with a parent-adolescent sexual-risk communication intervention increased HIV/AIDS knowledge, condom-use skills, and self-efficacy and had a marginal effect on consistent condom use. Regardless of prior exposure to a similar intervention as preadolescents, youths benefited from receipt of the intervention. Preadolescents and mid-adolescents in HIV-affected countries should receive HIV prevention interventions that include parental participation.

A study of the effectiveness of AIDS health education interventions among the adolescent population of Singapore.

PubMed

Quek, J T; Li, S C

2002-07-01

This study aims to evaluate the effectiveness of existing AIDS health education interventions in Singapore amongst the adolescent population of Singapore. By identifying specific target groups that lack knowledge and information regarding HIV, it is hoped that suggestions may be provided towards increasing the effectiveness of these interventions. A cross-sectional survey using a self-administered questionnaire of randomly selected adolescents between the ages of 13 and 19 years was performed to assess their knowledge of HIV and their opinions and awareness of HIV education in Singapore. A total of 400 adolescents of various backgrounds were surveyed. In general, the subjects surveyed possessed reasonably good knowledge about HIV/AIDS, with an average score of 77.4% (SD = 15.8%). However, the results also showed areas of knowledge deficiency and misconception prevalent among those surveyed. Subgroup analysis showed that adolescents from low-income families, relatively less academically successful schools and those of younger ages knew significantly less than other adolescents. In terms of the awareness of HIV/AIDS education and information, the percentage of the subjects who could recognise any of the three commonly issued pamphlets or poster or who knew of any telephone numbers to call to receive information on HIV and AIDS was low. Less than 40% of those surveyed felt that enough awareness was being created within the public regarding AIDS. It can be concluded that most adolescents surveyed felt that they are inadequately educated regarding HIV andAIDS. The results would certain target groups using the appropriate media in future educational intervention.

Ending AIDS by 2030: the importance of an interlinked approach and meaningful youth leadership.

PubMed

Gleeson, Hayley S; Oliveras Rodriguez, Carlo André; Hatane, Luann; Hart, Doortje't

2018-02-01

This commentary by authors from the Adolescent HIV Treatment Coalition calls for action to improve advocacy and service delivery for young people by leveraging the interlinkages between HIV and the broader development agenda. The 2030 Agenda for Sustainable Development includes target 3.3 on ending the AIDS epidemic by 2030, and along with the 2016 Political Declaration on HIV and AIDS, this has led to a global renewal of political commitment to the HIV response. However, young people are still being left behind, and to provide an equitable and sustainable response to HIV we must ensure that we are meeting the needs of the 3.9 million young people living with HIV, and the millions more at risk. While HIV has its own target within the 2030 Agenda, efforts to end AIDS are inextricable from other goals and targets, such as on poverty eradication, education, gender equality and peace. To tackle HIV we must work beyond target 3.3 and provide a comprehensive response that addresses the underlying structural inequalities that impact adolescents and young people, ensuring that we enable the meaningful engagement of youth and adolescents as partners and leaders of sustainable development and the HIV response. Finally, it is necessary to collect better disaggregated data and evidence on the HIV epidemic among adolescents, as well as on best practices for supporting them. Ending the AIDS epidemic among adolescents and young people (aged 10 to 24) by 2030 is possible. However, it requires an integrated, multi-sectoral response to HIV which pays attention to the social determinants that put adolescents at risk and fuel the epidemic. Positioning efforts to end AIDS among young people within the broader 2030 Agenda and building youth leadership will contribute to building a more healthy, equitable and sustainable society for all. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Adolescent girls and young women: key populations for HIV epidemic control

PubMed Central

Dellar, Rachael C; Dlamini, Sarah; Karim, Quarraisha Abdool

2015-01-01

Introduction At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers. This age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control. Discussion Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations. Conclusions There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative. PMID:25724504

Adolescent girls and young women: key populations for HIV epidemic control.

PubMed

Dellar, Rachael C; Dlamini, Sarah; Karim, Quarraisha Abdool

2015-01-01

At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15-24 contribute a disproportionate ~30% of all new infections and seroconvert 5-7 years earlier than their male peers. This age-sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control. Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations. There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative.

Risk of death among those awaiting treatment for HIV infection in Zimbabwe: adolescents are at particular risk

PubMed Central

Shroufi, Amir; Ndebele, Wedu; Nyathi, Mary; Gunguwo, Hilary; Dixon, Mark; Saint-Sauveur, Jean F; Taziwa, Fabian; Viñoles, Mari C; Ferrand, Rashida A

2015-01-01

Introduction Mortality among HIV-positive adults awaiting antiretroviral therapy (ART) has previously been found to be high. Here, we compare adolescent pre-ART mortality to that of adults in a public sector HIV care programme in Bulawayo, Zimbabwe. Methods In this retrospective cohort study, we compared adolescent pre-ART outcomes with those of adults enrolled for HIV care in the same clinic. Adolescents were defined as those aged 10–19 at the time of registration. Comparisons of means and proportions were carried out using two-tailed sample t-tests and chi-square tests respectively, for normally distributed data, and the Mann–Whitney U-tests for non-normally distributed data. Loss to follow-up (LTFU) was defined as missing a scheduled appointment by three or more months. Results Between 2004 and 2010, 1382 of 1628 adolescents and 7557 of 11,106 adults who registered for HIV care met the eligibility criteria for ART. Adolescents registered at a more advanced disease stage than did adults (83% vs. 73% WHO stage III/IV, respectively, p<0.001), and the median time to ART initiation was longer for adolescents than for adults [21 (10–55) days vs. 15 (7–42) days, p<0.001]. Among the 138 adolescents and 942 adults who never commenced ART, 39 (28%) of adolescents and 135 (14%) of adults died, the remainder being LTFU. Mortality among treatment-eligible adolescents awaiting ART was significantly higher than among adults (3% vs. 1.8%, respectively, p=0.004). Conclusions Adolescents present to ART services at a later clinical stage than adults and are at an increased risk of death prior to commencing ART. Improved and innovative HIV case-finding approaches and emphasis on prompt ART initiation in adolescents are urgently needed. Following registration, defaulter tracing should be used, whether or not ART has been commenced. PMID:25712590

"Being faithful" in a sexual relationship: perceptions of Tanzanian adolescents in the context of HIV and pregnancy prevention.

PubMed

Baumgartner, Joy Noel; Lugina, Helen; Johnson, Laura; Nyamhanga, Tumaini

2010-09-01

Little is known about what adolescents think about faithfulness and partner reduction for HIV prevention (the "B" in the ABC HIV prevention behavior change strategy), including how they understand its implementation within relationships. In addition, because adolescents face the twin threats of HIV and unintended pregnancy, it is important to understand how adolescents may integrate their thinking on pregnancy prevention if they are using faithfulness or partner reduction as their HIV prevention strategy. This study gathered evidence by conducting 20 focus group discussions (FGDs) with 158 adolescents, aged 14-20. The FGDs were stratified by sex, age, current school attendance, rural or urban residence, and marital status. Results showed that the vast majority of groups felt that "B" messages are important and relevant for unmarried (as well as married) youth to hear for HIV prevention, but the messages need to be explicit (e.g., "being faithful means having only one tested sexual partner at a time"). Faithful relationships are perceived as ideal in terms of romantic expectations and HIV prevention, but were considered unrealistic if the relationship had a power imbalance. Adolescents acknowledged the risks of multiple partners and a few recognized that concurrent partnerships are riskier than serial partnerships. Condoms were given as the primary method for pregnancy prevention among youth, yet faithfulness was usually seen as precluding condom use and many youth considered condom use as evidence of a lack of faithfulness. Overall, adolescents recognized that practicing fidelity is complex. Young people need life skills education for how to establish and maintain faithful relationships with one tested partner and how to integrate condom use for pregnancy prevention within that relationship. Programs also need to more explicitly address the issues of trust and repeat HIV testing within "faithful" relationships which is an uncomfortable but necessary reality for many adolescents.

Project STYLE: a multisite RCT for HIV prevention among youths in mental health treatment.

PubMed

Brown, Larry K; Hadley, Wendy; Donenberg, Geri R; DiClemente, Ralph J; Lescano, Celia; Lang, Delia M; Crosby, Richard; Barker, David; Oster, Danielle

2014-03-01

The study examined the efficacy of family-based and adolescent-only HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p<.01) and self-efficacy (p<.05). The family-based intervention, compared with the other interventions, produced significant improvements in parent-teen sexual communication (p<.01), parental monitoring (p<.01), and parental permissiveness (p=.05). This RCT found that the HIV prevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.

Cervical Dysplasia and High-Risk Human Papillomavirus Infections among HIV-Infected and HIV-Uninfected Adolescent Females in South Africa

PubMed Central

Mrubata, Megan; Williamson, Anna-Lise; Bekker, Linda-Gail

2014-01-01

Background. HIV-infected adolescents may be at higher risk for high-grade cervical lesions than HIV-uninfected adolescents. The purpose of this study was to compare the prevalence of high-risk HPV (HR-HPV) infections and Pap smear abnormalities between these two groups. Methods. In this cross-sectional study, we compared the HPV DNA and Pap smear results between 35 HIV-infected and 50 HIV-uninfected adolescents in order to determine the prevalence of HR-HPV genotypes and cervical cytological abnormalities. Comparisons were made using Pearson χ 2 and independent-samples t-tests analyses, and associations between demographic and behavioral characteristics and HPV infections were examined. Results. HIV-infected participants were more likely to be infected with any HPV (88.6% versus 48.0%; P < 0.001) and with at least one HR-HPV (60.0% versus 24.0%; P = 0.001), and to have multiple concurrent HPV infections (68.6% versus 22.0%; P < 0.001). HPV 16 and 18 were relatively underrepresented among HR-HPV infections. Abnormal Pap test results were more common among HIV-infected participants (28.8% versus 12.0%; P = 0.054). A history of smoking was associated with HR-HPV infection. Conclusions. HIV-infected adolescents have an increased risk of infection with HR-HPV and of Pap test abnormalities. The majority of HR-HPV infections among our participants would not be prevented by the currently available vaccinations against HPV. PMID:25389377

Self-Efficacy for Sexual Risk Reduction and Partner HIV Status as Correlates of Sexual Risk Behavior Among HIV-Positive Adolescent Girls and Women

PubMed Central

Boone, Melissa R.; Cherenack, Emily M.

2015-01-01

Abstract Little is known about the correlates of sexual risk behavior among HIV-positive adolescent girls and women in the United States. This study investigates two potential factors related to unprotected vaginal and anal intercourse (UVAI) that have yet to be thoroughly studied in this group: self-efficacy for sexual risk reduction and partner HIV status. Data was analyzed from 331 HIV-positive adolescent girls and women between 12 and 24 years old who reported vaginal and/or anal intercourse with a male partner in the past 3 months at fifteen sites across the United States. Results show that overall self-efficacy (B = −0.15, p=0.01), self-efficacy to discuss safe sex with one's partner (B = −0.14, p=0.01), and self-efficacy to refuse unsafe sex (B = −0.21, p=0.01) are related to UVAI episodes. Participants with only HIV-positive partners or with both HIV-positive and HIV-negative partners showed a trend towards higher percentages of UVAI episodes compared to participants with only HIV-negative partners (F(2, 319)=2.80, p=0.06). These findings point to the importance of including self-efficacy and partner HIV status in risk-reduction research and interventions developed for HIV-positive adolescent girls and young women. PMID:25856632

Self-Efficacy for Sexual Risk Reduction and Partner HIV Status as Correlates of Sexual Risk Behavior Among HIV-Positive Adolescent Girls and Women.

PubMed

Boone, Melissa R; Cherenack, Emily M; Wilson, Patrick A

2015-06-01

Little is known about the correlates of sexual risk behavior among HIV-positive adolescent girls and women in the United States. This study investigates two potential factors related to unprotected vaginal and anal intercourse (UVAI) that have yet to be thoroughly studied in this group: self-efficacy for sexual risk reduction and partner HIV status. Data was analyzed from 331 HIV-positive adolescent girls and women between 12 and 24 years old who reported vaginal and/or anal intercourse with a male partner in the past 3 months at fifteen sites across the United States. Results show that overall self-efficacy (B=-0.15, p=0.01), self-efficacy to discuss safe sex with one's partner (B=-0.14, p=0.01), and self-efficacy to refuse unsafe sex (B=-0.21, p=0.01) are related to UVAI episodes. Participants with only HIV-positive partners or with both HIV-positive and HIV-negative partners showed a trend towards higher percentages of UVAI episodes compared to participants with only HIV-negative partners (F(2, 319)=2.80, p=0.06). These findings point to the importance of including self-efficacy and partner HIV status in risk-reduction research and interventions developed for HIV-positive adolescent girls and young women.

Self-competence Among Early and Middle Adolescents Affected by Maternal HIV/AIDS

PubMed Central

Marelich, William D.; Murphy, Debra A.; Payne, Diana L.; Herbeck, Diane M.; Schuster, Mark A.

2012-01-01

Adolescent children of mothers with HIV face a host of stressors that place them at increased risk for poor outcomes. Using covariance structure analysis, this study examines adolescent risk outcomes and their relationships to maternal health, as well as the potentially protective factors of family environment and self-competence. The final model indicated that poor maternal health was negatively related to a protective family environment, which in turn was negatively related to adolescent risk outcomes. A protective family environment was also positively related to adolescent self-competence, which was negatively related to adolescent risk outcomes. Implications of the study are discussed, including how these findings can influence interventions aimed at reducing the risk for poor outcomes among adolescent youth with HIV-infected mothers. PMID:22485061

Effects of Rational-Emotive Health Education Program on HIV risk perceptions among in-school adolescents in Nigeria.

PubMed

Onyechi, Kay Chinonyelum Nwamaka; Eseadi, Chiedu; Okere, Anthony U; Otu, Mkpoikanke Sunday

2016-07-01

Exploring beliefs about personal risk for human immunodeficiency virus (HIV) infection is essential to understanding what motivates people to engage in behaviors that reduce or increase their risk of HIV infection. Therefore, the current study's objective was to examine the effects of a Rational-Emotive Health Education Program (REHEP) on HIV risk perceptions among in-school adolescents in Anambra State, Nigeria.Forty-four participants were identified as having high-risk perceptions about HIV infection through a self-report questionnaire and met the inclusion criteria. The treatment process was guided by a REHEP manual and consisted of 8 weeks of full intervention and 2 weeks of follow-up meetings that marked the end of intervention. The study used repeated measures analysis of variance to assess improvements in individual participants and across control and treatment group risk perceptions after the intervention.HIV risk perceptions of in-school adolescents did not differ across the treatment and control groups at baseline. Through REHEP, HIV risk perceptions significantly reduced in the treatment group compared to those in the control group. REHEP had significant effect on HIV risk perceptions of in-school adolescents exposed to treatment group, despite their sex. Religious background did not determine the significant effect of REHEP on HIV risk perceptions of in-school adolescents in the treatment group.Follow-up studies that would use a REHEP to assist client population from other parts of the country to promote HIV risk reduction, especially among those with high-risk behavior, are needed in Nigeria.

Effects of Rational-Emotive Health Education Program on HIV risk perceptions among in-school adolescents in Nigeria

PubMed Central

Onyechi, Kay Chinonyelum Nwamaka; Eseadi, Chiedu; Okere, Anthony U.; Otu, Mkpoikanke Sunday

2016-01-01

Abstract Exploring beliefs about personal risk for human immunodeficiency virus (HIV) infection is essential to understanding what motivates people to engage in behaviors that reduce or increase their risk of HIV infection. Therefore, the current study's objective was to examine the effects of a Rational-Emotive Health Education Program (REHEP) on HIV risk perceptions among in-school adolescents in Anambra State, Nigeria. Forty-four participants were identified as having high-risk perceptions about HIV infection through a self-report questionnaire and met the inclusion criteria. The treatment process was guided by a REHEP manual and consisted of 8 weeks of full intervention and 2 weeks of follow-up meetings that marked the end of intervention. The study used repeated measures analysis of variance to assess improvements in individual participants and across control and treatment group risk perceptions after the intervention. HIV risk perceptions of in-school adolescents did not differ across the treatment and control groups at baseline. Through REHEP, HIV risk perceptions significantly reduced in the treatment group compared to those in the control group. REHEP had significant effect on HIV risk perceptions of in-school adolescents exposed to treatment group, despite their sex. Religious background did not determine the significant effect of REHEP on HIV risk perceptions of in-school adolescents in the treatment group. Follow-up studies that would use a REHEP to assist client population from other parts of the country to promote HIV risk reduction, especially among those with high-risk behavior, are needed in Nigeria. PMID:27442633

Knowledge and awareness regarding menstruation and HIV/AIDS among schoolgoing adolescent girls.

PubMed

Jain, Rakhi; Anand, Puneet; Dhyani, Anuj; Bansal, Deshant

2017-01-01

Menstruation in our country is associated with various myths and restrictions leading to lack of awareness among adolescent girls. Insufficient menstrual hygiene practices are the cause of stress associated with menstruation and reproductive tract infections. Sexually transmitted infections and HIV/AIDS are not openly discussed in our society making adolescents vulnerable to them. To assess the knowledge of school going adolescent girls regarding menstrual hygiene and HIV/AIDS. Girls studying in class 8 th -12 th standard and who have attained menarche were included in the study. A predesigned questionnaire, which consisted of questions related to menstrual awareness and knowledge about HIV/AIDS was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages. 282 girls took part in the study. Mean age of girls was 14.70 ± 1.5 years. Median age of girls was 15 years. Knowledge regarding menstrual hygiene and HIV/AIDS was found to be only satisfactory leaving a scope of improvement. Mother was the main source of information regarding both menstruation and HIV/AIDS. A comprehensive health education programme involving mothers is required to remove various misconceptions and taboos associated with menstruation and make it a pleasant experience for adolescent girls. Information, education and awareness programmes need to be strengthened to spread awareness regarding HIV/AIDS.

HIV Testing among Detained Youth

ERIC Educational Resources Information Center

Voisin, Dexter R.; Salazar, Laura F.; Crosby, Richard; DiClemente, Ralph J.; Yarber, William L.; Staples-Horne, Michelle

2004-01-01

Published reports have not investigated the issue of voluntary HIV testing among detained youth, a population disproportionately infected with HIV compared to other adolescent groups. Data were collected from 467 sexually active detained adolescents in Georgia on demographic, environmental, and drug and sexual history variables, to explore…

The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV.

PubMed

Harper, Gary W; Fernandez, Isabel M; Bruce, Douglas; Hosek, Sybil G; Jacobs, Robin J

2013-01-01

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16-24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past 3 months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV.

The Role of Multiple Identities in Adherence to Medical Appointments among Gay/Bisexual Male Adolescents Living with HIV

PubMed Central

Harper, Gary W.; Fernandez, M. Isabel; Bruce, Douglas; Hosek, Sybil G.; Jacobs, Robin J.

2012-01-01

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16–24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past three months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV. PMID:22041930

HIV Knowledge and Risk among Zambian Adolescent and Younger Adolescent Girls: Challenges and Solutions

ERIC Educational Resources Information Center

Butts, Stefani A.; Kayukwa, Annette; Langlie, Jake; Rodriguez, Violeta J.; Alcaide, Maria L.; Chitalu, Ndashi; Weiss, Stephen M.; Jones, Deborah L.

2018-01-01

In sub-Saharan Africa, young women are at the highest risk of HIV infection. Comprehensive sexuality education and open parent-child communication about sex have been shown to mitigate risky sexual practices associated with HIV. This study aimed to identify sources of HIV prevention knowledge among young women aged 10-14 years and community-based…

Validation of the Worry about Sexual Outcomes Scale for Use in STI/HIV Prevention Interventions for Adolescent Females

ERIC Educational Resources Information Center

Sales, Jessica M.; Spitalnick, Josh; Milhausen, Robin R.; Wingood, Gina M.; Diclemente, Ralph J.; Salazar, Laura F.; Crosby, Richard A.

2009-01-01

This study examined the psychometric properties of a new scale to measure adolescents' worry regarding outcomes of risky sexual behavior (i.e. sexually transmitted infections, including HIV [STI/HIV], and unintended pregnancy). The 10-item worry about sexual outcomes (WASO) scale, resulting in two subscales STI/HIV worry and pregnancy worry, was…

Incident Anal HPV and HPV-Related Sequelae in HIV-Infected vs. HIV-Uninfected Adolescents in the United States

PubMed Central

Mullins, Tanya L. Kowalczyk; Wilson, Craig M.; Rudy, Bret J.; Sucharew, Heidi; Kahn, Jessica A.

2015-01-01

Background Little is known about the incidence of anal HPV infection and related sequelae, and factors associated with these outcomes, among adolescents who are HIV-infected vs. uninfected but at-risk. Methods We analyzed data from a multisite U.S. study, the Reaching for Excellence in Adolescent Care and Health Project. Adolescents aged 12–18 years who were behaviorally HIV-infected (n=319) or HIV-uninfected but at-risk (n=177) were recruited. Incidence rates for anal HPV, high-risk anal HPV, anogenital warts, and anal dysplasia were calculated using Poisson modeling. Factors associated with these outcomes were examined using Cox proportional hazards modeling. Results Mean age at entry was 16.8 years; mean follow-up time for detection of anal HPV was 22.4 months (SD 10.8). Most participants (76%) were female; 70% were black non-Hispanic. HIV-infected (vs. –uninfected) women had significantly higher incidence of anal HPV (30 vs. 14 per 100 person-years; p=0.002), high-risk anal HPV (12 vs. 5.3 per 100 person-years; p=0.04), and anogenital warts (6.7 vs. 1.6 per 100 person-years; p=0.002) but not anal dysplasia. Although incidence rates were higher for these outcomes among HIV-infected vs. -uninfected men, the differences were not statistically significant. Among women, factors associated with anal HPV and related sequelae differed by HIV status and included biological, behavioral, and HIV-related factors. No factors were associated with outcomes in men. Conclusions HIV-infected vs. -uninfected adolescent women had higher rates of anal HPV and anogenital warts. Because HIV-infected youth are at increased risk of these outcomes, enhanced HPV prevention efforts, such as vaccination, are warranted for this group. PMID:23949587

Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review

PubMed Central

Adejumo, Olurotimi A; Malee, Kathleen M; Ryscavage, Patrick; Hunter, Scott J; Taiwo, Babafemi O

2015-01-01

Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population. PMID:26385853

Impaired cellular immune response to tetanus toxoid but not to cytomegalovirus in effectively HAART-treated HIV-infected children.

PubMed

Alsina, Laia; Noguera-Julian, Antoni; Fortuny, Clàudia

2013-05-07

Despite of highly active antiretroviral therapy, the response to vaccines in HIV-infected children is poor and short-lived, probably due to a defect in cellular immune responses. We compared the cellular immune response (assessed in terms of IFN-γ production) to tetanus toxoid and to cytomegalovirus in a series of 13 HIV-perinatally-infected children and adolescents with optimal immunovirological response to first line antiretroviral therapy, implemented during chronic infection. A stronger cellular response to cytomegalovirus (11 out of 13 patients) was observed, as compared to tetanus toxoid (1 out of 13; p=0.003). These results suggest that the repeated exposition to CMV, as opposed to the past exposition to TT, is able to maintain an effective antigen-specific immune response in stable HIV-infected pediatric patients and strengthen current recommendations on immunization practices in these children. Copyright © 2013. Published by Elsevier Ltd.

Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland.

PubMed

Collins, Intira Jeannie; Foster, Caroline; Tostevin, Anna; Tookey, Pat; Riordan, Andrew; Dunn, David; Gibb, D M; Judd, Ali

2017-04-15

Increasing numbers of children infected perinatally with human immunodeficiency virus (HIV) are surviving to adolescence and transitioning to adult care, yet there are scarce data on their clinical status at transfer. We analyzed prospective cohort data from the UK/Ireland national Collaborative HIV Pediatric Study (CHIPS). Clinical status at last pediatric clinic visit prior to transfer was described. Factors associated with higher CD4 cell count and viral load (VL) suppression<400 c/mL among patients on antiretroviral therapy (ART) at transfer were assessed using linear and logistic regression, respectively. Data were matched with the UK HIV Drug Resistance Database (UKHIVDRB) to assess cumulative resistance profiles at transfer. Of 1,907 children followed in CHIPS from 1996 to November 2014, 644 (34%) transferred to adult care: 53% were female, 62% born outside the UK/Ireland, 75% black African. At last pediatric follow-up, median age was 17.4 years [interquartile range 16.5,18.1], 27% had previous AIDS diagnosis, CD4 was 444 cells/mm3 [280, 643], 76% were on ART, 13% off-ART, and 11% ART-naive. Among patients on ART, 74% had VL<400 c/mL. In multivariable analysis, higher CD4 at transfer was associated with younger age, higher CD4 at ART initiation and lower VL at transfer (P ≤ .001). Predictors of viral suppression include no AIDS diagnosis and later year of transfer (P ≤ .05). Of 291 patients with resistance data, 82% had resistance to ≥1 drug class, 56% to ≥2 classes and 12% had triple-class resistance. Three-quarters of adolescents were on stable ART at transfer, of whom 74% were virologically suppressed. The prevalence of triple-class resistance was relatively low at 12%. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com

Knowledge and disclosure of HIV status among adolescents and young adults attending an adolescent HIV clinic in Accra, Ghana.

PubMed

Kenu, Ernest; Obo-Akwa, Adjoa; Nuamah, Gladys B; Brefo, Anita; Sam, Miriam; Lartey, Margaret

2014-11-26

In Ghana it is estimated that 1.2% of HIV infections occur in young people aged 15-24 but the representation in our clinics is small. Adherence to treatment, appointment keeping and knowledge of HIV status remains a challenge. Disclosure has been shown to result in better adherence to therapy, good clinical outcomes, psychological adjustment and reduction in the risk of HIV transmission when the young person becomes sexually active. A baseline study was conducted to ascertain if adolescents and young adults knew their HIV status and their knowledge on HIV. Informed consent and assent were obtained from willing participants. Self-administered questionnaires on general knowledge of HIV, HIV treatment and disclosure were collected and analyzed. Thirty-four young persons participated in the study. The mean age was 16.9±SD 2.5 and 62% (21/32) were female. All of them were still in school. Eighty-five percent were aware that young people their age could fall sick, 91% had heard of HIV, 70% knew someone with HIV and 45% thought that adolescents were not at risk of HIV. On modes of HIV transmission, 66.7% knew HIV was transmitted through sex and 63.6% knew about mother to child transmission. Fifty three percent (18/34) knew their HIV status, 50% (17/34) were on antiretroviral and 35% (6/17) of them admitted to missing ARV doses. One person who said he was HIV negative and another who did not know his status were both on ARVs. Disclosure of HIV status to adolescents and young people is dependent on a complex mix of factors and most practitioners recommend an age and developmentally appropriate disclosure. Thus it is highly individualized. The knowledge and awareness of HIV was 91% compared to 97% of adults in the most recent Ghana Demographic and Health Survey however only about two thirds had acceptable in depth knowledge on HIV. Only half knew their HIV status which was not the best considering their ages. There is the need to strengthen education to young persons with HIV, support adhere to ARVs for better outcomes and assist care givers to disclose HIV status to them.

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures.

PubMed

Kaufman, Michelle R; Patel, Eshan U; Dam, Kim H; Packman, Zoe R; Van Lith, Lynn M; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-04-03

The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Quantitative surveys were conducted among male adolescents aged 10-19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization-recommended HIV minimum package and the US President's Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15-19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10-14 years; adjusted β, 0.17; 95% confidence interval [CI], .12-.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16-2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30-4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires standardizing counseling content, as there are significant age differences in HIV prevention content received by adolescents.

Availability of HIV-related health services in adolescent substance abuse treatment programs.

PubMed

Knudsen, H K; Oser, C B

2009-10-01

Given that alcohol and drug abuse heightens the risk of adolescents acquiring HIV, substance abuse treatment programs for youths may represent an important site of HIV prevention. In this research, we explored the adoption of three HIV-related health services: risk assessment during intake, HIV prevention programing, and HIV testing. Data were collection through telephone interviews with 149 managers of adolescent-only substance abuse treatment programs in the USA. About half of these programs had adopted HIV risk assessment and HIV prevention. On-site HIV testing was less widely adopted, with only one in four programs offering this service. At the bivariate level, the availability of on-site primary medical care and the availability of an overnight level of care were positively associated with these three types of services. The association for the measure of an overnight level of care was no longer significant once medical services were controlled. However, in a separate analysis, it was found that programs offering an overnight level of care were much more likely to offer on-site medical care than outpatient-only facilities. There was also evidence that publicly funded treatment programs were more likely to offer HIV prevention and on-site HIV testing, after controlling for other organizational characteristics. Much more research about the adoption of HIV-related services in adolescent substance abuse treatment is needed, particularly to offer greater insight into why certain types of organizations are more likely to adopt these health services.

Affect management for HIV prevention with adolescents in therapeutic schools: the immediate impact of project balance.

PubMed

Brown, Larry K; Houck, Christopher; Donenberg, Geri; Emerson, Erin; Donahue, Kelly; Misbin, Jesse

2013-10-01

Adolescents in therapeutic schools are at greater risk for HIV and other STIs than their peers due to earlier higher rates of sexual risk and difficulty managing strong emotions. HIV prevention programs that incorporate techniques for affect management (AM) during sexual situations may be beneficial. This paper determined the immediate impact of such an intervention, AM, compared to a standard, skills-based HIV prevention intervention and a general health promotion intervention (HP) for 377 youth, ages 13-19, in therapeutic schools in two cities. 1 month after the intervention, analyses that adjusted for the baseline scores found adolescents in AM were more likely to report condom use at last sex than those in HP (0.89 vs. 0.67, p = 0.02) and that their HIV knowledge was significantly greater. These data suggest that AM techniques might improve the impact of standard skills-based prevention programs for adolescents in therapeutic schools.

Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa

PubMed Central

Williams, Shannon; Renju, Jenny; Ghilardi, Ludovica; Wringe, Alison

2017-01-01

Abstract Introduction: Observational studies have shown considerable attrition among adolescents living with HIV across the “cascade” of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. Methods: We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. Results and discussion: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents’ engagement in HIV care. Stigma was the most salient factor impeding adolescents’ interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. Conclusions: Adolescents’ initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as “test and treat” policies are scaled up. PMID:28953326

Perceptions of risk to HIV Infection among Adolescents in Uganda: Are they Related to Sexual Behaviour?

PubMed Central

Kibombo, Richard; Neema, Stella; Ahmed, Fatima H.

2008-01-01

Uganda has been hailed as a success story in the fight against HIV that has seen a reversal in prevalence from a peak of 15% in 1991 to about 6.5% currently. Since 1992, the largest and most consistent declines in HIV have occurred among the 15–19-year-olds. While many studies have examined how key behavior changes (Abstinence, Be faithful and Condom use) have contributed to the decline in HIV prevalence, few have studied the relationship between sexual behaviors and risk perception. Using data from the 2004 National Survey of Adolescents, multivariate logistic regression models were fitted to examine the strength of the association between risky sexual behavior and perceived risk among 12–19-year-old adolescents in Uganda. After controlling for other correlates of sexual behavior such as age, education, residence, region and marital status, the findings indicate highly significant positive association between perceived risk and risky sexual behavior among males but not females. The findings reveal that, regardless of their current sexual behavior, most female adolescents in Uganda feel at great risk of HIV infection. The findings also show that adolescents with broken marriages are much more vulnerable to high risk sexual behaviors than other categories of adolescents. These results further emphasize the need for a holistic approach in addressing the social, economic and contextual factors that continue to put many adolescents at risk of HIV infection. PMID:18458740

75 FR 43985 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [30-Day-0920.... Proposed Project Preventing HIV Risk Behaviors among Hispanic Adolescents--New-- National Center for HIV... sex among Hispanic adolescents. Compared to non-Hispanic whites, Hispanic adolescents are highly...

Early and middle adolescents' autonomy development: impact of maternal HIV/AIDS.

PubMed

Murphy, Debra A; Greenwell, Lisa; Resell, Judith; Brecht, Mary-Lynn; Schuster, Mark A

2008-04-01

Progression toward autonomy is considered of central importance during the adolescent period. For young adolescents with an HIV-infected parent, there may be additional challenges. This study investigated current autonomy among early and middle adolescents affected by maternal HIV (N = 108), as well as examined longitudinally the children's responsibility taking when they were younger (age 6-11; N = 81) in response to their mother's illness and their current autonomy as early/middle adolescents. In analyses of self-care and family autonomy, children with greater attachment to their mothers had higher autonomy, and there was a trend for children who drink or use drugs alone to have lower autonomy. In analyses of management autonomy, attachment to peers was associated with higher autonomy. Trajectory group findings indicate that those children who had taken on more responsibility for instrumental caretaking roles directly because of their mother's illness showed better autonomy development as early and middle age adolescents. Therefore, 'parentification' of young children with a mother with HIV may not negatively affect later autonomy development.

Sexual behavior, knowledge and information sources of very young adolescents in four sub-Saharan African countries.

PubMed

Bankole, Akinrinola; Biddlecom, Ann; Guiella, Georges; Singh, Susheela; Zulu, Eliya

2007-12-01

Adolescents are a key target group for HIV and pregnancy prevention efforts, yet very little is known about the youngest adolescents: those under age 15. New survey data from 12-14 year olds in Burkina Faso, Ghana, Malawi and Uganda are used to describe their sexual activity, knowledge about HIV, STIs and pregnancy prevention, and sources of sexual and reproductive health information, including sex education in schools. Results show that very young adolescents are already beginning to be sexually active and many believe their close friends are sexually active. They have high levels of awareness but little in-depth knowledge about pregnancy and HIV prevention. Multiple information sources are used and preferred by very young adolescents. Given their needs for HIV, STI and pregnancy prevention information that is specific and practical and considering that the large majority are attending school in most countries in Sub-Saharan Africa, school-based sex education is a particularly promising avenue for reaching adolescents under age 15.

[Consensus document on psychiatric and psychological aspect in adults and children with HIV infection].

PubMed

2016-01-01

This consensus document is an update of psychiatric and psychological disorders guidelines in HIV-patientes, from the standpoint of care. This document has been approved by expert panel of SPNS, SEP, GESIDA and SEIP, after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented at conferences. The strength of recommendation and gradation of their evidence are based onthe GRADE system. HIV Patient care should include psychological and psychiatric care which is necessary for early detection thereof. Should suicidal ideation, refer the patient to a psychiatric unit. Pharmacological treatment is recommended when there is comorbidity with moderate or severe depression. You should look for the etiology of neuropsychiatric disorder before using psychoactive drugs in HIV patients. The overall management of the health of HIV adolescents should include an assessment of mental health, environmental stressors and support systems. Training in the management of the patient both own emotions is critical to getting provide optimal care. These new guidelines updated previous recommendations regarding psychiatric and psychological disorders, including the most common pathologies in adults and children. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Adolescent religiosity and attitudes to HIV and AIDS in Ghana.

PubMed

Amoako-Agyeman, Kofi Nyame

2012-11-01

This study investigated the relationships between adolescent religiosity and attitudes to HIV/AIDS based on two major techniques of analysis, factor and regression analysis towards informing preventive school education strategies. Using cross-sectional data of 448 adolescents in junior high school, the study incorporated survey in a self-administered questionnaire and sought to identify underlying factors that affect pupils' responses, delineate the pattern of relationships between variables and select models which best explain and predict relationships among variables. A seven-factor solution described the 'attitude' construct including abstinence and protection, and six for 'religiosity'. The results showed relatively high levels of religiosity and a preference for private religiosity as opposed to organisational religiosity. The regression analysis produced significant relationships between factors of attitudes to HIV/AIDS and of religiosity. Adolescent with very high private religiosity are more likely to abstain from sex but less likely to use condoms once they initiate: protection is inversely related to religiosity. The findings suggest that religious-based adolescent interventions should focus on intrinsic religiosity. Additionally, increasing HIV prevention information and incorporating culturally relevant and socially acceptable values might lend support to improved adolescent school-based HIV/AIDS prevention programmes.

The Case for Adolescent HIV Vaccination in South Africa

PubMed Central

Moodley, Nishila; Gray, Glenda; Bertram, Melanie

2016-01-01

Abstract Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective. PMID:26825890

The Case for Adolescent HIV Vaccination in South Africa: A Cost-Effectiveness Analysis.

PubMed

Moodley, Nishila; Gray, Glenda; Bertram, Melanie

2016-01-01

Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.

Effect of savings-led economic empowerment on HIV preventive practices among orphaned adolescents in rural Uganda: results from the Suubi-Maka randomized experiment

PubMed Central

Jennings, Larissa; Ssewamala, Fred M.; Nabunya, Proscovia

2015-01-01

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents’ cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10–17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US12.32, ±1.12, p < .001) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group (p < .001). The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home (ΔT1−T0 = +14.9, p < .001), pursue vocational training (ΔT1−T0 = +8.8, p < .01), and start a business (T1−T0 = +6.7, p < .01). Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores (b = +0.19, ±0.09, p < .05), most commonly toward perceived risk of HIV (95.8%, n = 159), sexual abstinence or postponement (91.6%, n = 152), and consistent condom use (93.4%, n = 144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR = 2.017, 95%CI: 1.43–2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions. PMID:26548549

Sex Isn't that Simple: Culture and Context in HIV Prevention Interventions for Gay and Bisexual Male Adolescents

ERIC Educational Resources Information Center

Harper, Gary W.

2007-01-01

Gay and bisexual male adolescents and young adults in the United States have been disproportionately impacted by the HIV pandemic. Despite the steadily increasing rise in their HIV infection rates, there has not been a commensurate increase in HIV prevention programs targeted to the unique social and sexual lives of these youths. Programs that…

Risk perceptions of STIs/HIV and sexual risk behaviours among sexually experienced adolescents in the Northern part of Lao PDR

PubMed Central

2013-01-01

Background Young people in Laos are more vulnerable to STIs/HIV due to their sexual risk behaviours, low perceptions of risk and their socio-cultural environments. Perceived risk of contracting STIs/HIV is crucial for the assessment of their risk regarding their actual sexual risk behaviors. Thus, the objective of this paper is to explore perceptions of risk related to STIs/HIV and identify factors associated with this perceived risk among adolescents. Methods This was a cross sectional study of sexually experienced adolescents aged 14 to 19 years old in the Luangnamtha province. The multistage sampling techniques were used for selecting 1008 adolescents aged 14-19 years old. Of these, 483 respondents reported having had sexual experience was selected for analysis. Univariate and Logistic regression were performed. Result Six per cent of respondents reported ever having had anal sex. Slightly less than two thirds initiated their first sexual intercourse before age 15. Two thirds of the sexually experienced males reported two or more sexual partners during their lifetime with the mean 3.1 + 3.65 while only twelve per cent of girls reported this cumulative number of partners. Slightly more than half (57.6%) regarded themselves to have no risk at all with 17.2 per cent considered themselves to have low risk. Respondents had poor knowledge on STIs/HIV. Factors associated with risk perception of getting STIs were: being male, high level of knowledge about STIs and having had symptoms of STIs in last six months. Perceived risk of getting HIV was significantly associated with being male, having more knowledge about STIs and HIV. Conclusion Adolescents in this study engaged in sexual risk behaviours, but they have low perception of risk getting STI/HIV. Socio-demographic factors, knowledge of STIs/HIV, and the level of exposure to STIs were the main determinants of the risk perception of STIs/HIV. Our finding supports the need to target adolescents in Luangnamtha province for HIV prevention intervention by addressing inaccurate perception of risk and increasing their knowledge on STIs/HIV. PMID:24304698

Prevalence of HIV testing and counseling and associated factors among secondary school students in Botswana.

PubMed

Bodika, Stephane M; Lekone, Phenyo E; Loeto, Peter; Alwano, Mary G; Zulu, Thekiso C; Kim, Evelyn; Machao, Gape; Voetsch, Andrew C

2016-05-01

The World Health Organization recommends HIV testing and counseling (HTC) for all adolescents living in countries with generalized HIV epidemics. In Botswana, HIV prevalence among adolescents 15-19 years is 3.7% and among pregnant adolescents is 10%. We describe the proportion and characteristics of secondary school students who have accessed HTC. A multistage sample survey was conducted among students in Botswana's public secondary schools in 2010. The survey was self-administered using a personal digital assistant device. The HTC rate was estimated using self-reported history of HIV testing. Of 1,632 participants, 52% were girls, 43% aged below 16 years, and 27% had ever had sexual intercourse. Most (81%) students knew where to get tested for HIV. Overall, 2.2% of students were HIV positive by self-report. The HTC rate was 23% overall, 34% among students who had ever had sexual intercourse, and 45% among students who had sexual intercourse in the past 12 months. Being pregnant or having made someone pregnant and having had sexual intercourse in the past 12 months were associated with having been tested for HIV among students who had ever had sexual intercourse. Overall, the HTC rate was low, and the self- reported HIV prevalence was high among secondary students in Botswana. Most sexually active students have never been tested for HIV. Health communications efforts for adolescents that increase demand for HTC, routine opt-out HIV testing in healthcare facilities, and school-based HIV testing are needed as part of a national HIV prevention strategy.

HIV/AIDS transmission knowledge among adolescents aged 11 years from Southern Brazil.

PubMed

Gonçalves, Helen; González-Chica, David Alejandro; Menezes, Ana M B; Hallal, Pedro C; Araújo, Cora L P; Dumith, Samuel C

2013-06-01

To investigate the effect of demographic, socioeconomic, educational and family variables on HIV/AIDS knowledge among adolescents aged 11 years. 3,949 adolescents born in Pelotas (Brazil). HIV/AIDS knowledge was assessed through a self-administered questionnaire and measured through five questions about HIV transmission: heterosexual intercourse, homosexual intercourse, needle sharing, open-mouth kissing and hugging someone with AIDS. All the analyses were adjusted based on a hierarchical model, using Poisson regression with robust adjustment of variance. Prevalence of wrong answers to the examined questions were 17.2% for heterosexual transmission, 44.1% for homosexual intercourse, 34.9% for needle sharing, 25.6% for kiss on the mouth and 16.2% for hugging someone with AIDS. In adjusted analysis, lower knowledge levels were more prevalent among boys, adolescents with lower socioeconomic status and with less maternal education level, among those who had not talked about sex with mother and without sexual education lessons at school. Knowledge was not associated with school type (public or private), skin color or talk about sex with father. Providing information to adolescents is essential to improve knowledge about HIV and other sexually transmitted infections, especially among young males, with lower socioeconomic status and with lower maternal education level. Public policies aimed to reducing HIV infection should consider maternal and school relevance to improve knowledge on adolescents.

[Clinical features of oral lesions in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome in Guangxi autonomous region].

PubMed

Yong, Xiangzhi; Jiang, Lanlan; Lu, Xiangchan; Liu, Wei; Wu, Nianning; Tao, Renchuan

2014-08-01

To investigate the features of oral lesions in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). A total of 127 HIV-seropositive patients were interviewed for health information and examined for their HIV-related oral lesions according to the EC Clearing House Criteria on Oral Problems related to HIV-Infection (1992). The examinations were conducted by dental specialist and HIV specialist. The CD4 T cell count in peripheral blood of the patients was tested by flow cytometry. The patients were divided into HIV- infected group (42) and AIDS group (85) according to CDC Classification System for HIV- Infected Adults and Adolescents (revised in 1993). Chi-square test was used to test the relationship between systemic disease and oral lesions, and the difference of the prevalence of oral lesions between the two groups. Among the 127 patients, oral candidiasis (51/127), oral hairy leukoplakia (24/127) were common oral manifestation. There was no relationship between the oral manifestation and systemic disease (P = 0.397). The occurrence of oral lesions and oral candidiasis was significantly different between the two groups (χ² = 7.684, P = 0.006; χ² = 14.410, P < 0.001). The CD4 count was related to the prevalence of oral lesions (P = 0.006) and oral candidasis (P = 0.003). Most oral lesions appeared before the appearance of systemic disease. Oral candidiasis and oral hairy leukoplakia were the most common lesions.Oral lesions had no relationship with systemic disease but could be still an indicator for disease progress.

Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

PubMed Central

Ahonkhai, Aimalohi A.; Banigbe, Bolanle; Adeola, Juliet; Adegoke, Abdulkabir B.; Regan, Susan; Bassett, Ingrid V.; Idigbe, Ifeoma; Losina, Elena; Okonkwo, Prosper; Freedberg, Kenneth A.

2016-01-01

Purpose Interruptions in HIV care are a major cause of morbidity and mortality, particularly in resource-limited settings. We compared engagement in care and virologic outcomes between HIV-infected adolescents and young adults (AYA) and older adults (OA) one year after starting antiretroviral therapy (ART) in Nigeria. Methods We conducted a retrospective cohort study of AYA (15–24 years) and OA (>24 years) who initiated ART from 2009–2011. We used negative binomial regression to model the risk of inconsistent care and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first year on ART. Regular care included monthly ART pick-up and 3-monthly clinical visits. Patients with ≤3 months between consecutive visits were considered in care. Those with inconsistent care had >3 months between consecutive visits. Results The cohort included 354 AYA and 2,140 OA. More AYA than OA were female (89% vs. 65%, p<0.001). Median baseline CD4 was 252/µL in AYA and 204/µL in OA (p=0.002). More AYA had inconsistent care than OA (55% vs. 47%, p=0.001). Adjusting for sex, baseline CD4, and education, AYA had a greater risk of inconsistent care than OA (RR 1.11, p=0.033). Among those in care after one year on ART, viremia was more common in AYA than OA (40% vs. 26% p=0.003, RR 1.53, p=0.002). Conclusions In a Nigerian cohort, AYA were at increased risk for inconsistent HIV care. Of patients remaining in care, youth was the only independent predictor of viremia at 1 year. Youth-friendly models of HIV care are needed to optimize health outcomes. PMID:27329680

Perceptions of adolescents' sexual behavior among mothers living with and without HIV: does dyadic sex communication matter?

PubMed

Marhefka, Stephanie L; Mellins, Claude Ann; Brackis-Cott, Elizabeth; Dolezal, Curtis; Ehrhardt, Anke A

2009-10-01

Previous studies suggest that mothers can help adolescents make responsible sexual decisions by talking with them about sexual health. Yet, it is not clear how and when mothers make decisions about talking with their adolescents about sex. We sought to determine: (1) the accuracy of mothers' and adolescents' predictions of adolescents' age of sexual debut; and (2) if mothers' beliefs about their adolescents' sexual behavior affected the frequency of mother-adolescent communication about sexual topics and, in turn, if mother-adolescent communication about sexual topics affected mothers' accuracy in predicting adolescents' current and future sexual behavior. Participants were 129 urban, ethnic minority HIV-negative youth (52% male and 48% female; ages 10-14 years at baseline; ages 13-19 years at follow-up) and their mothers; 47% of mothers were HIV-positive. Most mothers and adolescents predicted poorly when adolescents would sexually debut. At baseline, mothers' communication with their early adolescents about sexual topics was not significantly associated with mothers' assessments of their early adolescents' future sexual behavior. At follow-up, mothers were more likely to talk with their adolescents about HIV prevention and birth control if they believed that their adolescents had sexually debuted, though these effects were attenuated by baseline levels of communication. Only one effect was found for adolescents' gender: mothers reported greater communication about sex with daughters. Studies are needed to determine how mothers make decisions about talking with their adolescents about sex, as well as to examine to what extent and in what instances mothers can reduce their adolescents' sexual risk behavior by providing comprehensive, developmentally appropriate sex education well before adolescents are likely to debut.

Relationships between familial HIV/AIDS and symptoms of anxiety and depression: the mediating effect of bullying victimization in a prospective sample of South African children and adolescents.

PubMed

Boyes, Mark E; Cluver, Lucie D

2015-04-01

South African children and adolescents living in HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms. Poverty and HIV/AIDS-related stigma are additional risk factors for these negative mental health outcomes. Community level factors, such as poverty and stigma, are difficult to change in the short term and identifying additional potentially malleable mechanisms linking familial HIV/AIDS with mental health is important from an intervention perspective. HIV/AIDS-affected children are also at increased risk of bullying victimization. This longitudinal study aimed to determine whether prospective relationships between familial HIV/AIDS and both anxiety symptoms and depressive symptoms operate indirectly via bullying victimization. Adolescents (M = 13.45 years, 56.67 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up one year later (n = 3,401, 96.70 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces, and door-to-door sampling included all households with a resident child/adolescent. Familial HIV/AIDS at baseline assessment was not directly associated with mental health outcomes 1 year later. However, significant indirect effects operating via bullying victimization were obtained for both anxiety and depression scores. Importantly, these effects were independent of poverty, HIV/AIDS-related stigma, and baseline mental health, which highlight bullying victimization as a potential target for future intervention efforts. The implementation and rigorous evaluation of bullying prevention programs in South African communities may improve mental health outcomes for HIV/AIDS-affected children and adolescents and this should be a focus of future research and intervention.

Seroprevalence of HIV, HTLV, CMV, HBV and rubella virus infections in pregnant adolescents who received care in the city of Belém, Pará, Northern Brazil.

PubMed

Guerra, Aubaneide Batista; Siravenha, Leonardo Quintão; Laurentino, Rogério Valois; Feitosa, Rosimar Neris Martins; Azevedo, Vânia Nakauth; Vallinoto, Antonio Carlos Rosário; Ishak, Ricardo; Machado, Luiz Fernando Almeida

2018-05-16

Prenatal tests are important for prevention of vertical transmission of various infectious agents. The objective of this study was to describe the prevalence of human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), hepatitis B virus (HBV), cytomegalovirus (CMV), rubella virus and vaccination coverage against HBV in pregnant adolescents who received care in the city of Belém, Pará, Brazil. A cross-sectional study was performed with 324 pregnant adolescents from 2009 to 2010. After the interview and blood collection, the patients were screened for antibodies and/or antigens against HIV-1/2, HTLV-1/2, CMV, rubella virus and HBV. The epidemiological variables were demonstrated using descriptive statistics with the G, χ 2 and Fisher exact tests. The mean age of the participants was 15.8 years, and the majority (65.4%) had less than 6 years of education. The mean age at first intercourse was 14.4 years, and 60.8% reported having a partner aged between 12 and 14 years. The prevalence of HIV infection was 0.3%, and of HTLV infection was 0.6%. Regarding HBV, 0.6% of the participants had acute infection, 9.9% had a previous infection, 16.7% had vaccine immunity and 72.8% were susceptible to infection. The presence of anti-HBs was greater in adolescent between 12 and 14 years old (28.8%) while the anti-HBc was greater in adolescent between 15 and 18 years old (10.3%). Most of the adolescents presented the IgG antibody to CMV (96.3%) and rubella (92.3%). None of the participants had acute rubella infection, and 2.2% had anti-CMV IgM. This study is the first report of the seroepidemiology of infectious agents in a population of pregnant adolescents in the Northern region of Brazil. Most of the adolescents had low levels of education, were susceptible to HBV infection and had IgG antibodies to CMV and rubella virus. The prevalence of HBV, HIV and HTLV was similar to that reported in other regions of Brazil. However, the presence of these agents in this younger population reinforces the need for good prenatal follow-up and more comprehensive vaccination campaigns against HBV due to the large number of women susceptible to the virus.

Knowledge of HIV/AIDS among adolescents in Chillán, Chile.

PubMed

Pérez V, Ruth; Barrales C, Ingrid; Jara P, Jenny; Palma R, Virla; Ceballos M, Alejandra

2008-12-01

to analyse adolescents' knowledge of preventive sexual practices related to human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) by means of a questionnaire recommended by the Joint United Nations Programme on HIV/AIDS (UNAIDS). non-experimental, cross-sectional, descriptive and analytical investigation. four schools in Chillán, Chile, 2005. a total of 480 adolescents aged between 15 and 19 years. Students completed a questionnaire recommended by UNAIDS in order to develop basic indicators. the indicator of preventive sexual practices related to HIV/AIDS was 32.5%; forms of prevention (62.5%) were better known than erroneous ideas about transmission (46%). Adolescents from the only private school in the study demonstrated greater knowledge (43.3%) than students from the public schools (25%) (p<0.01). No significant differences were found in knowledge according to age, sex or educational level. adolescents have poor knowledge of preventive sexual practices related to HIV and AIDS. It is necessary to implement an indicator of knowledge that allows for the creation and monitoring of sexual education programmes.

Social-support needs among adolescents living with HIV in transition from pediatric to adult care in Cambodia: findings from a cross-sectional study.

PubMed

Toth, Graham; Mburu, Gitau; Tuot, Sovannary; Khol, Vohith; Ngin, Chanrith; Chhoun, Pheak; Yi, Siyan

2018-03-28

Understanding the circumstances of adolescents living with HIV is critical in designing adolescent-friendly services that will facilitate successful transition from pediatric to adult care. This study describes access, utilization and ongoing social support needs among adolescents living with HIV aged 15-17 in transition from pediatric to adult HIV care in Cambodia. A cross-sectional study was conducted among 328 adolescents, randomly selected from 11 antiretroviral therapy (ART) clinics across the country. Descriptive analyses were conducted to summarize their characteristics, access to social support and ongoing support needs among male and female adolescents. Mean age of the study participants was 15.8 (SD = 0.8) years. Just over half (55.2%) were male. Most had at least one deceased parent (mother 50.9%; father 60.5%), and majority were living with biological parents (40.8%) or relatives (49.3%). A third came from families with an ID poor card, and 21.0% were working for pay. Almost half (46.6%) reported that their family had received social support for their health care, including food support (76.5%), school allowance (62.1%), transport allowance to ART clinics (53.6%), psychosocial counseling (35.3%), vocational training (22.9%) or home visits (11.1%). Several ongoing social support needs were identified, including ongoing inability to cover health expenses unless they are supported by health insurance or health equity fund (55.0%). In addition, adolescents reported having been asked to come back earlier than their scheduled appointment (13.7%), having had to purchase their own drugs (2.7%), experiencing HIV stigma (32.0%), having been denied housing or food due to HIV (8.2%) or failing to attend school within the past month partly because of HIV (16.8%). Two-thirds did not have access to peer support groups. Social protection mechanisms are reaching some adolescents in need, while other remain without social support due to discontinuities in health and social care. Multi-sectoral interventions, supporting school attendance, adolescent-friendly clinic scheduling, reductions in child employment, mitigation of HIV-related stigma and strengthening of peer-to-peer support are required to improve coverage of social protection interventions for adolescents in transition.

Loss to follow-up among children and adolescents growing up with HIV infection: age really matters.

PubMed

Kranzer, Katharina; Bradley, John; Musaazi, Joseph; Nyathi, Mary; Gunguwo, Hilary; Ndebele, Wedu; Dixon, Mark; Ndhlovu, Mbongeni; Rehman, Andrea; Khan, Palwasha; Vogt, Florian; Apollo, Tsitsi; Ferrand, Rashida Abbas

2017-07-17

Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence. Individuals aged 5-19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5-9 (children), 10-14 (young adolescents) and 15-19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression. Of 2273 participants, 1013, 875 and 385 initiated ART aged 5-9, 10-14 and 15-19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94-2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05-3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups. Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.

Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming.

PubMed

Closson, Kalysha; Dietrich, Janan; Lachowsky, Nathan J; Nkala, Busi; Cui, Zishan; Chia, Jason; Hogg, Robert S; Gray, Glenda; Kaida, Angela; Miller, Cari L

2018-04-01

Sexual self-efficacy (SSE) - one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents' HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14-19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16-17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.

Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French perinatal cohort (EPF/ANRS CO10).

PubMed

Dollfus, C; Le Chenadec, J; Faye, A; Blanche, S; Briand, N; Rouzioux, C; Warszawski, J

2010-07-15

BACKGROUND. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited. METHODS. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10). RESULTS. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/microL, and 200 cells/microL was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART. CONCLUSIONS. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.

Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe.

PubMed

Vogt, Florian; Rehman, Andrea M; Kranzer, Katharina; Nyathi, Mary; Van Griensven, Johan; Dixon, Mark; Ndebele, Wedu; Gunguwo, Hilary; Colebunders, Robert; Ndlovu, Mbongeni; Apollo, Tsitsi; Ferrand, Rashida A

2017-04-01

Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown. To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents. We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models. Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively. Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.

Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe

PubMed Central

Rehman, Andrea M.; Kranzer, Katharina; Nyathi, Mary; Van Griensven, Johan; Dixon, Mark; Ndebele, Wedu; Gunguwo, Hilary; Colebunders, Robert; Ndlovu, Mbongeni; Apollo, Tsitsi; Ferrand, Rashida A.

2017-01-01

Background: Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown. Objective: To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents. Methods: We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models. Results: Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively. Conclusions: Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up. PMID:28002183

Receptivity of African American Adolescents to an HIV-Prevention Curriculum Enhanced by Text Messaging

PubMed Central

Cornelius, Judith B.; St Lawrence, Janet S.

2013-01-01

PURPOSE This study assessed African American adolescents’ receptivity to an HIV-prevention curriculum enhanced by text messaging. DESIGN AND METHODS Two focus groups were conducted with 14 African American adolescents regarding how an HIV-prevention curriculum could be enhanced for text messaging delivery. RESULTS The adolescents were receptive to the idea of text messaging HIV-prevention information but wanted to receive a maximum of three messages per day during the hours of 4:00–6:00 p.m. PRACTICE IMPLICATIONS By taking the findings of this study, nurses, other healthcare providers, and community-based organizations can adapt evidence-based interventions for text messaging delivery to individuals at high risk for HIV infection. PMID:19356206

Characteristics of Children and Adolescents Diagnosed with HIV By Targeted and Diagnostic Testing in a Children's Hospital Network.

PubMed

Gutman, Colleen K; Middlebrooks, Lauren S; Zmitrovich, April; Camacho-Gonzalez, Andres; Morris, Claudia R

2018-06-05

Across the United States (US), rates of new human immunodeficiency virus (HIV) diagnosis have declined 1 . Despite this, adolescents have experienced increases in HIV diagnosis rates 1,2 . It is estimated that half of adolescents are unaware of their diagnosis 1,3 and that, on average, they are infected with HIV for nearly 3 years prior to diagnosis 2 . The Centers for Disease Control and Prevention (CDC) recommends routine universal HIV screening for everyone over age 13 in healthcare settings. These recommendations have not been widely implemented in pediatrics 4,5 , where HIV testing is often offered only to select high-risk populations or as part of a diagnostic work-up. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The protective role of religious coping in adolescents’ responses to poverty and sexual decision-making in rural Kenya

PubMed Central

Watt, Melissa H.; Sikkema, Kathleen J.; Ogwang-Odhiambo, Rose A.; Broverman, Sherryl A.

2011-01-01

In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and Human Immunodeficiency Virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual decision-making; the majority (29) reported religious coping with these or other stressors. Adolescents reported praying for God to partner with them to engage in positive behaviors, praying for strength to resist unwanted behaviors, and passive strategies characterized by waiting for God to provide resources or protection from HIV. Adolescents in Sub-Saharan Africa may benefit from HIV prevention interventions that integrate and build upon their use of religious coping. PMID:22505794

Knowledge and awareness regarding menstruation and HIV/AIDS among schoolgoing adolescent girls

PubMed Central

Jain, Rakhi; Anand, Puneet; Dhyani, Anuj; Bansal, Deshant

2017-01-01

Introduction: Menstruation in our country is associated with various myths and restrictions leading to lack of awareness among adolescent girls. Insufficient menstrual hygiene practices are the cause of stress associated with menstruation and reproductive tract infections. Sexually transmitted infections and HIV/AIDS are not openly discussed in our society making adolescents vulnerable to them. Aim: To assess the knowledge of school going adolescent girls regarding menstrual hygiene and HIV/AIDS. Materials and Methods: Girls studying in class 8th-12th standard and who have attained menarche were included in the study. A predesigned questionnaire, which consisted of questions related to menstrual awareness and knowledge about HIV/AIDS was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages. Results: 282 girls took part in the study. Mean age of girls was 14.70 ± 1.5 years. Median age of girls was 15 years. Knowledge regarding menstrual hygiene and HIV/AIDS was found to be only satisfactory leaving a scope of improvement. Mother was the main source of information regarding both menstruation and HIV/AIDS. Conclusion: A comprehensive health education programme involving mothers is required to remove various misconceptions and taboos associated with menstruation and make it a pleasant experience for adolescent girls. Information, education and awareness programmes need to be strengthened to spread awareness regarding HIV/AIDS. PMID:29026748

Personalized Biobehavioral HIV Prevention for Women and Adolescent Girls.

PubMed

Brawner, Bridgette M; Teitelman, Anne M; Bevilacqua, Amanda W; Jemmott, Loretta Sweet

2013-09-01

Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk-reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk-reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Generalized programs and interventions may not have universal, transnational, and crosscultural implications. Personalized biobehavioral strategies are needed to comprehensively address vulnerabilities at biological, social, and structural levels.

Personalized Biobehavioral HIV Prevention for Women and Adolescent Girls

PubMed Central

Teitelman, Anne M.; Bevilacqua, Amanda W.; Jemmott, Loretta Sweet

2013-01-01

Background: Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. Primary Study Objective: The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. Methods: We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. Results: The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk—reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk—reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Conclusions: Generalized programs and interventions may not have universal, transnational, and crosscultural implications. Personalized biobehavioral strategies are needed to comprehensively address vulnerabilities at biological, social, and structural levels. PMID:24416702

Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?

PubMed

Cluver, L D; Toska, E; Orkin, F M; Meinck, F; Hodes, R; Yakubovich, A R; Sherr, L

2016-03-01

Low ART-adherence amongst adolescents is associated with morbidity, mortality and onward HIV transmission. Reviews find no effective adolescent adherence-promoting interventions. Social protection has demonstrated benefits for adolescents, and could potentially improve ART-adherence. This study examines associations of 10 social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10-19-year-olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa's Eastern Cape were traced and interviewed in 2014-2015 (n = 1175 eligible). About 90% of the eligible sample was included (n = 1059). Social protection provisions were "cash/cash in kind": government cash transfers, food security, school fees/materials, school feeding, clothing; and "care": HIV support group, sports groups, choir/art groups, positive parenting and parental supervision/monitoring. Analyses used multivariate regression, interaction and marginal effects models in SPSS and STATA, controlling for socio-demographic, HIV and healthcare-related covariates. Findings showed 36% self-reported past-week ART non-adherence (<95%). Non-adherence was associated with increased opportunistic infections (p = .005, B .269, SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1-3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR .57, CI .42-.76, p < .001); HIV support group attendance (aOR .60, CI .40-.91, p < .02), and high parental/caregiver supervision (aOR .56, CI .43-.73, p < .001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection 39-41%, with any two social protections, 27-28% and with all three social protections, 18%. These results demonstrate that social protection provisions, particularly combinations of "cash plus care", may improve adolescent adherence. Through this they have potential to improve survival and wellbeing, to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents.

Troubled Adolescents and HIV Infection.

ERIC Educational Resources Information Center

Woodruff, John O., Ed.; And Others

This report on adolescents, Acquired Immune Deficiency Syndrome (AIDS), and Human Immune Virus (HIV) infection had its beginning in the Knowledge Development Workshop "Issues in the Prevention and Treatment of AIDS Among Adolescents with Serious Emotional Disturbance," held June 9-10, 1988 in the District of Columbia. These papers are included:…

Environmental Barriers to HIV Prevention among Incarcerated Adolescents: A Qualitative Assessment

ERIC Educational Resources Information Center

Freedman, Darcy; Salazar, Laura F.; Crosby, Richard A.; DiClemente, Ralph J.

2005-01-01

The purpose of this research was to identify environmental factors that influence incarcerated adolescents' risk for HIV/STDs. Based on data from six gender-stratified focus groups consisting of 28 incarcerated adolescents from three detention centers in Georgia, the following salient environments emerged: schools, families, peer groups,…

Adolescent Behavior Change: A Review.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Educational Programs and Studies Information Service.

This focus paper contains reprints of 11 articles intended to provide an overview of the key issues in the area of adolescent behavior change as it relates to Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) education. Included are: (1) "Preventing HIV Infection and AIDS in Children and Adolescents" (J.…

Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis.

PubMed

Knopf, Amelia S; McNealy, Kim R; Al-Khattab, Halima; Carter-Harris, Lisa; Oruche, Ukamaka Marian; Naanyu, Violet; Draucker, Claire Burke

2017-01-01

AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics. Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population. The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy. The three phases of sexual learning interact to shape adolescents' sexual lives and their risk for HIV infection. This framework will contribute to the development of sexual education programs that address HIV risk within the broader context of sexual learning.

Adolescent HIV Prevention: An Application of the Elaboration Likelihood Model.

ERIC Educational Resources Information Center

Metzler, April E.; Weiskotten, David; Morgen, Keith J.

Ninth grade students (n=298) participated in a study to examine the influence source credibility, message, quality, and personal relevance on HIV prevention message efficacy. A pilot study with adolescent focus groups created the high and low quality messages, as well as the high (HIV+) and low (worried parent) credibility sources. Participants…

EveryBody[TM]: Preventing HIV and Other Sexually Transmitted Diseases among Young Teens.

ERIC Educational Resources Information Center

Schoeberlein, Deborah

EveryBody is a curriculum that emphasizes prevention of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among early adolescents. It fosters active learning and facilitates communication about HIV/STD prevention and promotes safer behaviors. EveryBody incorporates current research on adolescent development so it…

"Mbizi": Empowerment and HIV/AIDS Prevention for Adolescent Girls in Botswana

ERIC Educational Resources Information Center

Nitza, Amy; Chilisa, Bagele; Makwinja-Morara, Veronica

2010-01-01

This article describes a small group intervention for HIV/AIDS prevention among adolescent girls in Botswana. The psychoeducational group model is designed to empower girls to overcome the gender inequality that puts women at increased risk of HIV infection in the country. Group goals include heightening group members' awareness of the influence…

Female Secondary School Adolescents' Sexual Behavior and School Based HIV/AIDS Education Program

ERIC Educational Resources Information Center

Inyang, Mfrekemfon P.

2013-01-01

Most adolescents engage in indiscriminate sexual experimentations. This practice exposes them to the risk of contracting sexually transmitted infections including HIV/AIDS. Human immunodeficiency virus (HIV) and acquired immune deficiency syndromes (AIDS) are among the deadly diseases that exist globally. Twice as many girls, compared to boys…

Factors influencing teen mothers' enrollment and participation in prevention of mother-to-child HIV transmission services in Limpopo Province, South Africa.

PubMed

Varga, Christine; Brookes, Heather

2008-06-01

In this article, we examine barriers to HIV testing uptake and participation in prevention of mother-to-child HIV transmission (PMTCT) services among adolescent mothers aged 15 to 19 years in rural and urban Limpopo Province, South Africa. We used the narrative research method involving key informants constructing typical case studies of adolescent experiences with HIV testing and entry into PMTCT. Case studies formed the basis of a community-based questionnaire and focus group discussions with adolescent mothers. Client-counselor dynamics during pretest counseling were pivotal in determining uptake and participation, and counselor profile strongly influenced the nature of the interaction. Other factors found to influence adherence to PMTCT recommendations included HIV and early premarital pregnancy stigma, fear of a positive test result, and concerns over confidentiality and poor treatment by health care providers. Adolescents described elaborate strategies to avoid HIV disclosure to labor and delivery staff, despite knowing this would mean no antiretroviral therapy for their newborn infants. Theoretical, methodological, and programmatic implications of study findings are also discussed.

What HIV programs work for adolescent girls?

PubMed

Hardee, Karen; Gay, Jill; Croce-Galis, Melanie; Afari-Dwamena, Nana Ama

2014-07-01

Adolescent girls face unique challenges in reducing their risk of acquiring HIV because of gender inequalities, but much of HIV programming and evaluation lacks a specific focus on female adolescents. This article, based on a review of 150 studies and evaluations from 2001 to June 2013, reviews evidence on programming for adolescents that is effective for girls or could be adapted to be effective for girls. The evidence suggests specific interventions for adolescent girls across 3 critical areas: (1) an enabling environment, including keeping girls in school, promoting gender equity, strengthening protective legal norms, and reducing gender-based violence; (2) information and service needs, including provision of age-appropriate comprehensive sex education, increasing knowledge about and access to information and services, and expanding harm reduction programs for adolescent girls who inject drugs; and (3) social support, including promoting caring relationships with adults and providing support for adolescent female orphans and vulnerable children. Numerous gaps remain in evidence-based programming for adolescent girls, including a lack of sex- and age-disaggregated data and the fact that many programs are not explicitly designed or evaluated with adolescents in mind. However, evidence reinforces bolstering critical areas such as education, services, and support for adolescent girls. This article contributes to the growing body of literature on HIV and adolescent girls and reviews the vulnerabilities of girls, articulates the challenges of programming, develops a framework for addressing the needs of girls, and reviews the evidence for successful programming for adolescent girls.

The Botsha Bophelo Adolescent Health Study: A profile of adolescents in Soweto, South Africa

PubMed Central

Miller, Cari L.; Nkala, Busisiwe; Closson, Kalysha; Chia, Jason; Cui, Zishan; Palmer, Alexis; Hogg, Robert; Kaida, Angela; Gray, Glenda

2017-01-01

Background Youth between the ages of 15 years to 24 years account for almost half of new HIV infections in South Africa. Objectives To describe the study details of the Botsha Bophelo Adolescent Health Study (BBAHS) which was an investigation of HIV risk among adolescents living in Soweto, South Africa. Methods Eligibility criteria for the BBAHS included being 14 years – 19 years old and living in one of the 41 identified formal and informal areas in the township of Soweto. A cross-sectional survey was developed between investigators and an adolescent community advisory board consisting of previously validated scales and original questions including demographics, sexual and reproductive health, health service utilisation and psychosocial behaviours. Results Between 2010 and 2012, interviewers administered surveys among 830 adolescents (57% females), whose median age was 17 years (Q1, Q3: 16, 18), and found that 43% of participants identified their ethnicity as Zulu, 52% reported high food insecurity, 37% reported at least one parent had died, 15% reported living in a shack and 83% identified as heterosexual. Over half of the participants (55%) reported ever having sex (49% of females and 64% of males), 11% of whom initiated sex at < 15 years of age (3% females and 21% males). Almost half (47%) reported ever testing for HIV, 3% (n = 12) of whom self-reported being HIV-positive and 33% (n = 4) were on antiretroviral therapy. Conclusion Our study highlights important individual, relational and structural level determinants of HIV risk for adolescent men and women growing up within HIV hyperendemic settings. PMID:29568638

Clinical and virologic follow-up in perinatally HIV-1-infected children and adolescents in Madrid with triple-class antiretroviral drug-resistant viruses.

PubMed

Rojas Sánchez, P; de Mulder, M; Fernandez-Cooke, E; Prieto, L; Rojo, P; Jiménez de Ory, S; José Mellado, M; Navarro, M; Tomas Ramos, J; Holguín, Á

2015-06-01

Drug resistance mutations compromise the success of antiretroviral treatment in human immunodeficiency virus type 1 (HIV-1)-infected children. We report the virologic and clinical follow-up of the Madrid cohort of perinatally HIV-infected children and adolescents after the selection of triple-class drug-resistant mutations (TC-DRM). We identified patients from the cohort carrying HIV-1 variants with TC-DRM to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors and protease inhibitors according to IAS-USA-2013. We recovered pol sequences or resistance profiles from 2000 to 2011 and clinical-immunologic-virologic data from the moment of TC-DRM detection until December 2013. Viruses harbouring TC-DRM were observed in 48 (9%) of the 534 children and adolescents from 2000 to 2011, rising to 24.4% among those 197 with resistance data. Among them, 95.8% were diagnosed before 2003, 91.7% were Spaniards, 89.6% carried HIV-1-subtype B and 75% received mono/dual therapy as first regimen. The most common TC-DRM present in ≥50% of them were D67NME, T215FVY, M41L and K103N (retrotranscriptase) and L90M (protease). The susceptibility to darunavir, tipranavir, etravirine and rilpivirine was 67.7%, 43.7%, 33.3% and 33.3%, respectively, and all reported high resistance to didanosine, abacavir and nelfinavir. Despite the presence of HIV-1 resistance mutations to the three main antiretroviral families in our paediatric cohort, some drugs maintained their susceptibility, mainly the new protease inhibitors (tipranavir and darunavir) and nonnucleoside reverse transcriptase inhibitors (etravirine and rilpivirine). These data will help to improve the clinical management of HIV-infected children with triple resistance in Spain. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Association of State-Mandated Abstinence-only Sexuality Education with Rates of Adolescent HIV Infection and Teenage Pregnancy.

PubMed

Elliot, L M; Booth, M M; Patterson, G; Althoff, M; Bush, C K; Dery, M A

2017-01-01

Abstinence-only sexuality education (AOSE); is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Using publicly available data on all 50 United States' laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 - Level 3);. We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states' ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. The majority of states (~44 percent ); have legally mandated AOSE policies (Level 3); and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50 percent of an African American population. These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality education policies in US public schools.

Multidimensional family therapy HIV/STD risk-reduction intervention: an integrative family-based model for drug-involved juvenile offenders.

PubMed

Marvel, Francoise; Rowe, Cynthia L; Colon-Perez, Lissette; DiClemente, Ralph J; Liddle, Howard A

2009-03-01

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/ STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/ STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.

Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach.

PubMed

Wathuta, Jane

2016-11-10

The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-à-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.

A randomized control trial evaluating the educational effectiveness of a rapid HIV posttest counseling video.

PubMed

Calderon, Yvette; Leider, Jason; Hailpern, Susan; Haughey, Marianne; Ghosh, Reena; Lombardi, Pamela; Bijur, Polly; Bauman, Laurie

2009-04-01

Many of the individuals most at risk for HIV infection (i.e., minority populations, women, adolescents) are also the most marginalized by our health care system. Lacking primary care providers, they rely on the Emergency Department (ED) for their health care needs and education. In this prospective randomized controlled trial, we compared the educational effectiveness of a 15-minute posttest counseling video with the normal practice of a session with an HIV counselor. The study population was composed of ambulatory patients recruited for rapid HIV testing in the ED. The RAs (research assistants) recruited a convenience sample of stable patients presenting to the walk-in section of an inner-city adult ED for rapid HIV testing. Eligible patients for this study included patients who consented for the rapid HIV test and completed measures on condom intention and condom use self-efficacy. Before receiving their results, participants who consented to be in this study were randomized to either a 15-minute HIV posttest educational video available in English/Spanish or to a posttest educational session with an HIV counselor. Afterwards, both groups completed an assessment tool concerning HIV prevention and transmission. Of the 128 participants, 61 and 67 patients were randomized to the video and counselor groups, respectively. The groups were similar with respect to gender, ethnicity and experience with prior HIV testing. Mean knowledge scores were higher in the video group (76.20% vs. 69.3%; 90% CI for the difference, 2.8, 11.2). As the lower bound of the CI for the difference was higher than the lower equivalence boundary (-5%), we infer that the video was at least as effective as the counselor educational session. The use of an educational counseling video is a valid alternative for providing posttest education and prevention information during the waiting period associated with the 20-minute HIV rapid test. Without disruption in clinical flow, both testing and education can be accomplished in a meaningful way in a busy ED.

Text-Messaging-Enhanced HIV Intervention for African American Adolescents: A Feasibility Study

PubMed Central

Cornelius, Judith B.; Dmochowski, Jacek; Boyer, Cherrie; St Lawrence, Janet; Lightfoot, Marguerita; Moore, Michael

2013-01-01

We examined the feasibility and acceptability of an HIV prevention intervention for African American adolescents delivered via mobile cell phones and looked at intervention-related changes in beliefs and sexual behaviors. We used a longitudinal one-group comparison design with data collected at three points. Forty adolescents, 13–18 years old, participated in the Becoming a Responsible Teen intervention followed by the delivery of daily multimedia messages for 3 months. The mobile-cell-phone enhanced intervention was feasible and acceptable to the participants. Greater HIV knowledge, improved attitudes toward condoms, and increased perceived HIV risk scores were observed with older adolescents (16–18 years old). Behavior trends showed a decrease in the number of times participants reported engaging in unprotected sexual intercourse over the previous 2 months. Mobile-cell-phone multimedia-text-messaging boosters tested in this study provided preliminary evidence of efficacy of the enhanced HIV prevention intervention for African American youth. PMID:23122907

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures

PubMed Central

Kaufman, Michelle R; Patel, Eshan U; Dam, Kim H; Packman, Zoe R; Van Lith, Lynn M; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-01-01

Abstract Background The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Methods Quantitative surveys were conducted among male adolescents aged 10–19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization–recommended HIV minimum package and the US President’s Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Results Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15–19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10–14 years; adjusted β, 0.17; 95% confidence interval [CI], .12–.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16–2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30–4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Conclusions Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires standardizing counseling content, as there are significant age differences in HIV prevention content received by adolescents. PMID:29617776

Sexual and Gender Minority Adolescents' Views On HIV Research Participation and Parental Permission: A Mixed-Methods Study.

PubMed

Mustanski, Brian; Coventry, Ryan; Macapagal, Kathryn; Arbeit, Miriam R; Fisher, Celia B

2017-06-01

Sexual and gender minority adolescents are underrepresented in HIV research, partly because institutional review boards (IRBs) are reluctant to waive parental permission requirements for these studies. Understanding teenagers' perspectives on parental permission and the risks and benefits of participating in HIV research is critical to informing evidence-based IRB decisions. Data from 74 sexual and gender minority adolescents aged 14-17 who participated in an online focus group in 2015 were used to examine perspectives on the risks and benefits of participation in a hypothetical HIV surveillance study and the need for parental permission and adequate protections. Data were analyzed thematically; mixed methods analyses examined whether concerns about parental permission differed by whether teenagers were out to their parents. Most adolescents, especially those who were not out to their parents, would be unwilling to participate in an HIV study if parental permission were required. Perceived benefits of participation included overcoming barriers to HIV testing and contributing to the health of sexual and gender minority youth. Few risks of participation were identified. Adolescents suggested steps that researchers could take to facilitate informed decision making about research participation and ensure minors' safety in the absence of parental permission; these included incorporating multimedia presentations into the consent process and explaining researchers' motivations for conducting the study. Respondents believed that the benefits of HIV surveillance research outweighed the risks. Requiring parental permission may exclude many sexual and gender minority teenagers from taking part in HIV research, especially if they are not out. Copyright © 2017 by the Guttmacher Institute.

Social support among HIV-positive and HIV-negative adolescents in Umlazi, South Africa: changes in family and partner relationships during pregnancy and the postpartum period.

PubMed

Hill, Lauren M; Maman, Suzanne; Groves, Allison K; Moodley, Dhayendre

2015-05-17

Pregnancy is common among adolescents in South Africa, yet the social experiences of adolescents during the pregnancy and postpartum period remain understudied in this context. We aimed to explore how adolescent women's discovery and disclosure of both their pregnancy and HIV status affected their relationships with family members and sexual partners, with a particular focus on whether and how support changed throughout this time period. We conducted in-depth semi-structured interviews with 15 HIV-positive and HIV-negative adolescent women who were either pregnant or had delivered in the last 18 months from one urban clinic in Umlazi, South Africa. Interviews were audiotaped, transcribed, translated, and coded for analysis. Young women described stress and instability in their relationships with family and partners during pregnancy and the postpartum period, though prior to and during HIV-status disclosure women generally experienced less stress than in disclosing their pregnancy to family members and partners. After a destabilizing period immediately following pregnancy disclosure, families became and remained the primary source of material and emotional support for the young women. Women discussed heightened closeness with their partners during pregnancy, but few women had close relationships with their partners postpartum. Support experiences did not differ by HIV status. Programs should be aware of the relative importance of pregnancy-related concerns over HIV-related concerns in this population of young women. Engaging family members is critical in ensuring social support for this population of young pregnant women, and in encouraging timely initiation of antenatal care.

Hemorrhagic Stroke in an Adolescent Female with HIV-Associated Thrombotic Thrombocytopenic Purpura

PubMed Central

Rakhmanina, Natella; Wong, Edward CC; Davis, Jeremiah C; Ray, Patricio E

2014-01-01

HIV-1 infection can trigger acute episodes of Idiopathic Thrombocytoponic Purpura (ITP), and Thrombotic Thrombocytopenic Purpura (TTP), particularly in populations with advanced disease and poor adherence to antiretroviral therapy (ART). These diseases should be distinguished because they respond to different treatments. Previous studies done in adults with HIV-TTP have recommended the prompt initiation or re-initiation of ART in parallel with plasma exchange therapy to improve the clinical outcome of these patients. Here, we describe a case of HIV-TTP resulting in an acute hemorrhagic stroke in a 16 year old female with perinatally acquired HIV infection and non-adherence to ART, who presented with severe thrombocytopenia, microangiopathic hemolytic anemia, and a past medical history of HIV-ITP. Both differential diagnosis and treatments for HIV-ITP and HIV-TTP were considered simultaneously. A decrease in plasma ADAMTS13 activity (<5%) without detectable inhibitory antibodies confirmed the diagnosis of HIV-TTP. Re-initiation of ART and plasma exchange resulted in a marked decrease in the HIV-RNA viral load, recovery of the platelet count, and complete recovery was achieved with sustained virologic suppression. PMID:25429351

Maternal HIV Serostatus, Mother–Daughter Sexual Risk Communication and Adolescent HIV Risk Beliefs and Intentions

PubMed Central

Hutchinson, M. Katherine; Duan, Lei; Jemmott, Loretta S.

2012-01-01

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters’ abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter’s HIV risk and provide them with relationship building and parent process skills to help reduce these risks. PMID:22677973

Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions.

PubMed

Cederbaum, Julie A; Hutchinson, M Katherine; Duan, Lei; Jemmott, Loretta S

2013-09-01

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.

Gender-Specific HIV Prevention with Urban Early-Adolescent Girls: Outcomes of the Keepin' It Safe Program

ERIC Educational Resources Information Center

Di Noia, Jennifer; Schinke, Steven P.

2007-01-01

This study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls. Intervention effects were examined in a randomized, pretest-posttest wait-list control-group design. Changes in HIV/AIDS knowledge, protective attitudes, and skills for reducing HIV…

HIV Testing among Adolescents in Ndola, Zambia: How Individual, Relational, and Environmental Factors Relate to Demand

ERIC Educational Resources Information Center

Denison, Julie A.; McCauley, Ann P.; Dunnett-Dagg, Wendy A.; Lungu, Nalakwanji; Sweat, Michael D.

2009-01-01

This study examined how individual, relational and environmental factors related to adolescent demand for HIV voluntary counseling and testing (VCT). A cross-sectional survey among randomly selected 16-19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed…

Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis

PubMed Central

McNealy, Kim R.; Al-Khattab, Halima; Carter-Harris, Lisa; Oruche, Ukamaka Marian; Naanyu, Violet; Draucker, Claire Burke

2017-01-01

Background AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics. Methods Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population. Results The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy. Conclusions The three phases of sexual learning interact to shape adolescents’ sexual lives and their risk for HIV infection. This framework will contribute to the development of sexual education programs that address HIV risk within the broader context of sexual learning. PMID:28278210

Review: An urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations

PubMed Central

Lall, Priya; Lim, Sin How; Khairuddin, Norliana; Kamarulzaman, Adeeba

2015-01-01

Introduction The 50% increase in HIV-related deaths in youth and adolescents (aged 10–24) from 2005 to 2012 highlights the need to improve HIV treatment and care in this population, including treatment adherence and retention. Youth and adolescents from key populations or young key populations (YKP) in particular are highly stigmatized and may face additional barrier(s) in adhering to HIV treatment and services. We reviewed the current knowledge on treatment adherence and retention in HIV care among YKP to identify gaps in the literature and suggest future directions to improve HIV care for YKP. Methods We conducted a comprehensive literature search for YKP and their adherence to antiretroviral therapy (ART) and retention in HIV care on PsycInfo (Ovid), PubMed and Google Scholar using combinations of the keywords HIV/AIDS, ART, adolescents, young adults, adherence (or compliance), retention, men who have sex with men, transgender, injection drug users, people who inject drugs and prisoners. We included empirical studies on key populations defined by WHO; included the terms youth and adolescents and/or aged between 10 and 24; examined adherence to or retention in HIV care; and published in English-language journals. All articles were coded using NVivo. Results and discussion The systematic search yielded 10 articles on YKP and 16 articles on behaviourally infected youth and adolescents from 1999 to 2014. We found no studies reporting on youth and adolescents identified as sex workers, transgender people and prisoners. From existing literature, adherence to ART was reported to be influenced by age, access to healthcare, the burden of multiple vulnerabilities, policy involving risk behaviours and mental health. A combination of two or more of these factors negatively impacted adherence to ART among YKP. Collectively, these studies demonstrated that future programmes need to be tailored specifically to YKP to ensure adherence. Conclusions There is an urgent need for more systematic research in YKP. Current limited evidence suggests that healthcare delivery should be tailored to the unique needs of YKP. Thus, research on YKP could be used to inform future interventions to improve access to treatment and management of co-morbidities related to HIV, to ease the transition from paediatric to adult care and to increase uptake of secondary prevention methods. PMID:25724503

Persistence of hepatitis A virus antibodies after primary immunization and response to revaccination in children and adolescents with perinatal HIV exposure

PubMed Central

Gouvêa, Aída de Fátima Thomé Barbosa; Pinto, Maria Isabel de Moraes; Miyamoto, Maristela; Machado, Daisy Maria; Pessoa, Silvana Duarte; do Carmo, Fabiana Bononi; Beltrão, Suênia Cordeiro de Vasconcelos; Succi, Regina Célia de Menezes

2015-01-01

OBJECTIVE: To assess possible factors associated with the loss of antibodies to hepatitis A 7 years after the primary immunization in children of HIV-infected mothers and the response to revaccination in patients seronegative for hepatitis A. METHODS: Quantification of HAV antibodies by electrochemiluminescence was performed in 39 adolescents followed up at the Pediatric Aids Clinic of Federal University of São Paulo (Unifesp): 29 HIV-infected (HIV group) (median age: 12.8 years) and 10 HIV-exposed but non-infected (ENI group) (median age: 13.4 years). All of them received two doses of HAV vaccine (Havrix(r)) in 2002. RESULTS: The median age at primary immunization (PI) was 5.4 years for HIV group and 6.5 years for ENI group. All children, from both groups, had antibodies to HAV >20 mIU/mL after PI. Seven years later, the ENI group showed a median concentration of antibodies = 253.5 mIU/mL, while the HIV group = 113.0 mIU/mL (Mann-Whitney test, p=0.085). All ENI group and 23/29 (79.3%) from HIV group mantained HAV antibodies 7 years after PI. The levels of hepatitis A antibodies in the primary vaccination were the only factor independently associated with maintaining these antibodies for 7 years. The group that lost HAV seropositivity was revaccinated and 83.3% (5/6) responded with antibodies >20 mUI/mL. CONCLUSIONS: The antibodies levels acquired in the primary vaccination in the HIV group were the main factor associated with antibodies loss after HAV immunization. PMID:25918013

Ethical and practical challenges in implementing informed consent in HIV/AIDS clinical trials in developing or resource-limited countries.

PubMed

Mystakidou, Kyriaki; Panagiotou, Irene; Katsaragakis, Stelios; Tsilika, Eleni; Parpa, Efi

2009-09-01

Ethical issues regarding HIV/AIDS human research in the developing world remain under continuous evaluation; a critical area of concern includes informed consent. This paper reviews several of the most important ethical and practical aspects of informed consent in HIV research in developing countries. Enhancement of overall understanding of such key issues might promote higher ethical standards of future research. The major objective was to address informed consent in human research in non-Western societies, and specifically in HIV clinical trials of affected adults. Secondary end-points included the consent complexities in HIV research involving vulnerable patient populations in resource-limited nations, such as children, adolescents and women. A systematic review of the published literature using MEDLINE and EMBASE from 1998 until December 2008 was performed, using the search terms 'HIV/AIDS', 'informed consent', 'clinical trials', 'developing world'. Ethical complexities such as participants' diminished autonomy, coercion or monetary inducement, language difficulties, illiteracy or lack of true understanding of the entire study, cultural barriers mainly due to communitarianism and social diversities were identified in the 44 studies reviewed. Informed consent of vulnerable patient populations must be tailored to their sex and developmental age, while counselling is fundamental. Children and adolescents' assent must be ensured. Local language is to be used, while trusted community leaders and local cultural representatives may convey information. Despite the heterogeneity of studies, similarities were identified. Providing adequate and comprehensive information and assessing the true understanding of the research represent fundamental prerequisites. Potential solutions to the critical areas of concern include peer counselling and meetings with local community leaders or local cultural representatives. International investigators of HIV human research should bear in mind these ethical issues and their potential solutions, when trying to ensure ethical research conduct, based on a truly informed and culturally relevant consent.

PASHA: facilitating the replication and use of effective adolescent pregnancy and STI/HIV prevention programs.

PubMed

Card, Josefina J; Lessard, Laura; Benner, Tabitha

2007-03-01

It is important that interventions that have been shown effective in changing risky behavior be disseminated, so that they can be replicated (implemented in a new site) and so that their effectiveness in a new setting can be investigated. This article provides an update on an innovative resource for promoting the replication of effective teen pregnancy and STI/HIV prevention programs. The resource is called the Program Archive on Sexuality, Health & Adolescence (PASHA). A Scientist Expert Panel rates candidate adolescent pregnancy and STI/HIV prevention programs based on the strength of the evidence of their effectiveness in changing risky sexual behavior among youth ages 10-19 (10-21 for STI/HIV prevention programs). Developers of selected programs are invited to make their program and evaluation materials publicly available through PASHA. PASHA publishes and disseminates replication kits for programs it successfully acquires. Fifty-six programs have been selected by PASHA's Scientist Expert Panel as "effective" in changing one or more risky behaviors associated with adolescent pregnancy or STI/HIV. Complete program and evaluation materials from 35 of these programs are now currently available through PASHA, five are pending, 12 are publicly available from other sources, and only four are not publicly available. PASHA programs are aimed at a diverse target population and cover diverse content on many abstinence and contraception/condom-related topics. Many pedagogical techniques are used to effect behavior change, noticeably role play and group discussion. PASHA illustrates well the productive research-to-practice feedback loop that is the backbone of "translation research." The resource can be used by adolescent pregnancy and STI/HIV prevention practitioners to put what works to work to continue the lowering of the nation's adolescent pregnancy and STI/HIV rates.

The glory of guidelines and the twilight of reality: controversies and challenges in the prevention and treatment of HIV in children.

PubMed

Anderson, Evan J; Yogev, Ram

2012-07-01

Since the discovery of HIV 30 years ago, we have learned much about HIV in children and adolescents. Dramatic declines have occurred in mother-to-child transmission of HIV in resource-rich countries. Resource-poor countries struggle with improving prevention of mother-to-child transmission due to the lack of universal antiretroviral treatment for pregnant and nursing mothers. In children infected with HIV, pharmacokinetic, safety and efficacy data have been determined for many of the older drugs. Data are lacking for the newer, safer and more effective currently available drugs, resulting in the pediatric guidelines lagging behind adult recommendations. Although guidelines for prevention and treatment are helpful, the way they are created causes them to lag behind new scientific evidence, and in some situations they will be confusing or only based on expert opinion. Improving prevention of HIV infection in adolescents and young adults and in treating those who become HIV infected is crucially important. The next 10 years hold tremendous opportunities for improvements in prevention and treatment of HIV in children, adolescents and young adults.

Predicting hypothetical willingness to participate (WTP) in a future phase III HIV vaccine trial among high-risk adolescents.

PubMed

Giocos, Georgina; Kagee, Ashraf; Swartz, Leslie

2008-11-01

The present study sought to determine whether the Theory of Planned Behaviour predicted stated hypothetical willingness to participate (WTP) in future Phase III HIV vaccine trials among South African adolescents. Hierarchical logistic regression analyses showed that The Theory of Planned Behaviour (TPB) significantly predicted WTP. Of all the predictors, Subjective norms significantly predicted WTP (OR = 1.19, 95% C.I. = 1.06-1.34). A stepwise logistic regression analysis revealed that Subjective Norms (OR = 1.19, 95% C.I. = 1.07-1.34) and Attitude towards participation in an HIV vaccine trial (OR = 1.32, 95% C.I. = 1.00-1.74) were significant predictors of WTP. The addition of Knowledge of HIV vaccines and HIV vaccine trials, Perceived self-risk of HIV infection, Health-promoting behaviours and Attitudes towards HIV/AIDS yielded non-significant results. These findings provide support for the Theory of Reasoned Action (TRA) and suggest that psychosocial factors may play an important role in WTP in Phase III HIV vaccine trials among adolescents.

Inclusion of adolescents in preventive HIV vaccine trials: public health policy and research design at a crossroads.

PubMed

Jaspan, Heather B; Cunningham, Coleen K; Tucker, Tim J P; Wright, Peter F; Self, Steve G; Sheets, Rebecca L; Rogers, Audrey S; Bekker, Linda-Gail; Wilson, Craig M; Duerr, Ann; Wasserheit, Judith N

2008-01-01

The search for a safe effective HIV vaccine has been a centerpiece of HIV research for almost 2 decades. More than 60 clinical HIV vaccine trials have been conducted to date. Several promising candidate HIV vaccines are in advanced clinical development. To date, however, no trial has included adolescents, one of the most important target groups for any preventive HIV vaccine. To license a vaccine for use in this age group, efficacy data or, at a minimum, bridging safety and immunogenicity data in this population are needed. To accomplish this, several critical issues and special challenges in the development and implementation of HIV vaccine trials in adolescents must be addressed, including regulatory considerations, potential differentials in safety and immunogenicity, alternative trial design strategies, recruitment and retention challenges, community involvement models, and approaches to informed consent/assent. This article examines these issues and proposes specific next steps to facilitate the routine inclusion of this high-priority population in preventive HIV vaccine trials as early and seamlessly as possible.

Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa

PubMed Central

Hosek, Sybil; Celum, Connie; Wilson, Craig M; Kapogiannis, Bill; Delany-Moretlwe, Sinead; Bekker, Linda-Gail

2016-01-01

Introduction Adolescents and young adults aged <25 are a key population in the HIV epidemic, with very high HIV incidence rates in many geographic settings and a large number who have limited access to prevention services. Thus, any biomedical HIV prevention approach should prepare licensure and implementation strategies for young populations. Oral pre-exposure prophylaxis (PrEP) is the first antiretroviral-based prevention intervention with proven efficacy across many settings and populations, and regulatory and policy approvals at global and national levels are occurring rapidly. We discuss available data from studies in the United States and South Africa on the use of oral PrEP for HIV prevention in adolescent minors, along with some of the implementation challenges. Discussion Ongoing studies in the United States and South Africa among youth under the age of 18 should provide the safety data needed by the end of 2016 to contribute to licensure of Truvada as daily PrEP in adolescents. The challenges of completing these studies as well as foreseeable broader challenges highlighted by this work are presented. Adherence to daily PrEP is a greater challenge for younger populations, and poor adherence was associated with decreased efficacy in all PrEP trials. Individual-level barriers include limited familiarity with antiretroviral-based prevention, stigma, product storage, and social support. Structural challenges include healthcare financing for PrEP, clinician acceptability and comfort with PrEP delivery, and the limited youth-friendly health services available. These challenges are discussed in the context of the work done to date in the United States and South Africa, but will likely be magnified in the setting of limited resources in many other countries that are heavily impacted by HIV. Conclusions Adolescent populations are particularly vulnerable to HIV, and oral PrEP in these populations is likely to have an impact on population-level HIV incidence. The challenges of disseminating an HIV biomedical prevention tool requiring daily usage in adolescents are formidable, but addressing these issues and starting dialogues will lay the groundwork for the many other HIV prevention tools now being developed and tested. PMID:27760684

Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe.

PubMed

Dunbar, Megan S; Maternowska, M Catherine; Kang, Mi-Suk J; Laver, Susan M; Mudekunye-Mahaka, Imelda; Padian, Nancy S

2010-01-01

This study tested the feasibility of a combined microcredit and life-skills HIV prevention intervention among 50 adolescent female orphans in urban/peri-urban Zimbabwe. Quantitative and qualitative data were collected on intervention delivery, HIV knowledge and behavior, and economic indicators. The study also tested for HIV, HSV-2, and pregnancy. At 6 months, results indicated improvements in knowledge and relationship power. Because of the economic context and lack of adequate support, however, loan repayment and business success was poor. The results suggest that microcredit is not the best livelihood option to reduce risk among adolescent girls in this context.

Findings from SHAZ!: A Feasibility Study of a Microcredit and Life-Skills HIV Prevention Intervention to Reduce Risk among Adolescent Female Orphans in Zimbabwe

PubMed Central

Dunbar, Megan S.; Maternowska, Catherine; Kang, Mi-Suk J.; Laver, Susan M.; Mudekunye, Imelda; Padian, Nancy S.

2015-01-01

SUMMARY This study tested the feasibility of a combined microcredit and life-skills HIV prevention intervention among 50 adolescent female orphans in urban/peri-urban Zimbabwe. Quantitative and qualitative data were collected on intervention delivery, HIV knowledge and behavior, and economic indicators. The study also tested for HIV, HSV-2, and pregnancy. At 6 months, results indicated improvements in knowledge and relationship power. Because of the economic context and lack of adequate support, however, loan repayment and business success was poor. The results suggest that microcredit is not the best livelihood option to reduce risk among adolescent girls in this context. PMID:20391061

HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries.

PubMed

Mark, Daniella; Armstrong, Alice; Andrade, Catarina; Penazzato, Martina; Hatane, Luann; Taing, Lina; Runciman, Toby; Ferguson, Jane

2017-05-16

In 2013, an estimated 2.1 million adolescents (age 10-19 years) were living with HIV globally. The extent to which health facilities provide appropriate treatment and care was unknown. To support understanding of service availability in 2014, Paediatric-Adolescent Treatment Africa (PATA), a non-governmental organisation (NGO) supporting a network of health facilities across sub-Saharan Africa, undertook a facility-level situational analysis of adolescent HIV treatment and care services in 23 countries. Two hundred and eighteen facilities, responsible for an estimated 80,072 HIV-infected adolescents in care, were surveyed. Sixty per cent of the sample were from PATA's network, with the remaining gathered via local NGO partners and snowball sampling. Data were analysed using descriptive statistics and coding to describe central tendencies and identify themes. Respondents represented three subregions: West and Central Africa ( n  = 59; 27%), East Africa ( n  = 77, 35%) and southern Africa ( n  = 82, 38%). Half (50%) of the facilities were in urban areas, 17% peri-urban and 33% rural settings. Insufficient data disaggregation and outcomes monitoring were critical issues. A quarter of facilities did not have a working definition of adolescence. Facilities reported non-adherence as their key challenge in adolescent service provision, but had insufficient protocols for determining and managing poor adherence and loss to follow-up. Adherence counselling focused on implications of non-adherence rather than its drivers. Facilities recommended peer support as an effective adherence and retention intervention, yet not all offered these services. Almost two-thirds reported attending to adolescents with adults and/or children, and half had no transitioning protocols. Of those with transitioning protocols, 21% moved pregnant adolescents into adult services earlier than their peers. There was limited sexual and reproductive health integration, with 63% of facilities offering these services within their HIV programmes and 46% catering to the special needs of HIV-infected pregnant adolescents. Results indicate that providers are challenged by adolescent adherence and reflect an insufficiently targeted approach for adolescents. Guidance on standard definitions for adherence, retention and counselling approaches is needed. Peer support may create an enabling environment and sensitize personnel. Service delivery gaps should be addressed, with standardized transition and quality counselling. Integrated, comprehensive sexual reproductive health services are needed, with support for pregnant adolescents.

Preventing Sexual Risk Behaviors among Gay, Lesbian, and Bisexual Adolescents: The Benefits of Gay-Sensitive HIV Instruction in Schools.

ERIC Educational Resources Information Center

Blake, Susan M.; Ledsky, Rebecca; Lehman, Thomas; Goodenow, Carol; Sawyer, Richard; Hack, Tim

2001-01-01

Compared the sexual risk taking behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents, evaluating associations between gay-sensitive school HIV instruction and GLB adolescents' risk behaviors. Surveys indicated that GLB students had more high risk behaviors than heterosexual students, and those in schools with gay-sensitive…

Ecodevelopmental x Intrapersonal Risk: Substance Use and Sexual Behavior in Hispanic Adolescents

ERIC Educational Resources Information Center

Prado, Guillermo J.; Schwartz, Seth J.; Maldonado-Molina, Mildred; Shi Huang,; Pantin, Hilda M.; Lopez, Barbara; Szapocznik, Jose

2009-01-01

Hispanic adolescents are a rapidly growing population and are highly vulnerable to substance abuse and HIV infection. Many interventions implemented thus far have been "one size fits all" models that deliver the same dosage and sequence of modules to all participants. To more effectively prevent substance use and HIV in Hispanic adolescents,…

Family Routines and Parental Monitoring as Protective Factors among Early and Middle Adolescents Affected by Maternal HIV/AIDS

ERIC Educational Resources Information Center

Murphy, Debra A.; Marelich, William D.; Herbeck, Diane M.; Payne, Diana L.

2009-01-01

The influence of parenting skills on adolescent outcomes among children affected by maternal HIV/AIDS (N = 118, M age = 13) was investigated. Among families with more frequent family routines, over time adolescents showed lower rates of aggression, anxiety, worry, depression, conduct disorder, binge drinking, and increased self-concept. Among…

Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection

PubMed Central

Ruria, Eva Caroline; Masaba, Rose; Kose, Judith; Woelk, Godfrey; Mwangi, Eliud; Matu, Lucy; Ng’eno, Hillary; Bikeri, Beatrice; Rakhmanina, Natella

2017-01-01

Objective: Unsuccessful linkage to care and treatment increases adolescent HIV-related morbidity and mortality. This study evaluated the effect of a novel adolescent and youth Red Carpet Program (RCP) on the timing and outcomes of linkage to care. Design: A prepost implementation evaluation of the pilot RCP program. Settings: Healthcare facilities (HCFs) and schools in Homa Bay County, Kenya. Study participants: HIV-infected adolescents (15–19 years) and youth (20–21 years). Interventions: RCP provided fast-track peer-navigated services, peer counseling, and psychosocial support at HCFs and schools in six Homa Bay subcounties in 2016. RCP training and sensitization was implemented in 50 HCFs and 25 boarding schools. Main outcome measures: New adolescent and youth HIV diagnosis, linkage to and retention in care and treatment. Results: Within 6 months of program rollout, 559 adolescents and youths (481 women; 78 men) were newly diagnosed with HIV (15–19 years n = 277; 20–21 years, n = 282). The majority (n = 544; 97.3%) were linked to care, compared to 56.5% at preimplementation (P < 0.001). All (100.0%; n = 559) adolescents and youths received peer counseling and psychosocial support, and the majority (n = 430; 79.0%) were initiated on treatment. Compared to preimplementation, the proportion of adolescents and youths who were retained on treatment increased from 66.0 to 90.0% at 3 months (P < 0.001), and from 54.4 to 98.6% at 6 months (P < 0.001). Conclusion: Implementation of RCP was associated with significant improvement in linkage to and early retention in care among adolescent and youth. The ongoing study will fully assess the efficacy of this linkage-to-care approach. PMID:28665883

Engaging African American Faith-Based Organizations in Adolescent HIV Prevention.

PubMed

Woods-Jaeger, Briana A; Carlson, Mamie; Taggart, Tamara; Riggins, Linda; Lightfoot, Alexandra F; Jackson, Melvin R

2015-08-01

To reduce current HIV disparities among African American youth, it is imperative to find effective ways to extend the reach of evidence-based HIV prevention. One promising community resource to support this effort is faith-based organizations (FBOs), a credible and respected resource in the African American community. This paper describes the experiences, perceptions, and challenges that African American FBOs and faith leaders face in engaging in adolescent HIV prevention and highlights facilitators and barriers to implementing HIV prevention in African American FBOs. The findings suggest that African American FBOs and faith-based leaders are uniquely positioned to be instrumental resources in reducing African American youth HIV disparities.

Negative Affect and HIV Risk in Alcohol and Other Drug (AOD) Abusing Adolescent Offenders

ERIC Educational Resources Information Center

Lucenko, Barbara A.; Malow, Robert M.; Sanchez-Martinez, Mario; Jennings, Terri; Devieux, Jessy G.

2003-01-01

Various depressive symptoms have been linked to elevated levels of HIV risk across diverse adult populations in multiple studies. However, this link has been examined in a much more limited manner among adolescents, despite an exceedingly heightened risk of both HIV and negative affect in this age group. To address the current lack of clinically…

Polish Adolescents and Their Beliefs and Attitudes to HIV/AIDS and Sexual Relationships

ERIC Educational Resources Information Center

Ganczak, Maria; Boron-Kaczmarska, Anna; Leszczyszyn-Pynka, Magdalena; Szych, Zbigniew

2005-01-01

The aim of the study was to survey the needs for HIV/AIDS educational interventions and attitudes and beliefs concerning HIV infection, including sexual relationships, among 17-year-old Polish adolescents. A total of 761 students who attended schools located in urban and rural areas was surveyed. The study, based on the voluntary, self-completed,…

HIV and STD Knowledge, Sexual Behaviors and Drug Taking Behaviors of Adolescents in Southern Russia

ERIC Educational Resources Information Center

Kelley, R. Mark; Ball, Marcia; Cerullo, Jennie; Trunova, Elena

2004-01-01

For several years, HIV infection has increasing rapidly in Eastern Europe and Russia (UNAIDS, 2000, 2003). The purpose of the study was to investigate the HIV and STD knowledge, sexual behaviors and drug taking behaviors of adolescents in southern Russia. The instrument was compiled by the authors, professionally translated, and pilot tested. Most…

Predicting HIV/STD risk level and substance use disorders among incarcerated adolescents.

PubMed

Rowe, Cynthia L; Wang, Wei; Greenbaum, Paul; Liddle, Howard A

2008-12-01

Incarcerated adolescents are among the most vulnerable groups for STD infection, and substance abuse is prevalent in over half of this population. Substance abuse and HIV/STD-associated risk behaviors are closely linked among juvenile justice-involved youth, but it is unclear whether common antecedents explain these different problems. The current study examined predictors of HIV/STD risk level and substance use disorders, and investigated whether family variables added unique predictive variance for these problems among incarcerated youth. The sample included 154 substance-involved youth ages 13 to 17 recruited in detention facilities in Miami and Tampa, FL and was primarily male (82%) and African-American (58%). Using a comprehensive assessment strategy with data obtained from youth report, parent report, and laboratory confirmed STD testing, the results show that delinquency is a consistent predictor of both HIV/STD risk level and substance use disorders, and also that substance use directly predicts HIV/STD risk level among incarcerated adolescents. Consistent with previous research, family conflict is an important predictor of substance use disorders even after controlling for other factors. The results suggest the need for integrated family-based interventions addressing delinquency, substance abuse, and HIV/STD-associated risk factors with juvenile justice-involved adolescents.

Assessment of biomarkers of cardiovascular risk among HIV type 1-infected adolescents: role of soluble vascular cell adhesion molecule as an early indicator of endothelial inflammation.

PubMed

Syed, Salma S; Balluz, Rula S; Kabagambe, Edmond K; Meyer, William A; Lukas, Susan; Wilson, Craig M; Kapogiannis, Bill G; Nachman, Sharon A; Sleasman, John W

2013-03-01

Cardiovascular disease (CVD) biomarkers were examined in a cohort of HIV-infected and HIV-uninfected adolescents who participated in Adolescent Trials Network study 083 utilizing samples from the Reaching for Excellence in Adolescent Care cohort, a longitudinal study of youth infected through adult risk behavior. Nonfasting blood samples from 97 HIV-infected and 81 HIV-uninfected adolescents infected by adult risk behaviors were analyzed for total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), triglycerides, apolipoprotein A-I, high-sensitivity C-reactive protein (hsCRP), soluble vascular adhesion molecule-1 (sVCAM-1), myeloperoxidase, and neopterin at baseline and 18 months later. Results were analyzed using ANOVA, Wilcoxon signed-rank, and paired t tests. Among infected subjects 67 received antiretroviral therapy and 30 were treatment naive. The HIV-infected and HIV-uninfected subjects were similar in gender, ethnicity, and cardiovascular risk factors such as smoking and obesity. In all groups lipid parameters were within accepted guidelines for cardiovascular risk. Among HIV-infected youth on antiretroviral therapy (ART), HDL and apoprotein A-I were significantly lower when compared to uninfected youth. hsCRP was not elevated and thus not predictive for risk in any group. sVCAM-1 levels were significantly elevated in both HIV-infected groups: 1,435 ng/ml and 1,492 ng/ml in untreated and treated subjects, respectively, and 1,064 ng/ml in the uninfected group (p<0.0001). Across all groups neopterin correlated with sVCAM at 18 months (Spearman correlation coefficient 0.58, p<0.0001). Only 9% of ART-treated subjects fully suppressed virus. Lipid profiles and hsCRP, traditional markers of cardiovascular disease, are not abnormal among HIV-infected youth but elevated sVCAM may be an early marker of atherosclerosis.

HIV testing, care referral and linkage to care intervals affect time to engagement in care for newly diagnosed HIV-infected adolescents in fifteen adolescent medicine clinics in the United States

PubMed Central

Philbin, Morgan M.; Tanner, Amanda E.; DuVal, Anna; Ellen, Jonathan M.; Xu, Jiahong; Kapogiannis, Bill; Bethel, Jim; Fortenberry, J. Dennis

2016-01-01

Objective To examine how the time from HIV testing to care referral and from referral to care linkage influenced time to care engagement for newly diagnosed HIV-infected adolescents. Methods We evaluated the Care Initiative, a care linkage and engagement program for HIV-infected adolescents in 15 U.S. clinics. We analyzed client-level factors, provider type and intervals from HIV testing to care referral and from referral to care linkage as predictors of care engagement. Engagement was defined as a second HIV-related medical visit within 16 weeks of initial HIV-related medical visit (linkage). Results At 32 months, 2,143 youth had been referred. Of these, 866 were linked to care through the Care Initiative within 42 days and thus eligible for study inclusion. Of the linked youth, 90.8% were ultimately engaged in care. Time from HIV testing to referral (e.g., ≤7 days versus >365 days) was associated with engagement (AOR=2.91; 95% CI: 1.43–5.94) and shorter time to engagement (Adjusted HR=1.41; 95% CI: 1.11–1.79). Individuals with shorter care referral to linkage intervals (e.g., ≤7 days versus 22–42 days) engaged in care faster (Adjusted HR=2.90; 95% CI: 2.34–3.60) and more successfully (AOR=2.01; 95% CI: 1.04–3.89). Conclusions These data address a critical piece of the care continuum, and can offer suggestions of where and with whom to intervene in order to best achieve the care engagement goals outlined in the U.S. National HIV/AIDS Strategy. These results may also inform programs and policies that set concrete milestones and strategies for optimal care linkage timing for newly diagnosed adolescents. PMID:26885804

Paediatric advance care planning survey: a cross-sectional examination of congruence and discordance between adolescents with HIV/AIDS and their families.

PubMed

Lyon, Maureen E; Dallas, Ronald H; Garvie, Patricia A; Wilkins, Megan L; Garcia, Ana; Cheng, Yao Iris; Wang, Jichuan

2017-09-21

To identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family's perception of their needs. A cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey - Adolescent and Surrogate Versions-Revised. Adolescents' mean age was 18 years (range ≥14-<21); 54% male; 92% African-American; 27% with prior AIDS diagnosis. If dying, 92% believed in completing an advance directive ; 85% preferred to die at home ; 88% knowing how to say good bye ; 71% being off machines that extend life and 77% dying a natural death . Best timing for end-of-life (EOL) decisions was while healthy (38%), when first diagnosed (17%), when first sick from a life-threatening illness (4%), when first hospitalised (8%), if dying (4%) and all of the above (19%). Prevalence-adjusted bias-adjusted Kappa (PABAK) measured congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that being free from pain (PABAK=0.83), and understanding your treatment choices (PABAK=0.92) were very important or important. There was discordance about being off machines that extend life (PABAK=0.08) and when is the best time to bring up EOL decisions (PABAK=0.32). Areas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth's EOL wishes. NCT01289444; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Loss to follow-up among children and adolescents growing up with HIV infection: age really matters

PubMed Central

Kranzer, Katharina; Bradley, John; Musaazi, Joseph; Nyathi, Mary; Gunguwo, Hilary; Ndebele, Wedu; Dixon, Mark; Ndhlovu, Mbongeni; Rehman, Andrea; Khan, Palwasha; Vogt, Florian; Apollo, Tsitsi; Ferrand, Rashida Abbas

2017-01-01

Abstract Introduction: Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence. Methods: Individuals aged 5–19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5–9 (children), 10–14 (young adolescents) and 15–19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression. Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5–9, 10–14 and 15–19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94–2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05–3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups. Conclusions: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes. PMID:28715158

Characteristics and determinants of sexual behavior among adolescents of migrant workers in Shangai (China).

PubMed

Li, Shenghui; Huang, Hong; Cai, Yong; Xu, Gang; Huang, Fengrong; Shen, Xiaoming

2009-06-19

China is facing a critical challenge of rapid and widespread human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increase. Rural-to-urban migration plays a crucial role in shifting the HIV/sexual transmitted infection (STI) epidemic. The purpose of this study was to assess the prevalence of sexual behaviors and the correlates among the early adolescents of migrant workers in China. A cross-sectional study was conducted in 10 junior high schools from April to June of 2008. A total of 2821 adolescents aged 14.06 +/- 0.93 years (8.9% of migrant workers vs. 91.1% of general residents) participated in the survey. A self-administrated questionnaire was used to collect information on knowledge, attitude, and behaviors associated with increased risk for HIV/STI. The percentage of adolescents who ever had sexual intercourse or had sexual intercourse in last three months was 7.2% and 4.3% in adolescents of migrant workers, respectively; in contrast, 4.5% and 1.8% in their peers of general residents, respectively. 47.3% adolescents of migrant workers and 34.3% of those adolescents of general residents reported no condom use in sexual intercourse during last three months. Multivariate logistic regression analyses found that migration was a independent risk factor for sexual intercourse in last three months in our sampled adolescents (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.01-1.72). In adolescents of migrant workers, factors such as lower family income (OR: 2.22, CI: 1.09-3.05 for low level; OR:1.25, CI: 1.04-1.59 for medium level), younger age at first sexual intercourse (OR: 1.24, CI: 1.09-1.57), lower knowledge on HIV/AIDS (OR: 0.93, CI: 0.90-0.97), and fewer communication on HIV/AIDS related issues (OR: 0.79, CI: 0.90-0.97) were related to sexual intercourse in last three months. Based on these results, we advocated that heightened concerns targeting the adolescents of migrant workers be particularly necessary, given their higher level of sexual experience, lower socioeconomic status, restricted reproductive health information, and vulnerability to HIV/STI.

Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe.

PubMed

Judd, A; Lodwick, R; Noguera-Julian, A; Gibb, D M; Butler, K; Costagliola, D; Sabin, C; van Sighem, A; Ledergerber, B; Torti, C; Mocroft, A; Podzamczer, D; Dorrucci, M; De Wit, S; Obel, N; Dabis, F; Cozzi-Lepri, A; García, F; Brockmeyer, N H; Warszawski, J; Gonzalez-Tome, M I; Mussini, C; Touloumi, G; Zangerle, R; Ghosn, J; Castagna, A; Fätkenheuer, G; Stephan, C; Meyer, L; Campbell, M A; Chene, G; Phillips, A

2017-03-01

The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4. The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development. © 2016 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

Determinants of condom use among junior high school students in a minority, inner-city school district.

PubMed

DiClemente, R J; Durbin, M; Siegel, D; Krasnovsky, F; Lazarus, N; Comacho, T

1992-02-01

Condoms reduce the risk of human immunodeficiency virus (HIV) transmission; however, their use among adolescents has been inconsistent. Little is known about factors which motivate consistent condom use, particularly among younger adolescents. In a study designed to identify such factors, 1899 inner-city junior high school students were surveyed. In June 1988, students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, and behaviors. Among sexually active students (N = 403), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on frequency of condom use. Respondents who believe condoms are effective in preventing HIV transmission were 2.2 times more likely to report using condoms consistently during sexual intercourse; those with low perceived costs associated with condom use were 1.9 times more likely to be consistent users. Number of lifetime sexual partners was inversely related to frequency of condom use. Respondents with a history of three or more sex partners were half as likely to use condoms consistently. Factors not associated with consistent condom use include age, age at sexual debut, ethnicity, HIV knowledge, perceived efficacy to avoid HIV infection, and alcohol and drug use. School- and community-based HIV prevention programs will have to go beyond the didactic transfer of factual information and include more interactive teaching strategies to improve adolescents' attitudes toward condoms are self-efficacy to increase condom use and to counter negative peer influences and adolescents' perceptions of invulnerability. Physicians are an underutilized source of HIV prevention information. They have an important role in counseling adolescents about effective HIV-prevention methods and dispelling misperceptions which hinder consistent condom use.

Family communication about HIV/AIDS and sexual behaviour among senior secondary school students in Accra, Ghana.

PubMed

Adu-Mireku, Samuel

2003-04-01

Sexually active adolescents in Ghana are increasingly at risk of HIV and other sexually transmitted infections. As a primary agent of socialization, the family can exert a strong influence on adolescent sexual behaviour. Therefore, to aid in the design and implementation of effective prevention programmes, it is important to understand the role of the family in influencing sexual behaviour among school-going adolescents. To evaluate the relationship between family communications about HIV/AIDS and sexual activity and condom use among school-going adolescents in Accra, Ghana. A sample of 894 students (56.9% girls, 43.1% boys; mean age = 17.4 years, SD = 1.40) at two senior secondary schools in Accra completed a modified version of the Youth Risk Behavior Survey (YRBS) questionnaire, a self-administered instrument developed by the Centers for Disease Control and Prevention. Analytical techniques utilized included logistic regression and chi-square. Twenty-five percent of the participants reported being sexually experienced, and 73.6% had talked about HIV/AIDS with parents or other family members. Of the sexually experienced students, 64.7% initiated first sexual intercourse by age 16; and 55.7% did not use a condom at last sexual intercourse. Bivariate analysis showed significant gender differences in sexual activity, condom use, and family communication about HIV/AIDS. Logistic regression analysis showed that student-family communication about HIV/AIDS was not associated with sexual activity. However, communication about HIV/AIDS between students and parents or other family members increased the odds of using a condom at last sexual intercourse. The findings of this study suggest that prevention programmes that seek to educate Ghanaian school-going adolescents about sexual risk behaviour must strongly encourage communication about HIV/AIDS between students and family members.

Rising School Enrollment and Declining HIV and Pregnancy Risk Among Adolescents in Rakai District, Uganda, 1994-2013

PubMed Central

Santelli, John; Mathur, Sanyukta; Song, Xiaoyu; Huang, Tzu Jung; Wei, Ying; Lutalo, Tom; Nalugoda, Fred; Gray, Ron H.; Serwadda, David M.

2015-01-01

Background Poverty, family stability, and social policies influence the ability of adolescents to attend school. Likewise, being enrolled in school may shape an adolescent's risk for HIV and pregnancy. We identified trends in school enrollment, factors predicting school enrollment (antecedents), and health risks associated with staying in or leaving school (consequences). Methods Data from the Rakai Community Cohort Study (RCCS) were examined for adolescents 15-19 years (n=21,735 person-rounds) from 1994 to 2013. Trends, antecedents, and consequences were assessed using logistic and linear regression with robust variance estimation. Qualitative data were used to explore school leaving among HIV+ and HIV- youth (15-24 years). Results School enrollment and socioeconomic status (SES) rose steadily from 1994 to 2013 among adolescents; orphanhood declined after availability of antiretroviral therapy. Antecedent factors associated with school enrollment included age, SES, orphanhood, marriage, family size, and the percent of family members <20 years. In qualitative interviews, youth reported lack of money, death of parents, and pregnancy as primary reasons for school dropout. Among adolescents, consequences associated with school enrollment included lower HIV prevalence, prevalence of sexual experience, and rates of alcohol use and increases in consistent condom use. Young women in school were more likely to report use of modern contraception and never being pregnant. Young men in school reported fewer recent sexual partners and lower rates of sexual concurrency. Conclusions Rising SES and declining orphanhood were associated with rising school enrollment in Rakai. Increasing school enrollment was associated with declining risk for HIV and pregnancy. PMID:26075159

A Quasi-Experimental Evaluation of a Community-Based HIV Prevention Intervention for Mexican American Female Adolescents: The SHERO's Program

ERIC Educational Resources Information Center

Harper, Gary W.; Bangi, Audrey K.; Sanchez, Bernadette; Doll, Mimi; Pedraza, Ana

2009-01-01

This article describes a quasi-experimental evaluation of a community-based, culturally and ecologically tailored HIV prevention intervention for Mexican American female adolescents grounded in the AIDS risk reduction model. A total of 378 Mexican American female adolescents (mean age = 15.2) participated in either the nine-session SHERO's (a…

A Randomized Controlled Trial of a Parent-Centered Intervention in Preventing Substance Use and HIV Risk Behaviors in Hispanic Adolescents

ERIC Educational Resources Information Center

Prado, Guillermo; Pantin, Hilda; Briones, Ervin; Schwartz, Seth J.; Feaster, Daniel; Huang, Shi; Sullivan, Summer; Tapia, Maria I.; Sabillon, Eduardo; Lopez, Barbara; Szapocznik, Jose

2007-01-01

The present study evaluated the efficacy of Familias Unidas + Parent-Preadolescent Training for HIV Prevention (PATH), a Hispanic-specific, parent-centered intervention, in preventing adolescent substance use and unsafe sexual behavior. Two hundred sixty-six 8th-grade Hispanic adolescents and their primary caregivers were randomly assigned to 1 of…

The Protective Role of Religious Coping in Adolescents' Responses to Poverty and Sexual Decision-Making in Rural Kenya

ERIC Educational Resources Information Center

Puffer, Eve S.; Watt, Melissa H.; Sikkema, Kathleen J.; Ogwang-Odhiambo, Rose A.; Broverman, Sherryl A.

2012-01-01

In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and human immunodeficiency virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual…

Efficacy of the Young Women's CoOp: An HIV Risk-Reduction Intervention for Substance-Using African-American Female Adolescents in the South

ERIC Educational Resources Information Center

Wechsberg, Wendee M.; Browne, Felicia A.; Zule, William A.; Novak, Scott P.; Doherty, Irene A.; Kline, Tracy L.; Carry, Monique G.; Raiford, Jerris L.; Herbst, Jeffrey H.

2017-01-01

HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a…

Preparing Adolescents for Success in School: A School-Based Indicated Prevention Model for Adolescents in the Alternative High School Setting

ERIC Educational Resources Information Center

Watson, Donnie W.; McCuller, William J.; Bisesi, Lorrie; Tanamly, Susie; Sim, Tiffanie; Kavich, Julia-Anna

2004-01-01

Adolescents enrolled in alternative school settings evidence risk behaviors at a higher rate compared to students attending regular high schools. Histories of substance use, juvenile delinquency, high school expulsion, poor school attendance, and HIV-risk behaviors are typical. These youth are particularly vulnerable to HIV-risk behaviors and…

Substance Use and Mental Health Problems as Predictors of HIV Sexual Risk Behaviors among Adolescents in Foster Care

ERIC Educational Resources Information Center

Thompson, Ronald G., Jr.; Auslander, Wendy F.

2011-01-01

This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an…

The impact of ART on TB case fatality stratified by CD4 count for HIV-positive TB patients in Cape Town, South Africa (2009–2011)

PubMed Central

Kaplan, Richard; Caldwell, Judy; Middelkoop, Keren; Bekker, Linda-Gail; MMed, Robin Wood

2014-01-01

Objective To identify determinants of TB case fatality including the impact of antiretroviral therapy (ART) at different CD4 thresholds for HIV-positive adult and adolescent TB patients. Methods Through a retrospective analysis of the electronic TB database, we identified the HIV status of newly registered patients ≥15 yrs. Multivariable Cox proportional hazard models were used to determine risk factors for TB case fatality in these patients. Results In 2009, 2010 and 2011, 25,841, 26,104 and 25,554 newly registered adult TB patients were treated in primary health care clinics in Cape Town, of whom 49.7%, 50.4% and 50.9% were HIV-positive. ART uptake increased over the three years from 43% to 64.9% and case fatality of the HIV-positive patients decreased from 7.0% to 5.8% (p<0.001). Female gender, increasing age, retreatment TB, low CD4 counts and extrapulmonary TB (EPTB) were associated with increased case fatality while patients on ART had a substantial decrease in case fatality. The difference in case fatality between patients on ART and not on ART was most pronounced at low CD4 counts with the positive influence of ART noted up to a CD4 count threshold of 350 cells/mm3 (p<0.001). Despite improvements in ART uptake, in 2011, 21% of patients with CD4 counts <350 cells/mm3 did not start ART during TB treatment. Conclusion This study showed a relatively poor uptake of ART among severely immune-compromised TB patients. Patients with CD4 counts <350 cells/mm3 were shown to clearly benefit from ART during TB treatment and ART initiation should be prioritised for this category of patients. PMID:24820105

Impact of ART on TB case fatality stratified by CD4 count for HIV-positive TB patients in Cape Town, South Africa (2009-2011).

PubMed

Kaplan, Richard; Caldwell, Judy; Middelkoop, Keren; Bekker, Linda-Gail; Wood, Robin

2014-08-15

To identify determinants of tuberculosis (TB) case fatality including the impact of antiretroviral therapy (ART) at different CD4 thresholds for HIV-positive adult and adolescent TB patients. Through a retrospective analysis of the electronic TB database, we identified the HIV status of newly registered patients aged ≥15 years. Multivariable Cox proportional hazard models were used to determine the risk factors for TB case fatality in these patients. In 2009, 2010, and 2011, 25,841, 26,104, and 25,554 newly registered adult TB patients were treated in primary health care clinics in Cape Town, of whom 49.7%, 50.4%, and 50.9% were HIV positive. ART uptake increased over 3 years from 43% to 64.9%, and case fatality of the HIV-positive patients decreased from 7.0% to 5.8% (P < 0.001). Female gender, increasing age, retreatment TB, low CD4 counts, and extrapulmonary TB were associated with increased case fatality, whereas patients on ART had a substantial decrease in case fatality. The difference in case fatality between patients on ART and not on ART was most pronounced at low CD4 counts with the positive influence of ART noted up to a CD4 count threshold of 350 cells per cubic millimeter (P < 0.001). Despite improvements in ART uptake, in 2011, 21% of the patients with CD4 counts <350 cells per cubic millimeter did not start ART during TB treatment. This study showed a relatively poor uptake of ART among severely immune-compromised TB patients. Patients with CD4 counts <350 cells per cubic millimeter were shown to clearly benefit from ART during TB treatment, and ART initiation should be prioritized for this category of patients.

Cost-effectiveness decision analysis of intramuscular ceftriaxone versus oral cefixime in adolescents with gonococcal cervicitis.

PubMed

Friedland, L R; Kulick, R M; Biro, F M; Patterson, A

1996-03-01

We compared the cost-effectiveness of two single-dose treatment strategies for adolescents with uncomplicated Neisseria gonorrhoeae cervicitis. We used a cost-effectiveness decision- analysis model to compare the two methods: the standard, ceftriaxone 125 mg given by IM injection; and an alternative, cefixime 400 mg given orally. The effect of the costs associated with the risk of accidental needlestick during IM administration was also evaluated. Key baseline assumptions (with ranges, when tested) were from the literature or costs to our hospital. These included ceftriaxone, $8.60 per dose; cefixime, $4.67 per dose; ceftriaxone efficacy, 98% (range, 94.9% to 100%); cefixime efficacy, 97% (94.1% to 100%); and a 15% probability of pelvic inflammatory disease (PID) related to failed treatment. We included costs for PID necessitating hospitalization, disseminated gonococcal infection, infertility, and ectopic pregnancy. Assumptions related to accidental needlestick included the rate of needlesticks with the disposable syringe, 6.9 per 100,000 injections (range, 0 to 69); cost of accidental needlestick to hospital; risk of HIV seroconversion after needlestick exposure to HIV-infected blood, .36% (range, 0% to .86%); rate of HIV infection in 15- to 19-year-olds attending sexually transmitted diseases clinics, .4% (range, 0 to 5); and lifetime treatment costs for a person with HIV. At baseline values the model favored ceftriaxone ($45 per patient) or cefixime ($59 per patient). However, over the range of efficacy of both drugs, two-way sensitivity analysis revealed no consistent cost advantage for either drug. The model was also insensitive to the economic effects associated with the risk of accidental needlestick during IM injection. over the range of efficacy by the 95% confidence intervals of both drugs, our analysis demonstrated no clear cost advantage for either. The economic effects of accidental needlestick do not change this conclusion. Compared with the IM alternative, oral cefixime is painless to the patient and simpler for the practitioner to administer. Oral cefixime also eliminates the psychologic effects associated with needlesticks in health care workers. For these reasons, we favor the use of oral cefixime for uncomplicated gonococcal cervicitis in adolescents.

The Significance of Benefit Perceptions for the Ethics of HIV Research Involving Adolescents in Kenya.

PubMed

Rennie, Stuart; Groves, Allison K; Hallfors, Denise Dion; Iritani, Bonita J; Odongo, Fredrick S; Luseno, Winnie K

2017-10-01

Assessment of benefits is traditionally regarded as crucial to the ethical evaluation of research involving human participants. We conducted focus group discussions (FGDs) with health and other professionals engaged with adolescents, caregivers/parents, and adolescents in Siaya County, Kenya, to solicit opinions about appropriate ways of conducting HIV research with adolescents. Our data revealed that many focus group participants have a profoundly positive conception of participation in health research, including studies conferring seemingly few benefits. In this article, we identify and analyze five different but interrelated types of benefits as perceived by Kenyan adolescent and adult stakeholders in HIV research, and discuss their ethical significance. Our findings suggest that future empirical and conceptual research should concentrate on factors that may trigger researcher obligations to improve benefit perceptions among research participants.

[Persistence of hepatitis A virus antibodies after primary immunization and response to revaccination in children and adolescents with perinatal HIV exposure].

PubMed

Gouvêa, Aída de Fátima Thomé Barbosa; Pinto, Maria Isabel de Moraes; Miyamoto, Maristela; Machado, Daisy Maria; Pessoa, Silvana Duarte; Carmo, Fabiana Bononi do; Beltrão, Suênia Cordeiro de Vasconcelos; Succi, Regina Célia de Menezes

2015-01-01

To assess possible factors associated with the loss of antibodies to hepatitis A 7 years after the primary immunization in children of HIV-infected mothers and the response to revaccination in patients seronegative for hepatitis A. Quantification of HAV antibodies by electrochemiluminescence was performed in 39 adolescents followed up at the Pediatric Aids Clinic of Federal University of São Paulo (Unifesp): 29 HIV-infected (HIVgroup) (median age: 12.8 years) and 10 HIV-exposed but non-infected (ENI group) (median age: 13.4 years). All of them received two doses of HAV vaccine (Havrix(®)) in 2002. The median age at primary immunization (PI) was 5.4 years for HIV group and 6.5 years for ENI group. All children, from both groups, had antibodies to HAV >20 mIU/mL after PI. Seven years later, the ENI group showed a median concentration of antibodies = 253.5 mIU/mL, while the HIV group = 113.0 mIU/mL (Mann-Whitney test, p=0.085). All ENI group and 23/29 (79.3%) from HIV group mantained HAV antibodies 7 years after PI. The levels of hepatitis A antibodies in the primary vaccination were the only factor independently associated with maintaining these antibodies for 7 years. The group that lost HAV seropositivity was revaccinated and 83.3% (5/6) responded with antibodies >20 mUI/mL. The antibodies levels acquired in the primary vaccination in the HIV group were the main factor associated with antibodies loss after HAV immunization. Copyright © 2015 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

PubMed Central

Salou, Mounerou; Dagnra, Anoumou Y; Butel, Christelle; Vidal, Nicole; Serrano, Laetitia; Takassi, Elom; Konou, Abla A; Houndenou, Spero; Dapam, Nina; Singo-Tokofaï, Assetina; Pitche, Palokinam; Atakouma, Yao; Prince-David, Mireille; Delaporte, Eric; Peeters, Martine

2016-01-01

Introduction Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in their current ART regimen. Conclusions Our study provided important information on virological outcome on lifelong ART in perinatally HIV-1-infected children and adolescents who were still on ART and continued to attend antiretroviral (ARV) clinics for follow-up visits. Actual conditions for scaling up and monitoring lifelong ART in children in resource-limited countries can have dramatic long-term outcomes and illustrate that paediatric ART receives inadequate attention. PMID:27125320

African American Women: The Face of HIV/AIDS in Washington, DC

ERIC Educational Resources Information Center

Amutah, Ndidiamaka N.

2012-01-01

In 2007, the estimated HIV and AIDS case rates among adult and adolescent African-American females in the United States was 60.6 per 100,000, as compared to 3.3 per 100,000 for adult and adolescent white American females. Women living with HIV or AIDS often face complex social problems that may inhibit them from accessing resources and healthcare…

What African American Male Adolescents Are Telling Us about HIV Infection among Their Peers: Cultural Approaches for HIV Prevention

ERIC Educational Resources Information Center

Voisin, Dexter R.; Bird, Jason D. P.

2009-01-01

This study explored the beliefs of African American male adolescents concerning the high rates of HIV infection among their peers and their reasons for those beliefs. In-depth interviews were conducted with a sample of 16 male African Americans, and a thematic analysis of the data was conducted. Half of the participants believed that peers were…

Mental health of early adolescents from high-risk neighborhoods: the role of maternal HIV and other contextual, self-regulation, and family factors.

PubMed

Mellins, Claude A; Brackis-Cott, Elizabeth; Dolezal, Curtis; Leu, Cheng Shiun; Valentin, Cidna; Meyer-Bahlburg, Heino F L

2008-01-01

To examine the effect of maternal HIV infection, as well as other individual, family, and contextual factors on the mental health of inner-city, ethnic minority early adolescents. Participants included 220 HIV-negative early adolescents (10-14 years) and their mothers, half of whom were HIV-infected. Individual interviews were conducted regarding youth depression, anxiety, externalizing and internalizing behaviour problems, as well as a range of correlates of youth mental health guided by a modified version of Social Action Theory, a theoretical model of behavioral health. Although the HIV status of mothers alone did not predict youth mental health, youth knowledge of mother's HIV infection and mother's overall health were associated with worse youth mental health outcomes, as were contextual, self-regulation, and family interaction factors from our theoretical model. There is a need for family-based mental health interventions for this population, particularly focusing on parent-child relationships, disclosure, and youth self-esteem.

Pharmacotherapy of Pediatric HIV Infection

PubMed Central

Rakhmanina, Natella; Phelps, Ryan

2012-01-01

SYNOPSIS With the ongoing epidemic of human immune deficiency virus (HIV) infections in the pediatric age group, the delivery of safe and effective antiretroviral therapy to children and adolescents is crucial to save the lives of millions of children worldwide. Antiretroviral drugs have been demonstrated to significantly decrease HIV-associated morbidity and mortality, assure normal growth and development, and improve survival and quality of life in children and adolescents. The immunologic response to HIV infection is closely related to the child’s development and creates age specific parameters for the evaluation of therapeutic response to antiretroviral therapy in pediatric HIV disease. In addition to the changes in immunological response to HIV infection, the development and maturation of organ systems involved in drug absorption, distribution, metabolism, and elimination determines significant changes in the pharmacokinetics of antiretroviral drugs throughout the childhood. Multiple factors including age-specific adherence barriers, changes in social and economical surroundings, and psychological and sexual maturation affect the choices and outcomes of the treatment of pediatric HIV disease. In this chapter we will review the evolution of antiretroviral treatment from early infancy through adolescence. PMID:23036246

Blocking the benefit of group-based HIV-prevention efforts during adolescence: the problem of HIV-related stigma.

PubMed

Barker, David H; Swenson, Rebecca R; Brown, Larry K; Stanton, Bonita F; Vanable, Peter A; Carey, Michael P; Valois, Robert F; Diclemente, Ralph J; Salazar, Laura F; Romer, Daniel

2012-04-01

HIV-related stigma has been shown to impede HIV-antibody testing and safer sexual practices in adults. Less is known about its effects on prevention programs among at-risk youth. This study examined the longitudinal relationships between HIV-stigma and HIV-knowledge following completion of a validated group-based intervention. Data were provided by 1,654 African-American adolescents who participated in a large multi-city prevention trial (Project iMPACCS). Participants were randomly assigned to an empirically-validated skill-based intervention or a general health promotion control group. Both stigma and knowledge were assessed at baseline and post-intervention. Results suggested that adolescents participating in the intervention showed improvements in knowledge and decreases in stigma when compared to controls. Improvements in stigma appeared to be partly driven by improvements in knowledge. Higher baseline stigma was shown to reduce gains in knowledge in both the treatment and control groups. Results suggest that HIV-stigma can interfere with how youth identify with and internalize messages from group-based prevention trials.

[Refusal of care by a HIV-positive adolescent: role of the cross-cultural approach].

PubMed

Bouaziz, Nora; Titia Rizzi, Alice

The refusal of treatment is frequent in human immunodeficiency virus-positive adolescents. The clinical history of a teenage girl presenting severe immunodepression secondary to the virus, a depressive disorder and a refusal of treatment, illustrates the benefit of combined paediatric, child psychiatric and cross-cultural care as proposed by the Cochin-Paris Adolescent Centre. Working on the meaning of the refusal was a prerequisite for the construction of a care project forming part of a life project, as the psychopathological work could only begin once somatic care ensuring the patient's protection was in place. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Work It Out Together: Preliminary Efficacy of a Parent and Adolescent DVD and Workbook Intervention on Adolescent Sexual and Substance Use Attitudes and Parenting Behaviors.

PubMed

Hadley, Wendy; Brown, L K; Barker, D; Warren, J; Weddington, P; Fortune, T; Juzang, I

2016-09-01

The purpose of the current study was to test an interactive DVD and workbook specifically designed for African-American parents and adolescents (ages 13-18), based on an efficacious face-to-face intervention, to address key factors associated with risk. A total of 170 parent-adolescent dyads were enrolled and randomly assigned to receive either the "Work It Out Together" DVD or a General Health Promotion DVD (HP). Parents and adolescents completed measures of HIV knowledge, self-efficacy, and parenting behaviors. Immediately after receiving the Work It Out Together intervention, parents and adolescents demonstrated higher HIV knowledge and greater HIV prevention self-efficacy. Three months after receiving the Work It Out Together intervention, parents and adolescents reported higher levels of parental monitoring and sexually active adolescents reported higher levels of condom use self-efficacy and a lower rate of recent sex. These outcomes provide preliminary evidence that the "Work It Out Together" DVD impacted individual attitudes and protective parenting behaviors.

Work It Out Together: Preliminary Efficacy of a Parent and Adolescent DVD and Workbook Intervention on Adolescent Sexual and Substance Use Attitudes and Parenting Behaviors

PubMed Central

Brown, L. K.; Barker, D.; Warren, J.; Weddington, P.; Fortune, T.; Juzang, I.

2016-01-01

The purpose of the current study was to test an interactive DVD and workbook specifically designed for African-American parents and adolescents (ages 13–18), based on an efficacious face-to-face intervention, to address key factors associated with risk. A total of 170 parent-adolescent dyads were enrolled and randomly assigned to receive either the “Work It Out Together” DVD or a General Health Promotion DVD (HP). Parents and adolescents completed measures of HIV knowledge, self-efficacy, and parenting behaviors. Immediately after receiving the Work It Out Together intervention, parents and adolescents demonstrated higher HIV knowledge and greater HIV prevention self-efficacy. Three months after receiving the Work It Out Together intervention, parents and adolescents reported higher levels of parental monitoring and sexually active adolescents reported higher levels of condom use self-efficacy and a lower rate of recent sex. These outcomes provide preliminary evidence that the “Work It Out Together” DVD impacted individual attitudes and protective parenting behaviors. PMID:27155880

Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study.

PubMed

Ndongmo, Therese Ntigwa; Ndongmo, Clement Bertin; Michelo, Charles

2017-01-01

As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.

Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study

PubMed Central

Ndongmo, Therese Ntigwa; Ndongmo, Clement Bertin; Michelo, Charles

2017-01-01

Introduction As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. Methods This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. Results A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). Conclusion The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV. PMID:28451048

Adaptation of an HIV Medication Adherence Intervention for Adolescents and Young Adults

PubMed Central

Thurston, Idia B.; Bogart, Laura M.; Wachman, Madeline; Closson, Elizabeth F.; Skeer, Margie R.; Mimiaga, Matthew J.

2014-01-01

Rising rates of human immunodeficiency virus (HIV) infection among adolescents and young adults underscore the importance of interventions for this population. While the morbidity and mortality of HIV has greatly decreased over the years, maintaining high rates of adherence is necessary to receive optimal medication effects. Few studies have developed interventions for adolescents and young adults and none have specifically been developed for sexual minority (lesbian, gay, and bisexual; LGB) youth. Guided by an evidence-based adult intervention and adolescent qualitative interviews, we developed a multicomponent, technology-enhanced, customizable adherence intervention for adolescents and young adults for use in a clinical setting. The two cases presented in this paper illustrate the use of the five-session positive strategies to enhance problem solving (Positive STEPS) intervention, based on cognitive-behavioral techniques and motivational interviewing. We present a perinatally infected heterosexual woman and a behaviorally infected gay man to demonstrate the unique challenges faced by these youth and showcase how the intervention can be customized. Future directions include varying the number of intervention sessions based on mode of HIV infection and incorporating booster sessions. PMID:25452680

[Human immunodeficiency virus vulnerabilities and related health risk behaviors of out-of-school children of the floating population in Beijing].

PubMed

Ma, Ying-hua; Ding, Su-qin; Wang, Chao

2007-10-18

To explore the vulnerability and related risk behaviors of the out-of-school adolescents floating with their parents from country to city. From September to October in 2005, 260 out-of-school adolescents who were 14 to 20 years old were investigated in our study. The out-of-school adolescents lacked of HIV/AIDS knowledge and life skills, and their psychosocial competence was at a lower level. The adolescents were open-minded to sex, but they were not conscious of using condoms. Attitude towards people with HIV was positively correlated with a well-being family, harmonious relation between their parents, a stable job, knowledge, life skills and psychosocial competence (such as in control of emotions, empathy). Their life skills were positively correlated with their mothers' schooling satisfaction with family income, a stable job, high scores of knowledge, social responsibility,and interpersonal relationship. Competence of HIV/AIDS prevention was positively correlated with schooling, a stable job, knowledge, life skills, and psychosocial competence. Out-of-school adolescents were vulnerable to HIV/AIDS. Individual level intervention combined with structural intervention could effectively reduce their vulnerability. Effective and feasible health education approach to enhance their life skills and psychosocial competence was a key point to health education on HIV/AIDS prevention.

A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers

PubMed Central

Katz, Ingrid T.; Nkala, Busisiwe; Dietrich, Janan; Wallace, Melissa; Bekker, Linda-Gail; Pollenz, Kathryn; Bogart, Laura M.; Wright, Alexi A.; Tsai, Alexander C.; Bangsberg, David R.; Gray, Glenda E.

2013-01-01

Background In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto. Methods The HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis. Results Of 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV. Conclusions In a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine’s target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making. PMID:24023613

A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers.

PubMed

Katz, Ingrid T; Nkala, Busisiwe; Dietrich, Janan; Wallace, Melissa; Bekker, Linda-Gail; Pollenz, Kathryn; Bogart, Laura M; Wright, Alexi A; Tsai, Alexander C; Bangsberg, David R; Gray, Glenda E

2013-01-01

In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto. The HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis. Of 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV. In a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine's target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making.

Reducing HIV and AIDS through Prevention (RHAP): a theoretically based approach for teaching HIV prevention to adolescents through an exploration of popular music.

PubMed

Boutin-Foster, Carla; McLaughlin, Nadine; Gray, Angela; Ogedegbe, Anthony; Hageman, Ivan; Knowlton, Courtney; Rodriguez, Anna; Beeder, Ann

2010-05-01

Using popular culture to engage students in discussions of HIV prevention is a nontraditional approach that may complement current prevention efforts and enhance the ability to reach youth who are at high risk of contracting HIV and other sexually transmitted infections. Hip-hop or rap music is the dominant genre of music among adolescents, especially Black and Latino youth who are disproportionately impacted by HIV and AIDS. This paper describes the rationale and development of the Reducing HIV and AIDS through Prevention (RHAP) program, a school-based program that uses hip-hop/rap music as a vehicle for raising awareness among adolescents about HIV/AIDS. Constructs from the Social Cognitive Theory and the Sexual Script Theory were used in developing the program. It was piloted and evaluated among 26 middle school students in East Harlem, New York. The lessons learned from a formative evaluation of the program and the implications for developing other programs targeting public health problems are discussed. The RHAP program challenges the traditional pedagogue-student paradigm and provides an alternative approach to teaching about HIV prevention and awareness.

Sexual risk among orphaned adolescents: is country-level HIV prevalence an important factor?

PubMed Central

Robertson, Laura; Gregson, Simon; Garnett, Geoff P.

2010-01-01

Previous studies from sub-Saharan Africa have found that orphans experience increased sexual risk compared to non-orphans. We developed a theoretical framework for the investigation of determinants of HIV risk and used it to generate specific hypotheses regarding the effect of country-level HIV prevalence on the sexual risk experience of orphans. We expected that countries with high HIV prevalence would experience a higher prevalence of orphanhood. We further hypothesised that orphans in countries with high HIV prevalence would experience increased sexual risk, compared to non-orphans, due to pressure on the extended family network, which is primarily responsible for the care of orphans in sub-Saharan Africa, resulting in poorer standards of care and guidance. We used hierarchical logistic regression models to investigate this hypothesis using cross-sectional, Demographic and Health Survey data from 10 sub-Saharan African countries. We found that countries with high HIV prevalence did indeed have higher prevalence of orphanhood. We also found that, amongst female adolescents, maternal and double orphans were significantly more likely to have started sex than non-orphans in countries with high HIV prevalence but were not at increased risk in low HIV prevalence countries. This effect of country-level HIV prevalence on the sexual risk of orphans was not explained by household level factors such as wealth, overcrowding or age of the household head. The same pattern of risk was not observed for male adolescents — male orphans were not more likely to have started sex than non-orphans. This suggests that orphaned adolescent women are an important target group for HIV prevention and that efforts should be made to integrate prevention messages into existing support programmes for orphans and vulnerable children. PMID:20552462

Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women.

PubMed

Parillo, K M; Freeman, R C; Collier, K; Young, P

2001-03-01

The first purpose was to determine whether sexual abuse involving penetration that occurred in childhood only, adolescence only, or both childhood and adolescence differently impacted whether community-recruited women had ever traded sex for money or drugs, their number of recent sex partners, and the number of times they had engaged in recent unprotected sex. The second purpose was to assess the mediating effects of adulthood rape, recent drug use, and recent sex with an injection drug user on these three HIV-risky sexual behaviors. Women (n = 1,490) recruited from three US sites were questioned about their childhood and/or adolescent sexual abuse histories, adulthood rape experiences, recent drug use, and adult HIV-risky sexual behaviors via structured interviews. One-third of the women reported having experienced sexual abuse involving penetration in childhood and/or adolescence. Overall, regression analyses indicated a significant relationship between early sexual abuse and adult risky behaviors; rape in adulthood mediated this relationship for all three HIV-risky behaviors. Abuse that occurred in childhood only and abuse that occurred in both childhood and adolescence had a stronger impact on later risky behaviors than did abuse that occurred in adolescence only. Because childhood constitutes a critical period in individuals' sexual, social, and personal development, sexual abuse precipitated during this time may distort women's constructions of sex and sexuality. Women abused in childhood may therefore engage in HIV-risky sexual behaviors to a greater extent than women abused in adolescence as a result of these disruptions to their development. Rape in adulthood appears to intensify the effects of early sexual abuse,

Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: a view from the United States of America.

PubMed

Lipshultz, Steven E; Miller, Tracie L; Wilkinson, James D; Scott, Gwendolyn B; Somarriba, Gabriel; Cochran, Thomas R; Fisher, Stacy D

2013-06-18

Human immunodeficiency virus (HIV) infection is a primary cause of acquired heart disease, particularly of accelerated atherosclerosis, symptomatic heart failure, and pulmonary arterial hypertension. Cardiac complications often occur in late-stage HIV infections as prolonged viral infection is becoming more relevant as longevity improves. Thus, multi-agent HIV therapies that help sustain life may also increase the risk of cardiovascular events and accelerated atherosclerosis. Before highly active antiretroviral therapy (HAART), the two-to-five-year incidence of symptomatic heart failure ranged from 4 to 28% in HIV patients. Patients both before and after HAART also frequently have asymptomatic abnormalities in cardiovascular structure. Echocardiographic measurements indicate left ventricular (LV) systolic dysfunction in 18%, LV hypertrophy in 6.5%, and left atrial dilation in 40% of patients followed on HAART therapy. Diastolic dysfunction is also common in long-term survivors of HIV infection. Accelerated atherosclerosis has been found in HIV-infected young adults and children without traditional coronary risk factors. Infective endocarditis, although rare in children, has high mortality in late-stage AIDS patients with poor nutritional status and severely compromised immune systems. Although lymphomas have been found in HIV-infected children, the incidence is low and cardiac malignancy is rare. Rates of congenital cardiovascular malformations range from 5.6 to 8.9% in cohorts of HIV-uninfected and HIV-infected children with HIV-infected mothers. In non-HIV-infected infants born to HIV-infected mothers, foetal exposure to ART is associated with reduced LV dimension, LV mass, and septal wall thickness and with higher LV fractional shortening and contractility during the first two years of life. Routine, systematic, and comprehensive cardiac evaluation, including a thorough history and directed laboratory assays, is essential for the care of HIV-infected adults and children as cardiovascular illness has become a part of care for long-term survivors of HIV infection. The history should include traditional risk factors for atherosclerosis, prior opportunistic infections, environmental exposures, and therapeutic and illicit drug use. Laboratory tests should include a lipid profile, fasting glucose, and HIV viral load. Asymptomatic cardiac disease related to HIV can be fatal, and secondary effects of HIV infection often disguise cardiac symptoms, so systematic echocardiographic monitoring is warranted.

The role of cultural proverbs and myths in shaping sexual worldviews of adolescents in Botswana: evidence from an HIV/STD prevention research study.

PubMed

Malinga-Musamba, Tumani; Ntshwarang, Poloko N

2014-01-01

The literature has shown that adolescents are exposed to socio-cultural activities that put them at risk of HIV and other sexually transmitted infections. To develop effective intervention strategies and programs, it is imperative to understand how the cultural proverbs and myths create sexual norms and shape the worldview of adolescents. The findings indicate that some cultural proverbs and myths negatively influence adolescents hence expose them to risky sexual behaviors.

Individual-Level Predictors of Nonparticipation and Dropout in a Life-Skills HIV Prevention Program for Adolescents in Foster Care

ERIC Educational Resources Information Center

Thompson, Ronald G., Jr.; Auslander, Wendy F.; Alonzo, Dana

2012-01-01

The purpose of this study is to identify individual-level characteristics of foster care adolescents who are more likely to not participate in, and drop out of, a life-skills HIV prevention program delivered over 8 months. Structured interviews were conducted with 320 foster care adolescents (15-18 years). Logistic regression and survival analyses…

[Sexually transmitted diseases and HIV-1 infection in Italian adolescents].

PubMed

Giuliani, M; Suligoi, B

2000-12-01

To assess the distribution of specific sexually transmitted diseases (STD), including HIV-1 infection, among Italian adolescents with an acute STD and to evaluate these individuals behavioural characteristics. The database of Italy's STD Surveillance System was used as the source of data. Data on all STD cases reported among individuals under 20 years of age were analysed. From September 1990 to December 1997, 57,046 cases of STDs were reported to the surveillance system; 1,757 (3.1%) of these were reported among adolescents, of whom 896 (51.0%) were males. The most commonly reported diseases among males were genital warts (30.7%) and non-gonococcal urethritis (18.5%); among females, the most commonly reported diseases were non-gonococcal vaginitis (39.1%) and genital warts (30.0%). Of the 555 males tested for HIV-1 antibodies, 28 (5.0%) were seropositive; of the 510 females tested, 17 (3.3%) were seropositive. The highest HIV-1 seroprevalence rates were found among intravenous drug users (IDU) (33.3% among male IDUs and 23.8% among female IDUs) and among homosexual males (17.6%). In Italy, the impact of STDs among adolescents is not negligible, though the distribution of STDs among this population group differs from the distribution among adults. Moreover, the prevalence of HIV-1 among adolescents with STDs is similar to that among adults with STDs. This study's data suggest the need to further develop STD/HIV prevention programmes that specifically target youths.

Combination Social Protection for Reducing HIV-Risk Behavior Among Adolescents in South Africa.

PubMed

Cluver, Lucie D; Orkin, F Mark; Yakubovich, Alexa R; Sherr, Lorraine

2016-05-01

Social protection (ie, cash transfers, free schools, parental support) has potential for adolescent HIV prevention. We aimed to identify which social protection interventions are most effective and whether combined social protection has greater effects in South Africa. In this prospective longitudinal study, we interviewed 3516 adolescents aged 10-18 between 2009 and 2012. We sampled all homes with a resident adolescent in randomly selected census areas in 4 urban and rural sites in 2 South African provinces. We measured household receipt of 14 social protection interventions and incidence of HIV-risk behaviors. Using gender-disaggregated multivariate logistic regression and marginal effects analyses, we assessed respective contributions of interventions and potential combination effects. Child-focused grants, free schooling, school feeding, teacher support, and parental monitoring were independently associated with reduced HIV-risk behavior incidence (odds ratio: 0.10-0.69). Strong effects of combination social protection were shown, with cumulative reductions in HIV-risk behaviors. For example, girls' predicted past-year incidence of economically driven sex dropped from 11% with no interventions to 2% among those with a child grant, free school, and good parental monitoring. Similarly, girls' incidence of unprotected/casual sex or multiple partners dropped from 15% with no interventions to 10% with either parental monitoring or school feeding, and to 7% with both interventions. In real world, high-epidemic conditions, "combination social protection," shows strong HIV prevention effects for adolescents and may maximize prevention efforts.

Current status of herpesvirus identification in the oral cavity of HIV-infected children.

PubMed

Pinheiro, Raquel dos Santos; Ferreira, Dennis de Carvalho; Nóbrega, Flávia; Santos, Norma Suely de Oliveira; Souza, Ivete Pomarico Ribeiro de; Castro, Gloria Fernanda Barbosa de Araujo

2013-01-01

Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%). The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda.

PubMed

Ssewamala, Fred M; Bermudez, Laura Gauer; Neilands, Torsten B; Mellins, Claude A; McKay, Mary M; Garfinkel, Irv; Sensoy Bahar, Ozge; Nakigozi, Gertrude; Mukasa, Miriam; Stark, Lindsay; Damulira, Christopher; Nattabi, Jennifer; Kivumbi, Apollo

2018-06-05

Asset-based economic empowerment interventions, which take an integrated approach to building human, social, and economic capital, have shown promise in their ability to reduce HIV risk for young people, including adolescent girls, in sub-Saharan Africa. Similarly, community and family strengthening interventions have proven beneficial in addressing mental health and behavioral challenges of adolescents transitioning to adulthood. Yet, few programs aimed at addressing sexual risk have applied combination interventions to address economic stability and mental health within the traditional framework of health education and HIV counseling/testing. This paper describes a study protocol for a 5-year, NIMH-funded, cluster randomized-controlled trial to evaluate a combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. The intervention, titled Suubi4Her, combines savings-led economic empowerment through youth development accounts (YDA) with an innovative family strengthening component delivered via Multiple Family Groups (MFG). Suubi4Her will be evaluated via a three-arm cluster randomized-controlled trial design (YDA only, YDA + MFG, Usual Care) in 42 secondary schools in the Central region of Uganda, targeting a total of 1260 girls (ages 15-17 at enrollment). Assessments will occur at baseline, 12, 24, and 36 months. This study addresses two primary outcomes: 1) change in HIV risk behavior and 2) change in mental health functioning. Secondary exploratory outcomes include HIV and STI incidence, pregnancy, educational attainment, financial savings behavior, gender attitudes, and self-esteem. For potential scale-up, cost effectiveness analysis will be employed to compare the relative costs and outcomes associated with each study arm. Suubi4Her will be one of the first prospective studies to examine the impact and cost of a combination intervention integrating economic and social components to reduce known HIV risk factors and improve mental health functioning among adolescent girls, while concurrently exploring mental health as a mediator in HIV risk reduction. The findings will illuminate the pathways that connect economic needs, mental health, family support, and HIV risk. If successful, the results will promote holistic HIV prevention strategies to reduce risk among adolescent girls in Uganda and potentially the broader sub-Saharan Africa region. Clinical Trials NCT03307226 (Registered: 10/11/17).

Information and attitudes about HIV/AIDS in Portuguese adolescents: state of art and changes in a four year period.

PubMed

Reis, Marta; Ramiro, Lúcia; de Matos, Margarida Gaspar; Diniz, José Alves; Simões, Celeste

2011-04-01

The incidence of infection with HIV/AIDS among the heterosexual population has been increasing in young adults. The goal of this research was to deepen knowledge of preventive sexual behavior in Portuguese adolescents, including knowledge and attitudes about HIV/AIDS, and assessing whether they changed from 2002 to 2006. Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in School-aged Children (HBSC), a collaborative WHO study. The study provides national representative data of 7093 Portuguese adolescents, randomly chosen from those attending 8th and 10th grade of high school. Results showed there was an increase in the age of first sexual intercourse and a decrease in the number of teenagers who reported having had sexual intercourse, also in the level of information regarding HIV/AIDS transmission/prevention and in positive attitudes towards people with HIV/AIDS. In general, adolescents have good knowledge about how to protect themselves from becoming infected. However, comparing to 2002, there was a reduction of knowledge and consequent increase in the doubts regarding HIV/AIDS. Given the incipient state of sex education in 2006, the results cannot be attributed to sex education, but they will be relevant for comparison with the 2010 HBSC results.

Childhood adversity increases the risk of onward transmission from perinatal HIV-infected adolescents and youth in South Africa.

PubMed

Kidman, Rachel; Nachman, Sharon; Dietrich, Janan; Liberty, Afaaf; Violari, Avy

2018-05-01

Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13-24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09-1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth. Copyright © 2018 Elsevier Ltd. All rights reserved.

We Never Thought This Would Happen: Transitioning Care of Adolescents with Perinatally-Acquired HIV Infection from Pediatrics to Internal Medicine

PubMed Central

Vijayan, Tara; Benin, Andrea L.; Wagner, Krystn; Romano, Sostena; Andiman, Warren A.

2009-01-01

Purpose Transitioning the medical care of children with perinatally-acquired HIV from pediatric care to internal medicine practices has become increasingly important as newer therapies prolong survival. The study aims to describe challenges to caring for these adolescents and the potential barriers to transitioning them to internal medicine-based care. Methods Qualitative study in which data were gathered from open-ended interviews conducted from November 2005-April 2006 with 18 adolescents with HIV, 15 of their principal guardians, and 9 pediatric health care providers from the Yale Pediatric AIDS Care Program, New Haven, Connecticut. Results Issues of stigma played a prominent role in both the challenges to care and barriers to transitioning care. Challenges to care were: (1) poor adherence to medication regimens; (2) adolescent sexuality; and (3) disorganized social environments. Potential barriers to transitioning care were: (1) families’ negative perceptions of and experiences with stigma of HIV disease--which undermined the desire to meet new providers; (2) perceived and actual lack of autonomy-- pediatric providers feared that staff in adult clinics would demand a level of independence that adolescents did not have; and (3) difficulty letting-go of relationships-- adolescents, guardians, and providers described a familial relationship and expressed anxiety about terminating their relationships. Conclusion Understanding these challenges and barriers can inform both pediatric and adult HIV care providers and enable them to create successful transition programs, with the goal of improving retention and follow-up to care. PMID:20024697

Prevalence of, and barriers to the disclosure of HIV status to infected children and adolescents in a district of Ghana.

PubMed

Gyamfi, Eric; Okyere, Paul; Enoch, Acheampong; Appiah-Brempong, Emmanuel

2017-04-08

Globally there are about 3.3million children under the age of 15 years living with HIV. Of this number, 88% live in sub-Saharan Africa. In Ghana, an estimated 33,000 children were said to be living with the HIV infection in 2012. Lack of disclosure adversely affects the well-being of the child, including access to paediatric HIV treatment and care and adherence to treatment. However, the greatest psychosocial challenges that parents and caregivers of HIV-infected children face is disclosure of HIV status to their infected children. This study sought to determine the prevalence of and the barriers to the disclosure of HIV status to infected children and adolescents in Lower Manya-Krobo District in Ghana. A cross sectional study with a sample of 118 caregivers of HIV infected children and adolescents aged 4-19 years attending three HIV clinics in the Lower Manya Krobo District, and 10 key informants comprising of healthcare workers and HIV volunteer workers involved in the provision of care to infected children and their families. The prevalence of disclosure was higher. Main barriers to disclosure identified in this study included age of child, perceived cause of HIV, stigma attached to HIV, child's inability to keep diagnosis to self and fear of psychological harm to child. There is the need for the Ghana Health Service in conjunction with the Ghana Aids Commission and the National Aids Control Programme to develop comprehensive context-based disclosure guidelines.

Use of Technology for HIV Prevention Among Adolescent and Adult Women in the United States.

PubMed

Blackstock, Oni J; Patel, Viraj V; Cunningham, Chinazo O

2015-12-01

Although the proportion of new HIV infections in the USA among women has decreased over the last few years, still, approximately 20 % of new infections occur annually among adolescent and adult women. The development of effective evidence-based prevention interventions remains an important approach to further decreasing these numbers. Technology-delivered prevention interventions hold tremendous potential due, in part, to their ability to reach beyond the walls of brick-and-mortar intervention sites to engage individuals where they are. While most technology-delivered interventions have focused on adolescents and men who have sex with men, much fewer have specifically targeted adolescent or adult women despite evidence showing that interventions tailored to specific target populations are most effective. We summarize the recently published literature on technology-delivered HIV prevention interventions for US adolescent and adult women and provide suggestions for next steps in this nascent but emergent area of prevention research.

Recent and Past Intimate Partner Abuse and HIV Risk Among Young Women

PubMed Central

Teitelman, Anne M.; Ratcliffe, Sarah J.; Dichter, Melissa E.; Sullivan, Cris M.

2011-01-01

Objective To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners. Design Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health). Setting The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents. Sample Analyses involved 2,058 sexually active young adult women. Main Outcome Measures HIV risk was measured by consistent condom use over the past 12 months. Results Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts. Conclusion A causal pathway may exist between prior abuse, current abuse, and HIV risk. PMID:18336447

Common Processes in Evidence-Based Adolescent HIV Prevention Programs

PubMed Central

Ingram, Barbara L.; Flannery, Diane; Elkavich, Amy

2014-01-01

Dissemination of evidence-based HIV prevention programs for adolescents will be increased if community interventionists are able to distinguish core, essential program elements from optional, discretionary ones. We selected five successful adolescent HIV prevention programs, used a qualitative coding method to identify common processes described in the procedural manuals, and then compared the programs. Nineteen common processes were categorized as structural features, group management strategies, competence building, and addressing developmental challenges of adolescence. All programs shared the same structural features (goal-setting and session agendas), used an active engagement style of group management, and built cognitive competence. Programs varied in attention to developmental challenges, emphasis on behavioral and emotional competence, and group management methods. This qualitative analysis demonstrated that successful HIV programs contain processes not articulated in their developers’ theoretical models. By moving from the concrete specifics of branded interventions to identification of core, common processes, we are consistent with the progress of “common factors” research in psychotherapy. PMID:18330687

Redeeming Lost Mothers: Adolescent Antiretroviral Treatment and the Making of Home in South Africa.

PubMed

Vale, Beth; Thabeng, Mildred

2016-01-01

In this article, we explore how adolescent antiretroviral treatment (ART) might be signified to repair sociality in Eastern Cape homes that have been ruptured by HIV/AIDS and maternal loss. The post-apartheid period has exposed these families to new forms of social fragmentation, propelled by the disintegration of wage labor, declining marriage rates, and a rampant HIV/AIDS epidemic. Drawing on eight months of ethnographic fieldwork (August 2013-April 2014), we show that in the homes of some adolescents born with HIV, these present-day domestic ruptures were discursively connected to the past shortcomings of their dead and absent mothers. In some familial narratives lost mothers were accused of disobeying their elders, neglecting their children, and flouting custom; their social transgressions were made manifest in their child's inherited HIV. By signifying adolescent ART-taking as an enactment of the discipline and care purportedly absent in their mothers, these families might also attempt to imbue ART, beyond its biomedical function, as a means of social repair.

Added benefits: Reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention

PubMed Central

Brown, Jennifer L.; Sales, Jessica M.; Swartzendruber, Andrea L.; Eriksen, Michael D.; DiClemente, Ralph J.; Rose, Eve S.

2014-01-01

Background Adolescents experience elevated depressive symptoms which health promotion interventions may reduce. Purpose This study investigated whether HIV prevention trial participation decreased depressive symptoms among African-American female adolescents. Methods Adolescents (N=701; M age = 17.6) first received a group-delivered HIV prevention intervention and then either 12 sexual health (intervention condition) or 12 general health (comparison condition) phone counseling contacts over 24 months. ACASI assessments were conducted at baseline, and at 6-, 12-, 18-, and 24-months post-baseline. Linear generalized estimating equations were used to detect percent relative change in depressive symptoms. Results Participants reported a 2.7% decrease in depressive symptoms (p = 0.001) at each assessment. Intervention participants endorsed an additional 3.6% decrease in depressive symptoms (p = 0.058). Conclusions Trial participation was associated with reduced depressive symptomatology, particularly among those receiving personalized sexual health counseling. HIV prevention interventions may benefit from incorporating additional content to address adolescents’ mental health needs. PMID:24366521

Masculinity, vulnerability and prevention of STD/HIV/AIDS among male adolescents: social representations in a land reform settlement.

PubMed

Arraes, Camila de Oliveira; Palos, Marinésia Aparecida Prado; Barbosa, Maria Alves; Teles, Sheila Araujo; Souza, Márcia Maria de; Matos, Marcos André de

2013-01-01

to analyze the relationship of masculinity, vulnerability and prevention of STD / HIV / AIDS among adolescent males of a land reform settlement in central Brazil. a qualitative study using as precepts the strands of social representations with teenagers between 12 to 24 years. three categories emerged - Perception of vulnerability; Gender and vulnerability; and, Prevention and vulnerability to STD / HIV / AIDS. Adolescents felt invulnerable to sexually transmitted diseases anchored in the social representations in favor of the male hegemony. An ignorance about forms of prevention for STD / HIV / AIDS was demonstrated in their statements. It is believed that institutional projects such as the School Health Program and the Men's Health Care Program constitute essential tools to minimize factors of vulnerability in this population, since the school is recognized as a social facility that promotes socialization of experiences and contributes to the construction of the identity of the adolescent. the social representations of masculinity collaborate for the vulnerable behavior of the adolescents for the acquisition of sexually transmitted diseases. One hopes that this study can contribute to the production of knowledge and technical-scientific improvement of the professionals, especially the nurse, in order to discuss issues related to male sexuality of adolescents in the situation of the land reform settlement.

Meningococcal Conjugate and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccination Among HIV-infected Youth.

PubMed

Setse, Rosanna W; Siberry, George K; Moss, William J; Wheeling, John; Bohannon, Beverly A; Dominguez, Kenneth L

2016-05-01

The meningococcal conjugate vaccine (MCV4) and the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) were first recommended for adolescents in the US in 2005. The goal of our study was to determine MCV4 and Tdap vaccines coverage among perinatally and behaviorally HIV-infected adolescents in 2006 and to compare coverage estimates in our study population to similarly aged healthy youth in 2006. Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) is a retrospective cohort study of HIV-infected youth in 22 HIV specialty clinics across the US. Among LEGACY participants ≥11 years of age in 2006, we conducted a cross-sectional analysis to determine MCV4, Tdap and MCV4/Tdap vaccine coverage. We compared vaccine coverage among our study population to coverage among similarly aged youth in the 2006 National Immunization Survey for Teens (NIS-Teen Survey). Multivariable mixed effects logistic regression modeling was used to examine associations between MCV4/Tdap vaccination and mode of HIV transmission. MCV4 and Tdap coverage rates among 326 eligible participants were 31.6% and 28.8%, respectively. Among adolescents 13-17 years of age, MCV4 and Tdap coverage was significantly higher among HIV-infected youth than among youth in the 2006 NIS-Teen Survey (P <0.01). In multivariable analysis, perinatally HIV-infected youth were significantly more likely to have received MCV4/Tdap vaccination compared with their behaviorally infected counterparts (adjusted odds ratio: 5.1; 95% confidence interval: 2.0, 12.7). HIV-infected youth with CD4 cell counts of 200-499 cells/μL were more likely to have had MCV4/Tdap vaccination compared with those with CD4 counts ≥500 cells/μL (adjusted odds ratio: 2.2; 95% confidence interval: 1.2, 4.3). Participants with plasma HIV RNA viral loads of >400 copies/mL were significantly less likely to have received MCV4/Tdap vaccination (P < 0.05). MCV4 and Tdap coverage among HIV-infected youth was suboptimal but higher than for healthy adolescents in the 2006 NIS-Teen Survey. Perinatal HIV infection was associated with increased likelihood of vaccination. Specific measures are needed to improve vaccine coverage among adolescents in the US.

Sex in the shadow of HIV: A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa

PubMed Central

Haghighat, Roxanna; Cluver, Lucie

2017-01-01

Background Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Methods Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10–24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. Results 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored <50% in the quality checklist. Living with a partner, living alone, gender-based violence, food insecurity, and employment were correlated with increased sexual risk-taking, while knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs), three evaluated group-based interventions, and one evaluated an individual-focused combination intervention. Three of the interventions were effective at reducing sexual risk-taking, with one reporting no difference between the intervention and control groups. Conclusion Sexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group. PMID:28582428

Characteristics and determinants of sexual behavior among adolescents of migrant workers in Shangai (China)

PubMed Central

Li, Shenghui; Huang, Hong; Cai, Yong; Xu, Gang; Huang, Fengrong; Shen, Xiaoming

2009-01-01

Background China is facing a critical challenge of rapid and widespread human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increase. Rural-to-urban migration plays a crucial role in shifting the HIV/sexual transmitted infection (STI) epidemic. The purpose of this study was to assess the prevalence of sexual behaviors and the correlates among the early adolescents of migrant workers in China. Methods A cross-sectional study was conducted in 10 junior high schools from April to June of 2008. A total of 2821 adolescents aged 14.06 ± 0.93 years (8.9% of migrant workers vs. 91.1% of general residents) participated in the survey. A self-administrated questionnaire was used to collect information on knowledge, attitude, and behaviors associated with increased risk for HIV/STI. Results The percentage of adolescents who ever had sexual intercourse or had sexual intercourse in last three months was 7.2% and 4.3% in adolescents of migrant workers, respectively; in contrast, 4.5% and 1.8% in their peers of general residents, respectively. 47.3% adolescents of migrant workers and 34.3% of those adolescents of general residents reported no condom use in sexual intercourse during last three months. Multivariate logistic regression analyses found that migration was a independent risk factor for sexual intercourse in last three months in our sampled adolescents (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.01–1.72). In adolescents of migrant workers, factors such as lower family income (OR: 2.22, CI: 1.09–3.05 for low level; OR:1.25, CI: 1.04–1.59 for medium level), younger age at first sexual intercourse (OR: 1.24, CI: 1.09–1.57), lower knowledge on HIV/AIDS (OR: 0.93, CI: 0.90–0.97), and fewer communication on HIV/AIDS related issues (OR: 0.79, CI: 0.90–0.97) were related to sexual intercourse in last three months. Conclusion Based on these results, we advocated that heightened concerns targeting the adolescents of migrant workers be particularly necessary, given their higher level of sexual experience, lower socioeconomic status, restricted reproductive health information, and vulnerability to HIV/STI. PMID:19538756

Understanding the experience and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe

PubMed Central

Mavhu, Webster; Wogrin, Carol; Mutsinze, Abigail; Kagee, Ashraf

2018-01-01

Background Studies have found that adolescents living with HIV are at risk of depression, which in turn affects adherence to medication. This study explored the experience and manifestation of depression in adolescents living with HIV in Zimbabwe in order to inform intervention development. Methods We conducted a body mapping exercise with 21 HIV positive 15–19 years olds who had been diagnosed with major depressive disorder. Participants created a painted map of their body to assist them in expressing their somatic and emotional experiences in qualitative interviews. The interviews were transcribed and thematically coded using NVivo 10. Results Participants attributed their experiences of depression to their relationships and interactions with significant people in their lives, primarily family members and peers. A sense of being different from others was common among participants, both due to their HIV status and the impact HIV has had on their life circumstances. Participants described a longing to be important or to matter to the people in their lives. A sense of isolation and rejection was common, as well as grief and loss, including ambiguous and anticipated loss. Participants’ idioms of distress included ‘thinking deeply’ (‘kufungisisa’), ‘pain’, darkness, ‘stress’ or a lack of hope and ambiguity for the future. Suicidal ideation was described, including slow suicide through poor adherence. Supportive factors were also relational, including the importance of supportive relatives and peers, clinic staff and psychosocial support programmes. Conclusions An understanding of HIV positive adolescents’ own narratives around depression can inform the development and integration of appropriate mental health interventions within HIV care and treatment programmes. Study findings suggest that family and peer-led interventions are potentially useful in the prevention and management of depression in adolescents living with HIV. PMID:29298326

Adolescents’ experience of a rapid HIV self-testing device in youth-friendly clinic settings in Cape Town South Africa: a cross-sectional community based usability study

PubMed Central

Smith, Philip; Wallace, Melissa; Bekker, Linda-Gail

2016-01-01

Abstract Introduction: Since HIV testing in South African adolescents and young adults is sub-optimal, the objective of the current study was to investigate the feasibility and acceptability of an HIV rapid self-testing device in adolescents and young people at the Desmond Tutu HIV Foundation Youth Centre and Mobile Clinic. Methods: Self-presenting adolescents and young adults were invited to participate in a study investigating the fidelity, usability and acceptability of the AtomoRapid HIV Rapid self-testing device. Trained healthcare workers trained participants to use the device before the participant conducted the HIV self-test with device usage instructions. The healthcare worker then conducted a questionnaire-based survey to assess outcomes. Results: Of the 224 enrolled participants between 16 and 24 years of age, 155 (69,2%) were female. Overall, fidelity was high; 216 (96,4%) participants correctly completed the test and correctly read and interpreted the HIV test result. There were eight (3,6%) user errors overall; six participants failed to prick their finger even though the lancet fired correctly. There were two user errors where participants failed to use the capillary tube correctly. Participants rated acceptability and usability highly, with debut testers giving significantly higher ratings for both. Younger participants gave significantly higher ratings of acceptability. Conclusions: Adolescents and young adults found HIV self-testing highly acceptable with the AtomoRapid and they used the device accurately. Further research should investigate how, where and when to deploy HIV self-testing as a means to accompany existing strategies in reaching the UNAIDS goal to test 90% of all individuals worldwide. PMID:28406597

Sexual and Gender Minority Adolescents’ Views on HIV Research Participation and Parental Permission: A Mixed- Methods Study

PubMed Central

Mustanski, Brian; Coventry, Ryan; Macapagal, Kathryn; Arbeit, Miriam R.; Fisher, Celia B.

2018-01-01

CONTEXT Sexual and gender minority adolescents are underrepresented in HIV research, in part because institutional review boards (IRBs) are reluctant to waive parental permission requirements for these studies. Understanding teenagers’ perspectives on parental permission and the risks and benefits of participating in HIV research is critical to informing evidence-based IRB decisions. METHODS Data from 74 sexual and gender minority adolescents aged 14–17 who participated in an online focus group in 2015 were used to examine perspectives on the risks and benefits of participation in a hypothetical HIV surveillance study and on the need for parental permission and adequate protections. Data were analyzed thematically; mixed methods analyses examined whether concerns about parental permission differed by whether teenagers were out to their parents. RESULTS Most adolescents, especially those who were not out to their parents, would be unwilling to participate in an HIV study if parental permission were required. Perceived benefits of participation included overcoming barriers to HIV testing and contributing to the health of sexual and gender minority youth. Few risks of participation were identified. Adolescents suggested several steps that researchers could take to facilitate informed decision making about research participation and ensure minors’ safety in the absence of parental permission; these included incorporating multimedia presentations into the consent process and explaining researchers’ motivations for conducting the study. CONCLUSIONS Respondents believed that the benefits of HIV surveillance research outweighed the risks. Requiring parental permission may exclude many sexual and gender minority teenagers from taking part in HIV research, especially if they are not out. PMID:28445608

Psychosocial issues in children and adolescents with HIV infection evaluated with a World Health Organization age-specific descriptor system.

PubMed

Giannattasio, Antonietta; Officioso, Annunziata; Continisio, Grazia Isabella; Griso, Giovanna; Storace, Cinzia; Coppini, Simonetta; Longhi, Daniela; Mango, Carmela; Guarino, Alfredo; Badolato, Raffaele; Pisacane, Alfredo

2011-01-01

After active antiretroviral therapy, children with HIV are clinically well, whereas psychosocial issues continue to influence their quality of life. The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization evaluates health status and environmental and social factors associated with health. We investigated the efficacy of the ICF to describe the health status and needs of a cohort of children and adolescents with HIV seen at a reference center for pediatric AIDS in Europe. A quantitative analysis of structured interviews was performed. Caregivers of children and adolescents with HIV infection in follow-up at 2 reference centers for pediatric AIDS were enrolled. Four major areas included in the ICF instrument were investigated: impairments of body structures; impairments of body functions; environmental factors; and activity limitations and restrictions to social life. Forty-one families of children with HIV were enrolled. Body structures and functions were marginally impaired, whereas environmental factors and psychosocial issues had a relevant impact on quality of life. Most families considered environmental factors to be "barriers"; these were poverty, unemployment, and single-parent family structure. Activity limitations and social restrictions were also reported in a few cases. Almost all parents reported problems in disclosing their child's HIV status because of the fear of social stigma. Psychosocial issues are part of the well-being of children with HIV. The ICF is a standard tool to evaluate the clinical and psychosocial status of children and adolescents with HIV infection and to measure the impact of therapeutic interventions and strategies on psychosocial functioning.

A quasi-experimental evaluation of a community-based HIV prevention intervention for Mexican American female adolescents: the SHERO's program.

PubMed

Harper, Gary W; Bangi, Audrey K; Sanchez, Bernadette; Doll, Mimi; Pedraza, Ana

2009-10-01

This article describes a quasi-experimental evaluation of a community-based, culturally and ecologically tailored HIV prevention intervention for Mexican American female adolescents grounded in the AIDS risk reduction model. A total of 378 Mexican American female adolescents (mean age = 15.2) participated in either the nine-session SHERO's (a female-gendered version of the word hero) intervention or a single session information-only HIV prevention intervention. Assessment data were collected at pretest, posttest, and 2-month follow up. Significant improvements across all time points were revealed on measures of self-esteem, condom attitudes, beliefs regarding a woman's control of her sexuality, beliefs regarding sexual assault, perceived peer norms, and HIV/AIDS and STI knowledge. At posttest SHERO's participants were more likely to carry condoms and to report abstaining from vaginal sex in the previous 2 months; and at 2-month follow up they reported using condoms more often in the preceding 2 months and planned on using them more frequently in the coming 2 months. Findings support the development of community-based adolescent HIV prevention interventions that address culturally specific ecological factors.

Growing up in a world with AIDS: social advantages of having AIDS in Brazil.

PubMed

Abadía-Barrero, C E

2002-06-01

Could HIV/AIDS become a positive factor for a child's life? This contradiction is explored in this paper based on anthropological fieldwork and research in Brazil. I used participant observation and informal interviewing both with children living with HIV/AIDS and uninfected street children to obtain qualitative data. Brazil is known as a country leader in social responses towards the AIDS epidemic. Not only has access to antiretroviral medications been assured, but also a series of help networks guarantee that the human rights of HIV-infected people be respected. Children and adolescents benefit equally from these social gains. As such, many children born to HIV-positive women have reached adolescence and have 'normal' lives. This article explores the life experiences of children and adolescents infected by HIV and compares them to the life experiences of street children. Even though the AIDS epidemic is linked to death, infected children and adolescents dream about their lives and futures. Contradictorily, street children, who have not acquired the virus and are considered healthy from a biological stand point, have no prospective plans and answer without hope to questions about the future.

A comparison of network-based strategies for screening at-risk Hispanic/Latino adolescents and young adults for undiagnosed asymptomatic HIV infection.

PubMed

Boyer, Cherrie B; Robles-Schrader, Grisel M; Li, Su X; Miller, Robin L; Korelitz, James; Price, Georgine N; Rivera Torres, Carmen M; Chutuape, Kate S; Stines, Stephanie J; Straub, Diane M; Peralta, Ligia; Febo, Irma; Hightow-Weidman, Lisa; Gonin, René; Kapogiannis, Bill G; Ellen, Jonathan M

2014-12-01

Hispanic/Latino adolescents and young adults are disproportionately impacted by the HIV/AIDS epidemic; yet little is known about the best strategies to increase HIV testing in this group. Network-based approaches are feasible and acceptable means for screening at-risk adults for HIV infection, but it is unknown whether these approaches are appropriate for at-risk young Hispanics/Latinos. Thus, we compared an alternative venue-based testing (AVT) strategy with a social and sexual network-based interviewing and HIV testing (SSNIT) strategy. All participants were Hispanics/Latinos aged 13-24 years with self-reported HIV risk; they were recruited from 11 cities in the United States and Puerto Rico and completed an audio computer-assisted self-interview and underwent HIV screening. A total of 1,596 participants (94.5% of those approached) were enrolled: 784 (49.1%) through AVT and 812 (50.9%) through SSNIT. HIV infection was identified in three SSNIT (.37%) and four AVT (.51%) participants (p = .7213). Despite high levels of HIV risk, a low prevalence of HIV infection was identified with no differences by recruitment strategy. We found overwhelming support for the acceptability and feasibility of AVT and SSNIT for engaging and screening at-risk young Hispanics/Latinos. Further research is needed to better understand how to strategically implement such strategies to improve identification of undiagnosed HIV infection. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Internet use, social networking, and HIV/AIDS risk for homeless adolescents.

PubMed

Rice, Eric; Monro, William; Barman-Adhikari, Anamika; Young, Sean D

2010-12-01

To examine the association between sexual health and internet use, including social networking websites such as MySpace and Facebook, among a sample of homeless adolescents at high risk of contracting HIV/AIDS. In 2009, a survey of internet use among 201 homeless adolescents was carried out. Multivariate logistic regression models assessed how patterns of use were associated with engaging in exchange sex (sex for money, drugs, or housing), recent HIV testing, and online partner-seeking behaviors. Among the surveyed adolescents, 96.5% reported internet use. Most youth accessed the internet at public libraries or youth service agencies. Increased time online and recent engagement in exchange sex were both positively associated with online partner-seeking. Youth connected to family members online were less likely to practice exchange sex and more likely to report a recent HIV test. Youth connected to street-based peers online were more likely to practice exchange sex, whereas youth connected to home-based peers online were more likely to report a recent HIV test. Although these data are preliminary, homeless youth need more access to the internet, as access facilitates connecting with family and home-based peers whose presence may reduce sexual risk-taking. Access, however, must be carefully monitored to prevent youth soliciting sex online. Copyright © 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Efficacy of an HIV Prevention Program Among Female Adolescents Experiencing Gender-Based Violence

PubMed Central

Wingood, Gina M.; DiClemente, Ralph J.; Harrington, Kathy F.; Lang, Delia L.; Davies, Susan L.; Hook, Edward W.; Oh, M. Kim; Hardin, James W.

2006-01-01

Objectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence. PMID:16670238

Impact of lopinavir-ritonavir exposure in HIV-1 infected children and adolescents in Madrid, Spain during 2000-2014.

PubMed

Rojas Sánchez, Patricia; Prieto, Luis; Jiménez De Ory, Santiago; Fernández Cooke, Elisa; Navarro, Maria Luisa; Ramos, José Tomas; Holguín, África

2017-01-01

The most-used protease-inhibitor in children is Lopinavir-ritonavir (LPV/r), which provides durable suppression of viral load and increases CD4+T-counts. This study describes the virological outcome of the HIV-1-infected paediatric population exposed to LPV/r during 15 years in Spain. Patients from the Madrid Cohort of HIV-1-infected-children and adolescents exposed to LPV/r as different line therapy during 2000-2014 were selected. The baseline epidemiological-clinical features, viral suppression, changes in CD4+T-CD8+T cell counts and drug susceptibility were recorded before and during LPV/r exposure. Drug resistance mutations (DRM) were identified in viruses from samples collected until 2011. We predicted drug susceptibility to 19 antiretrovirals among those carrying DRM using the Stanford's HIVdb Algorithm. A total of 199 (37.3%) of the 534 patients from the cohort were exposed to LPV/r during 2000-2014 in first (group 1), second (group 2) or more line-therapies (group 3). Patients were mainly Spaniards (81.9%), perinatally infected (96.5%) with subtype-B (65.3%) and HIV-diagnosed before year 2000 (67.8%). The mean age at first LPV/r exposure was 9.7 years. After protease-inhibitor exposure, viral suppression was higher in groups 1 and 2 than in group 3. Viral suppression occurred in 87.5%, 68.6% and 64.8% patients from groups 1, 2 and 3, respectively. Among the 64 patients with available resistance data during LPV/r treatment, 27(42.3%) carried DRM to protease-inhibitor, 28 (58.3%) to reverse-transcriptase-inhibitors and 21 (43.7%) to non-reverse-transcriptase-inhibitors. Darunavir/ritonavir, atazanavir-ritonavir and tipranavir/ritonavir presented the highest susceptibility and nelfinavir the lowest. A better lymphocyte recovering occurred when protease-inhibitor was taken as part of a first-line regimen and a higher number of patients reached viral suppression. The least compromised antiretrovirals for rescue antiretroviral regimens, according to DRM in the LPV/r-exposed-paediatric cohort, were mainly the new protease inhibitors.

HIV Stigma: Perspectives from Kenyan Child Caregivers and Adolescents Living with HIV.

PubMed

McHenry, Megan Song; Nyandiko, Winstone M; Scanlon, Michael L; Fischer, Lydia J; McAteer, Carole I; Aluoch, Josephine; Naanyu, Violet; Vreeman, Rachel C

Stigma shapes all aspects of HIV prevention and treatment, yet there are limited data on how HIV-infected youth and their families are affected by stigma in sub-Saharan Africa. The authors conducted a qualitative study using focus group discussions among 39 HIV-infected adolescents receiving care at HIV clinics in western Kenya and 53 caregivers of HIV-infected children. Participants felt that while knowledge and access to treatment were increasing, many community members still held negative and inaccurate views about HIV, including associating it with immorality and believing in transmission by casual interactions. Stigma was closely related to a loss of social and economic support but also included internalized negative feelings about oneself. Participants identified treatment-related impacts of stigma, including nonadherence, nondisclosure of status to child or others, and increased mental health problems. Qualitative inquiry also provided insights into how to measure and reduce stigma among affected individuals and families.

HIV Stigma: Perspectives from Kenyan Child Caregivers and Adolescents Living with HIV

PubMed Central

McHenry, Megan Song; Nyandiko, Winstone M.; Scanlon, Michael L.; Fischer, Lydia J.; McAteer, Carole I.; Aluoch, Josephine; Naanyu, Violet; Vreeman, Rachel C.

2017-01-01

Stigma shapes all aspects of HIV prevention and treatment, yet there are limited data on how HIV-infected youth and their families are affected by stigma in sub-Saharan Africa. The authors conducted a qualitative study using focus group discussions among 39 HIV-infected adolescents receiving care at HIV clinics in western Kenya and 53 caregivers of HIV-infected children. Participants felt that while knowledge and access to treatment were increasing, many community members still held negative and inaccurate views about HIV, including associating it with immorality and believing in transmission by casual interactions. Stigma was closely related to a loss of social and economic support but also included internalized negative feelings about oneself. Participants identified treatment-related impacts of stigma, including nonadherence, nondisclosure of status to child or others, and increased mental health problems. Qualitative inquiry also provided insights into how to measure and reduce stigma among affected individuals and families. PMID:27655835

Factors affecting the HIV/AIDS epidemic: an ecological analysis of global data.

PubMed

Mondal, M N I; Shitan, M

2013-06-01

All over the world the prevalence of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) has became a stumbling stone in progress of human civilization and is a huge concern for people worldwide. To determine the social and health factors which contribute to increase the size of HIV epidemic globally. The country level indicators of HIV prevalence rates, are contraceptive prevalence rate, physicians density, proportion of Muslim populations, adolescent fertility rate, and mean year of schooling were compiled of 187 countries from the United Nations (UN) agencies. To extract the major factors from those indicators of the later five categories, backward multiple regression analysis was used as the statistical tool. The national HIV prevalence rate was significantly correlated with almost all the predictors. Backward multiple linear regression analysis identified the proportion of Muslims, physicians density, and adolescent fertility rate are as the three most prominent factors linked with the national HIV epidemic. The findings support the hypotheses that a higher adolescent fertility rate in the population is the adverse effect of premarital and extramarital sex that leads to longer period of sexual activity which increases the risk of HIV infection. On the hand, and cultural restrictions of Muslims and sufficient physicians will decelerate the spread of HIV infections in the society.

Safety and immunogenicity of a quadrivalent human papillomavirus vaccine in HIV-infected and HIV-negative adolescents and young adults.

PubMed

Giacomet, Vania; Penagini, Francesca; Trabattoni, Daria; Viganò, Alessandra; Rainone, Veronica; Bernazzani, Giada; Bonardi, Claudia Maria; Clerici, Mario; Bedogni, Giorgio; Zuccotti, Gian Vincenzo

2014-09-29

Human papillomavirus (HPV) infection is highly prevalent and can lead to cancer; the development of safe and efficacious vaccines for HPV is a major public health concern. The two licensed HPV vaccines contain recombinant virus-like particles of HPV 16 and 18; one of such vaccines also protects against HPV types 6 and 11 which cause genital warts. We determined safety and immunogenicity of quadrivalent HPV vaccine in HIV-infected and HIV-negative adolescents and young adults, aged 13-27 years. The seroconversion rate, assessed by antibody titers, 1 month after the administration of the third vaccine dose was 0.85 (95% CI 0.75-0.95) in the HIV-infected group and 0.91 (0.83-0.99) in the HIV-negative subjects (p=0.52). The vaccine was generally safe and well tolerated; the most common side effect was local pain and the most frequent systemic side effect was headache. This is the first report on response to HPV vaccination in both female and male HIV-infected adolescents and young adults and highlights that this population may benefit from HPV immunoprophylaxis. Further studies are needed to examine the long term efficacy of this vaccine in HIV-infected individuals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Congruence of Transition Perspectives Between Adolescents With Perinatally-Acquired HIV and Their Guardians: An Exploratory Qualitative Study.

PubMed

Fair, Cynthia D; Goldstein, Becca; Dizney, Rachel

2015-01-01

Youth with perinatally-acquired HIV infection (PHIV) routinely survive into adulthood requiring transition to adult care. Research underscores the importance of assessing transition perspective congruence between adolescents and guardians. Interviews focused on transition decisions were conducted with 18 adolescents with PHIV and their guardians recruited from a southeastern US pediatric infectious disease clinic. Transcribed responses were coded as congruent or divergent. Adolescents and guardians held congruent views that the transition process had not started. Fewer dyads agreed upon the level of adolescent and guardian involvement in transition decisions. Providers should assess congruence of adolescent and guardian perspectives regarding transition-related decisions. Copyright © 2015 Elsevier Inc. All rights reserved.

'Don't know' and 'didn't think of it': condom use at first intercourse by Latino adolescents.

PubMed

Sneed, C D; Morisky, D E; Rotheram-Borus, M J; Ebin, V; Malotte, C K; Lyde, M; Gill, J K

2001-06-01

We examined the specific reasons Latino adolescents did or did not use condoms at first intercourse and their specific reasons for their perceived risk for contracting HIV. Latino adolescents (n = 618), ages 11-19, completed a face-to-face interview that included information on demographics (sex, age, family-status (lives with both natural parents versus other family structure) and country of birth) and sexual behaviour. The respondents cited 'don't know' (25.9%), 'not available' (25.9%) and 'didn't think of it' (23.5%) as the most frequent reasons for not using condoms at first intercourse. Anyone can get it (41.8%), unknown knowledge of partner's serostatus (24.7%) and unprotected sex (23.8%) were the top three reasons for perceiving oneself as being at risk for contracting HIV. Sexually active adolescents were more likely to perceive themselves at risk for contracting HIV than adolescents that had not had sex. Males were significantly more likely to report using condoms for protection at first intercourse than females. The remaining demographic factors were not significantly related to use of condoms at first intercourse nor to perceived risk for contracting HIV.

Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors.

PubMed

Koenig, Linda J; Nesheim, Steven; Abramowitz, Susan

2011-10-01

Because of widespread availability of highly active antiretroviral therapy in the developed world, a large proportion of children with perinatally acquired HIV have survived to adolescence and young adulthood. Although their survival is remarkable, many now experience the long-term effects of HIV infection and its treatment. Further, as these youths have entered adolescence, more is known about the impact of normative developmental transitions on health maintenance behaviors. Although perinatally infected adolescents are healthier than they were a decade or more ago, they are significantly experienced with antiretroviral therapy, with increased virological resistance and other consequences of extended antiretroviral use. Three behavioral health challenges have been documented in the first cohort of long-term survivors: decreased medication adherence, sexual debut and accompanying pregnancy and transmission risk, and mental health problems. These issues are consistent with a developmental press for autonomy, mature sexual relationships and future planning, but must be carefully managed to preserve health. Adolescents with perinatally acquired HIV require coordinated multidisciplinary support services - including adherence support, reproductive health counseling addressing both pregnancy planning and disease transmission, and mental health and educational/vocational planning - so that they can fully benefit from treatment advances. (C) 2011 Lippincott Williams & Wilkins, Inc.

Is AIDS education related to condom acquisition?

PubMed

Rickert, V I; Gottlieb, A A; Jay, M S

1992-04-01

The acquisition and subsequent use of condoms are two important behaviors that sexually active adolescents must adopt to reduce the transmission of human immunodeficiency virus (HIV). The aims of this study were: first, to evaluate whether combining prescriptions for free condoms with anticipatory guidance would increase the number of adolescents actually using the prescription-redemption plan; and second, to see if education about acquired immunodeficiency syndrome (AIDS) might make adolescents more willing to obtain an HIV blood test. Adolescents were randomly assigned to one of three groups, but only those who were sexually active were included in the data analyses. Each participant was given a prescription to be redeemed for free condoms at the hospital pharmacy, and each was privately offered a confidential, free HIV blood test. Education about AIDS did not increase the likelihood that adolescents would take the blood test, since only seven subjects did so. Our logistic regression model showed the most significant variables influencing a teenager to obtain condoms were gender, socioeconomic status, lifetime number of partners, and experimental condition. Anticipatory guidance concerning HIV promoted the use of the prescription-redemption plan especially among more sexually active males who come from middle-class families.

Negative life events and depression in adolescents with HIV: a stress and coping analysis.

PubMed

Lewis, Jennifer V; Abramowitz, Susan; Koenig, Linda J; Chandwani, Sulachni; Orban, Lisa

2015-01-01

The prevalence of negative life events (NLE) and daily hassles, and their direct and moderated associations with depression, were examined among HIV-infected adolescents. Specifically, we examined whether the negative association with depression of NLE, daily hassles, and/or passive coping were moderated by social support or active coping strategies. Demographic characteristics, depression, coping, social support, NLE, and daily hassles were collected at baseline as part of the Adolescent Impact intervention via face-to-face and computer-assisted interviews. Of 166 HIV-infected adolescents, 53% were female, 72.9% black, 59.6% with perinatally acquired HIV (PIY), the most commonly reported NLE were death in family (81%), violence exposure (68%), school relocation (67%), and hospitalization (61%); and for daily hassles "not having enough money (65%)". Behaviorally infected youth (BIY--acquired HIV later in life) were significantly more likely to experience extensive (14-21) lifetime NLE (38.8% vs. 16.3%, p < .012) than PIY. In multiple stepwise regression analysis, the model accounting for the greatest variability in depression scores (32%) included (in order of entry): daily hassles, low social support, behaviorally acquired HIV, minority sexual orientation, and passive coping. A significant passive coping-by-social support interaction revealed that the association between passive coping and depression was exacerbated when social support was low. Social support moderated the effect of NLE, such that NLE were associated with greater depression when social support was low, although the effect did not remain statistically significant when main effects of other variables were accounted for. Daily hassles, poor coping, and limited social support can adversely affect the psychological well-being of HIV-infected adolescents, particularly sexual minority youth with behaviorally acquired HIV. Multimodal interventions that enhance social support and teach adaptive coping skills may help youth cope with environmental stresses and improve mental health outcomes.

Pediatric HIV disclosure: a process-oriented framework.

PubMed

Cantrell, Kathryn; Patel, Nehali; Mandrell, Belinda; Grissom, Shawna

2013-08-01

As children with vertically transmitted human immunodeficiency virus (HIV) infection live into adulthood, caregivers face the stressful process of informing their children about their infection. Although developmentally guided disclosure of HIV status is widely recommended, there are few specific frameworks to guide caregivers, families, and health care providers through the disclosure process. The authors propose a process-oriented framework for the disclosure of HIV in children and adolescents. This educational framework incorporates Piaget's cognitive development theory in an attempt to disclose and assist children and adolescents in understanding their HIV status. The framework is organized into 10 sequential stages of disclosure and three assessment stages in which health care providers discuss HIV health concepts with the child and caregiver, based on the child's developmental readiness. The described framework can be easily replicated by health care providers in disclosing disease status to children with HIV.

Adolescents' Behavior and Attitudes toward AIDS.

ERIC Educational Resources Information Center

Salehi, Saeed; And Others

The need for effective programs to delay sexual activity and to educate adolescents regarding the human immunodeficiency virus (HIV) has never been greater. Statistics point out that a significant number of teenagers throughout the United States engage in behavior that increases their risks of becoming infected with HIV. This study examined…

Young People's Sexual Risk Behaviors in Nigeria

ERIC Educational Resources Information Center

Abdulraheem, I. S.; Fawole, O. I.

2009-01-01

The prevalence and correlates of HIV-related risk behaviors among adolescents and youths in Nigeria are poorly documented. This study aims at determining the prevalence and correlates of HIV-related risk behaviors among adolescents and youths in order to plan appropriate intervention measures. This is a descriptive cross-sectional survey using…

AMP!: A Cross-site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness, Attitudes, and Knowledge about HIV.

PubMed

Taggart, Tamara; Taboada, Arianna; Stein, Judith A; Milburn, Norweeta G; Gere, David; Lightfoot, Alexandra F

2016-07-01

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = 0.05), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = 0.001), HIV awareness (p = 0.001), and HIV attitudes (p = 0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = 0.01), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05)). Thus, AMP!'s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.

Reticence in disclosure of HIV infection and reasons for bereavement: impact on perinatally infected adolescents' mental health and understanding of HIV treatment and prevention in Johannesburg, South Africa.

PubMed

Woollett, Nataly; Black, Vivian; Cluver, Lucie; Brahmbhatt, Heena

2017-07-01

Survival rates of perinatally infected HIV-positive adolescents (PIA) are increasing in sub-Saharan Africa. There is a gap in understanding how disclosure and bereavement have an impact on PIA beliefs and understanding of their HIV infection and its management. In-depth interviews were conducted with 25 purposively selected adolescents aged 13-19 years from 5 public health clinics in Johannesburg, South Africa. Data were analysed using NVivo 10 using a thematic approach. PIA experience incomplete disclosure both of their HIV status and reasons for their bereavements, which limits their understanding of how they became infected, vertical transmission and prevention options like prevention of mother-to-child transmission (PMTCT). Most participants were orphaned and were experiencing complicated grieving (i.e., engaged in unresolved tasks of grieving) which had a negative impact on their mental health, and ability to accept their HIV status and adhere to treatment. PIA need improved communication regarding vertical transmission and how they became HIV-positive, as well as reasons for death of their loved ones to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and truthful engagement in the process of disclosure of HIV status is necessary to reduce stigma and complicated grieving, and improve mental health in this population.

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria

PubMed Central

Folayan, Morenike Oluwatoyin

2016-01-01

Objectives Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. Methods We analyzed data from 436 sexually active 10–19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman’s conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Results Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14–11.87), and transactional sex (OR: 2.80; 95% CI: 1.56–4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96–1.11) and loss and grief (OR: 1.34; 95% CI: 0.73–2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34–1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62–3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49–1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09–0.83). Conclusion History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries. PMID:27163436

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.

PubMed

Folayan, Morenike Oluwatoyin; Harrison, Abigail; Brown, Brandon; Odetoyinbo, Morolake; Stockman, Jamila K; Ajuwon, Ademola J; Cáceres, Carlos F

2016-01-01

Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83). History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.

Orphan Status, HIV Risk Behavior, and Mental Health Among Adolescents in Rural Kenya

PubMed Central

Drabkin, Anya S.; Stashko, Allison L.; Broverman, Sherryl A.; Ogwang-Odhiambo, Rose A.; Sikkema, Kathleen J.

2012-01-01

Objective To examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya. Methods Randomly selected adolescents aged 10–18 years completed surveys assessing sexual activity, sex-related beliefs and self-efficacy, mental health, social support, caregiver–child communication, time since parental death, and economic resources. Analysis of covariance and regression analyses compared orphans and nonorphans; orphan status was tested as a moderator between well-being and HIV risk. Results Orphans reported poorer mental health, less social support, and fewer material resources. They did not differ from nonorphans on HIV risk indicators. Longer time since parental death was associated with poorer outcomes. In moderator analyses, emotional problems and poorer caregiver–youth communication were more strongly associated with lower sex-related self-efficacy for orphans. Conclusions Orphans are at higher risk for psychosocial problems. These problems may affect orphans’ self-efficacy for safer sex practices more than nonorphans. Decreased HIV risk could be one benefit of psychosocial interventions for orphans. PMID:22728899

Orphan status, HIV risk behavior, and mental health among adolescents in rural Kenya.

PubMed

Puffer, Eve S; Drabkin, Anya S; Stashko, Allison L; Broverman, Sherryl A; Ogwang-Odhiambo, Rose A; Sikkema, Kathleen J

2012-09-01

To examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya. Randomly selected adolescents aged 10-18 years completed surveys assessing sexual activity, sex-related beliefs and self-efficacy, mental health, social support, caregiver-child communication, time since parental death, and economic resources. Analysis of covariance and regression analyses compared orphans and nonorphans; orphan status was tested as a moderator between well-being and HIV risk. Orphans reported poorer mental health, less social support, and fewer material resources. They did not differ from nonorphans on HIV risk indicators. Longer time since parental death was associated with poorer outcomes. In moderator analyses, emotional problems and poorer caregiver-youth communication were more strongly associated with lower sex-related self-efficacy for orphans. Orphans are at higher risk for psychosocial problems. These problems may affect orphans' self-efficacy for safer sex practices more than nonorphans. Decreased HIV risk could be one benefit of psychosocial interventions for orphans.

Parent–Adolescent Communication About Sexual Pressure, Maternal Norms About Relationship Power, and STI/HIV Protective Behaviors of Minority Urban Girls

PubMed Central

Teitelman, Anne M.; Ratcliffe, Sarah J.; Cederbaum, Julie A.

2011-01-01

Racial/ethnic minority adolescent girls bear a disproportionate risk for HIV and face barriers to autonomous sexual decision making, but parental messages may help protect against sexual risk taking. The authors examined African American and Hispanic girls’ sexually transmitted infection (STI) and HIV prevention practices, parent–adolescent communication about sexual pressure, and maternal gender norms (N = 118). Teens were more likely to practice consistent STI/HIV prevention when mothers talked about partner sexual pressure (p = .017) and fathers talked about resisting partner sexual pressure (p = .034). Sexually active girls who perceived that their mothers held egalitarian beliefs about partner decision making had more consistent condom use (p = .029). Given the context of increased STI/HIV risk, it is critical that parents discuss partner dynamics with daughters. Nurses play a unique role in facilitating these conversations; they provide parents with age-appropriate resources and assist in normalizing fears, which can help increase parent–child sexual-risk communication. PMID:21672881

HIV-Positive Mothers With Late Adolescent/Early Adult Children: “Empty Nest” Concerns

PubMed Central

Murphy, Debra A.; Roberts, Kathleen Johnston; Herbeck, Diane M.

2012-01-01

In-depth interviews about the “empty nest” were conducted with 57 HIV-positive mothers of late adolescent/early adult children. Empty nest worries included: (1) identity loss, (2) loss of social support, (3) financial insecurity, (4) worsening of physical health, and (5) death/dying. Hopes included: (1) self-improvement, (2) change of life focus, (3) travel, (4) romantic partners, and (5) familial ties. Respondents’ HIV/AIDS status colored their thoughts/feelings about the empty nest; some worries were specific to being HIV-positive, and would not occur for non-ill mothers. Midlife HIV positive women need healthcare/social service resources as they navigate health and social-psychological challenges to successful aging. PMID:22420679

HIV-positive mothers with late adolescent/early adult children: "empty nest" concerns.

PubMed

Murphy, Debra A; Roberts, Kathleen Johnston; Herbeck, Diane M

2012-01-01

In-depth interviews about the "empty nest" were conducted with 57 HIV-positive mothers of late adolescent/early adult children. Empty nest worries included the following: (a) identity loss, (b) loss of social support, (c) financial insecurity, (d) worsening of physical health, and (e) death/dying. Hopes included the following: (a) self-improvement, (a) change of life focus, (c) travel, (d) romantic partners, and (e) familial ties. Respondents' HIV/AIDS status colored their thoughts/feelings about the empty nest; some worries were specific to being HIV positive and would not occur for nonill mothers. Midlife HIV-positive women need health care/social service resources as they navigate health and social-psychological challenges to successful aging.

Ethical issues in adolescent HIV research in resource-limited countries.

PubMed

Bekker, Linda-Gail; Slack, Catherine; Lee, Sonia; Shah, Seema; Kapogiannis, Bill

2014-01-01

Globally, there are 5 million young people aged 15-24 years living with HIV, and many more millions are at risk for HIV acquisition. Compelling research questions exist that require the involvement of young people and other vulnerable populations in HIV-related research in diverse settings around the world. Despite this, there remains a reluctance to involve adolescent participants, including young women, in clinical research. Complex and, at times, contradictory legal and ethical requirements can be a challenge. Ethical benchmarks can be applied to ensure that research meets high-level standards and is planned for appropriately.

Trends in U.S. Global AIDS Spending: FY2000-FY2008

DTIC Science & Technology

2008-07-16

Young Women from HIV/AIDS: The Case Against Child and Adolescent Marriage.” International Family Planning Perspectives, Volume 32, Number 2, June...are more likely to contract HIV than their single counterparts.63 For example, 30% of married adolescents ’ spouses were HIV-positive in Kenya, while...includes language similar CRS-26 69 Ensuring Access to Contraceptives Act of 2007, H.R. 2367. 70 According to the UNAIDS website, “[an] in-depth

"I Learned to Be Okay with Talking about Sex and Safety": Assessing the Efficacy of a Theatre-Based HIV Prevention Approach for Adolescents in North Carolina

ERIC Educational Resources Information Center

Lightfoot, Alexandra F.; Taboada, Arianna; Taggart, Tamara; Tran, Trang; Burtaine, Amy

2015-01-01

Adolescents are at increased risk of HIV and sexually transmitted infections (STIs) in the Southern states of the USA, where rates among youth are higher than in the rest of the nation. This paper reports on findings from a pilot study of an HIV prevention intervention that uses interactive theatre to educate young people about sexual health. The…

The Impact of School Subsidies on HIV-Related Outcomes among Adolescent Female Orphans

PubMed Central

Hallfors, Denise Dion; Cho, Hyunsan; Rusakaniko, Simbarashe; Mapfumo, John; Iritani, Bonita; Zhang, Lei; Luseno, Winnie; Miller, Ted

2014-01-01

Objectives We examine effects of school support as a structural HIV prevention intervention for adolescent female orphans in Zimbabwe after 5 years. Methods 328 orphan adolescent girls were followed in a clustered randomized control trial from 2007 to 2010. The experimental group received school fees, uniforms, and school supplies and were assigned a school-based “helper.” In 2011-12, the control group received delayed partial treatment of school fees only. At the final data point in 2012, survey, HIV, and HSV-2 biomarker data were collected from approximately 88% of the sample. Bivariate and multivariate analyses were conducted on endpoint outcomes, controlling for age, religious affiliation, and baseline SES. Results The two groups did not differ on HIV or HSV-2 biomarkers. The comprehensive five-year intervention continued to reduce the likelihood of marriage, improve school retention, improve SES (food security), and marginally maintain gains in quality of life, even after providing school fees to the control group. Conclusions Paying school fees and expenses resulted in significant improvements in life outcomes for orphan adolescent girls. Biological evidence of HIV infection prevention, however, was not observed. Our study adds to the growing body of research on school support as HIV prevention for girls in sub-Saharan Africa, but as yet, no clear picture of effectiveness has emerged. PMID:25530603

A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania

PubMed Central

Sullivan, Kristen A.; O' Donnell, Karen; Cunningham, Coleen K.; Shayo, Aisa M.; Mmbaga, Blandina T.; Dow, Dorothy E.

2016-01-01

Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12–24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth. PMID:27851797

Parent-child communication: a model for Hispanics on HIV prevention.

PubMed

Benavides, Raquel; Bonazzo, Claude; Torres, Rosamar

2006-01-01

The prevalence of Acquired Immunodeficiency Syndrome has become a global epidemic that has affected many different racial and ethnic groups. One group that has lacked attention is the Hispanic population, due to its distinctive cultural characteristics. Many of the Human Immunodeficiency Virus (HIV) infections in Hispanics occur in adolescents. A protective factor for preventing HIV infections in adolescents is parent-child communication about sexual intercourse; however discussions about sexuality are uncommon in Hispanic families. When promoting parent-child communication among Hispanics regarding sex, it is essential to include cultural characteristics and the use of a model for empowering both parents and adolescents. The cultural characteristics examined in this article are allocentrism, familialism, personal space, time orientation, power distance, gender roles, and fatalism. A partnership model for empowering parents and adolescents, and 5 steps of the partnership process are discussed.

Comorbidities in Children and Adolescents with AIDS Acquired by HIV Vertical Transmission in Vitória, Brazil

PubMed Central

Moreira-Silva, Sandra F.; Zandonade, Eliana; Frauches, Diana O.; Machado, Elisa A.; Lopes, Lays Ignacia A.; Duque, Lívia L.; Querido, Polyana P.; Miranda, Angélica E.

2013-01-01

Background Studying diseases associated with AIDS is essential for establishing intervention strategies because comorbidities can lead to death. The objectives were to describe the frequency of comorbidities and verify their distribution according to demographic, epidemiological and clinical data as well as to classify diseases in children and adolescents with AIDS in Vitória, Brazil. Methods A retrospective cohort study was conducted among children with AIDS, as defined according to the criteria established by the Ministry of Health, who acquired HIV via vertical transmission, were aged 0 to 18 years, and were monitored at a referral hospital from January 2001 to December 2011. Results A total of 177 patients were included, of whom 97 were female (55%). There were 60 patients (34%) <1 year old, 67 patients (38%) between the ages of 1 and 5, and 50 patients (28%) ≥6 years of age included at the time of admission to the Infectious Diseases Ward. Regarding clinical-immunological classification, 146 patients (82.5%) showed moderate/severe forms of the disease at the time of admission into the Ward, and 26 patients (14.7%) died during the study. The most common clinical signs were hepatomegaly (81.62%), splenomegaly (63.8%), lymphadenopathy (68.4%) and persistent fever (32.8%). The most common comorbidities were anaemia (67.2%), pneumonia/septicaemia/acute bacterial meningitis (ABM) (64.2%), acute otitis media (AOM)/recurrent sinusitis (55.4%), recurrent severe bacterial infections (47.4%) and dermatitis (43.1%). An association between severe clinical-immunological classification and admission to the Ward for children aged less than one year old was found for several comorbidities (p<0.001). Conclusion Delayed diagnosis was observed because the majority of patients were admitted to the Infectious Diseases Ward at ≥1 year of age and were already presenting with serious diseases. The general paediatrician should be alert to this possibility to make an early diagnosis in children infected with HIV. PMID:24324741

Comorbidities in children and adolescents with AIDS acquired by HIV vertical transmission in Vitória, Brazil.

PubMed

Moreira-Silva, Sandra F; Zandonade, Eliana; Frauches, Diana O; Machado, Elisa A; Lopes, Lays Ignacia A; Duque, Lívia L; Querido, Polyana P; Miranda, Angélica E

2013-01-01

Studying diseases associated with AIDS is essential for establishing intervention strategies because comorbidities can lead to death. The objectives were to describe the frequency of comorbidities and verify their distribution according to demographic, epidemiological and clinical data as well as to classify diseases in children and adolescents with AIDS in Vitória, Brazil. A retrospective cohort study was conducted among children with AIDS, as defined according to the criteria established by the Ministry of Health, who acquired HIV via vertical transmission, were aged 0 to 18 years, and were monitored at a referral hospital from January 2001 to December 2011. A total of 177 patients were included, of whom 97 were female (55%). There were 60 patients (34%) <1 year old, 67 patients (38%) between the ages of 1 and 5, and 50 patients (28%) ≥6 years of age included at the time of admission to the Infectious Diseases Ward. Regarding clinical-immunological classification, 146 patients (82.5%) showed moderate/severe forms of the disease at the time of admission into the Ward, and 26 patients (14.7%) died during the study. The most common clinical signs were hepatomegaly (81.62%), splenomegaly (63.8%), lymphadenopathy (68.4%) and persistent fever (32.8%). The most common comorbidities were anaemia (67.2%), pneumonia/septicaemia/acute bacterial meningitis (ABM) (64.2%), acute otitis media (AOM)/recurrent sinusitis (55.4%), recurrent severe bacterial infections (47.4%) and dermatitis (43.1%). An association between severe clinical-immunological classification and admission to the Ward for children aged less than one year old was found for several comorbidities (p<0.001). Delayed diagnosis was observed because the majority of patients were admitted to the Infectious Diseases Ward at ≥1 year of age and were already presenting with serious diseases. The general paediatrician should be alert to this possibility to make an early diagnosis in children infected with HIV.

Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center.

PubMed

Reisner, Sari L; Vetters, Ralph; White, Jaclyn M; Cohen, Elijah L; LeClerc, M; Zaslow, Shayne; Wolfrum, Sarah; Mimiaga, Matthew J

2015-01-01

The sexual health of transgender adolescents and young adults who present for health care in urban community health centers is understudied. A retrospective review of electronic health record (EHR) data was conducted from 180 transgender patients aged 12-29 years seen for one or more health-care visits between 2001 and 2010 at an urban community health center serving youth in Boston, MA. Analyses were restricted to 145 sexually active transgender youth (87.3% of the sample). Laboratory-confirmed HIV and sexually transmitted infections (STIs) seroprevalence, demographics, sexual risk behavior, and structural and psychosocial risk indicators were extracted from the EHR. Analyses were descriptively focused for HIV and STIs. Stratified multivariable logistic regression models were fit for male-to-female (MTF) and female-to-male (FTM) patients separately to examine factors associated with any unprotected anal and/or vaginal sex (UAVS). The mean age was 20.0 (SD=2.9); 21.7% people of color, 46.9% white (non-Hispanic), 21.4% race/ethnicity unknown; 43.4% MTF, and 56.6% FTM; and 68.3% were on cross-sex hormones. Prevalence of STIs: 4.8% HIV, 2.8% herpes simplex virus, 2.8% syphilis, 2.1% chlamydia, 2.1% gonorrhea, 2.8% hepatitis C, 1.4% human papilloma virus. Only gonorrhea prevalence significantly differed by gender identity (MTF 2.1% vs. 0.0% FTM; p=0.046). Nearly half (47.6%) of the sample engaged in UAVS (52.4% MTF, 43.9% FTM, p=0.311). FTM more frequently had a primary sex partner compared to MTF (48.8% vs. 25.4%; p=0.004); MTF more frequently had a casual sex partner than FTM (69.8% vs. 42.7% p=0.001). In multivariable models, MTF youth who were younger in age, white non-Hispanic, and reported a primary sex partner had increased odds of UAVS; whereas, FTM youth reporting a casual sex partner and current alcohol use had increased odds of UAVS (all p<0.05). Factors associated with sexual risk differ for MTF and FTM youth. Partner type appears pivotal to understanding sexual risk in transgender adolescents and young adults. HIV and STI prevention efforts, including early intervention efforts, are needed in community-based settings serving transgender youth that attend to sex-specific (biological) and gender-related (social) pathways.

A Longitudinal Test of the Parent-Adolescent Family Functioning Discrepancy Hypothesis: A Trend toward Increased HIV Risk Behaviors Among Immigrant Hispanic Adolescents.

PubMed

Córdova, David; Schwartz, Seth J; Unger, Jennifer B; Baezconde-Garbanati, Lourdes; Villamar, Juan A; Soto, Daniel W; Des Rosiers, Sabrina E; Lee, Tae Kyoung; Meca, Alan; Cano, Miguel Ángel; Lorenzo-Blanco, Elma I; Oshri, Assaf; Salas-Wright, Christopher P; Piña-Watson, Brandy; Romero, Andrea J

2016-10-01

Parent-adolescent discrepancies in family functioning play an important role in HIV risk behaviors among adolescents, yet longitudinal research with recent immigrant Hispanic families remains limited. This study tested the effects of trajectories of parent-adolescent family functioning discrepancies on HIV risk behaviors among recent-immigrant Hispanic adolescents. Additionally, we examined whether and to what extent trajectories of parent-adolescent family functioning discrepancies vary as a function of gender. We assessed family functioning of 302 Hispanic adolescents (47 % female) and their parent (70 % female) at six time points over a three-year period and computed latent discrepancy scores between parent and adolescent reports at each timepoint. Additionally, adolescents completed measures of sexual risk behaviors and alcohol use. We conducted a confirmatory factor analysis to determine the feasibility of collapsing parent and adolescent reported family functioning indicators onto a single latent discrepancy variable, tested model invariance over time, and conducted growth mixture modeling (GMM). GMM yielded a three-class solution for discrepancies: High-Increasing, High-Stable, and Low-Stable. Relative to the Low-Stable class, parent-adolescent dyads in the High-Increasing and High-Stable classes were at greater risk for adolescents reporting sexual debut at time 6. Additionally, the High-Stable class was at greater risk, relative to the Low-Stable class, in terms of adolescent lifetime alcohol use at 30 months post-baseline. Multiple group GMM indicated that trajectories of parent-adolescent family functioning trajectories did not vary by gender. Implications for future research and practice are discussed.

A Longitudinal Test of the Parent–Adolescent Family Functioning Discrepancy Hypothesis: A Trend toward Increased HIV Risk Behaviors among Immigrant Hispanic Adolescents

PubMed Central

Cordova, David; Schwartz, Seth J.; Unger, Jennifer B.; Baezconde-Garbanati, Lourdes; Villamar, Juan A.; Soto, Daniel W.; Des Rosiers, Sabrina E.; Lee, Tae Kyoung; Meca, Alan; Cano, Miguel Ángel; Lorenzo-Blanco, Elma I.; Oshri, Assaf; Salas-Wright, Christopher P.; Piña-Watson, Brandy M.; Romero, Andrea J.

2016-01-01

Parent-adolescent discrepancies in family functioning play an important role in HIV risk behaviors among adolescents, yet longitudinal research with recent immigrant Hispanic families remains limited. This study tested the effects of trajectories of parent–adolescent family functioning discrepancies on HIV risk behaviors among recent-immigrant Hispanic adolescents. Additionally, we examined whether and to what extent trajectories of parent-adolescent family functioning discrepancies vary as a function of gender. We assessed family functioning of 302 Hispanic adolescents (47% female) and their parent (70% female) at six time points over a three-year period and computed latent discrepancy scores between parent and adolescent reports at each timepoint. Additionally, adolescents completed measures of sexual risk behaviors and alcohol use. We conducted a confirmatory factor analysis to determine the feasibility of collapsing parent and adolescent reported family functioning indicators onto a single latent discrepancy variable, tested model invariance over time, and conducted growth mixture modeling (GMM). GMM yielded a three-class solution for discrepancies: High-Increasing, High-Stable, and Low-Stable. Relative to the Low-Stable class, parent–adolescent dyads in the High-Increasing and High-Stable classes were at greater risk for adolescents reporting sexual debut at time 6. Additionally, the High-Stable class was at greater risk, relative to the Low-Stable class, in terms of adolescent lifetime alcohol use at 30 months post-baseline. Multiple group GMM indicated that trajectories of parent-adolescent family functioning trajectories did not vary by gender. Implications for future research and practice are discussed. PMID:27216199

Adolescent Health Providers' Willingness to Prescribe Pre-Exposure Prophylaxis (PrEP) to Youth at Risk of HIV Infection in the United States.

PubMed

Hart-Cooper, Geoffrey D; Allen, Isabel; Irwin, Charles E; Scott, Hyman

2018-05-26

HIV disproportionately affects young men who have sex with men. Pre-exposure prophylaxis (PrEP) can prevent HIV acquisition; however, youth access to PrEP is limited by provider willingness to prescribe PrEP. We conducted an online survey of clinicians working with adolescents (aged 13-17 years) and young adults (aged 18-26 years) in the United States through the Society of Adolescent Health and Medicine. We used multivariate logistic regression to assess provider beliefs associated with willingness to provide PrEP. Nearly all (93.2%) providers had heard of PrEP, and 57 (35.2%) had prescribed PrEP. While almost all providers (95%) agreed that PrEP prevents HIV, fewer were willing to prescribe to young adults (77.8%) or adolescents (64.8%). Willingness to prescribe PrEP was strongly associated with the belief that providers had enough knowledge to safely provide PrEP to adolescents (OR 2.11, confidence interval [CI]: 1.18-3.76, p = .01) and young adults (odds ratio 5.19, CI: 2.15-12.50, p ≤ .001), and that adolescents would be adherent (odds ratio 3, CI: 1.30-6.90, p = .01). Response rate was 17%. Almost all providers had heard of PrEP and most providers were willing to prescribe PrEP. Provider education and tools to promote provider self-efficacy and adolescent adherence might improve provider willingness to provide PrEP. Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions.

PubMed

Bailey, Heather; Cruz, Maria Letícia Santos; Songtaweesin, Wipaporn Natalie; Puthanakit, Thanyawee

2017-05-16

The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities. We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes. The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed. Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

Disclosing in utero HIV/ARV exposure to the HIV-exposed uninfected adolescent: is it necessary?

PubMed Central

Jao, Jennifer; Hazra, Rohan; Mellins, Claude A; Remien, Robert H; Abrams, Elaine J

2016-01-01

Introduction The tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV-infected children on the one hand and a mounting number of HIV-exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status. Discussion Disclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status. It is necessary to weigh the benefits and harms which could occur with disclosure in each of the following domains: psychosocial impact, long-term physical health of the HEU individual and the public health impact. Does disclosure improve or worsen the psychological health of the HEU individual and extended family unit? Do present data on the long-term safety of in utero HIV/ARV exposure reveal potential health risks which merit disclosure to the HEU adolescent? What research and public health programmes or systems need to be in place to afford monitoring of HEU individuals and which, if any, of these require disclosure? Conclusions At present, it is not clear that there is sufficient evidence on whether long-term adverse effects are associated with in utero HIV/ARV exposures, making it difficult to mandate universal disclosure. However, as more countries adopt electronic medical record systems, the HEU status of an individual should be an important piece of the health record which follows the infant not only through childhood and adolescence but also adulthood. Clinicians and researchers should continue to approach the dialogue around mother–child disclosure with sensitivity and a cogent consideration of the evolving risks and benefits as new information becomes available while also working to maintain documentation of an individual's perinatal HIV/ARV exposures as a vital part of his/her medical records. As more long-term adult safety data on in utero HIV/ARV exposures become available these decisions may become clearer, but at this time, they remain complex and multi-faceted. PMID:27741954

Leveraging microfinance to impact HIV and financial behaviors among adolescents and their mothers in West Bengal: a cluster randomized trial.

PubMed

Spielberg, Freya; Crookston, Benjamin T; Chanani, Sheila; Kim, Jaewhan; Kline, Sean; Gray, Bobbi L

2013-01-01

Microfinance can be used to reach women and adolescent girls with HIV prevention education. We report findings from a cluster-randomized control trial among 55 villages in West Bengal to determine the impact of non-formal education on knowledge, attitudes and behaviors for HIV prevention and savings. Multilevel regression models were used to evaluate differences between groups for key outcomes while adjusting for cluster correlation and differences in baseline characteristics. Women and girls who received HIV education showed significant gains in HIV knowledge, awareness that condoms can prevent HIV, self-efficacy for HIV prevention, and confirmed use of clean needles, as compared to the control group. Condom use was rare and did not improve for women. While HIV testing was uncommon, knowledge of HIV-testing resources significantly increased among girls, and trended in the positive direction among women in intervention groups. Conversely, the savings education showed no impact on financial knowledge or behavior change.

Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand

PubMed Central

Munir, Kerim; Kanabkaew, Cheeraya; Le Coeur, Sophie

2017-01-01

Background Existing studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children. Methods We used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12–19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010–2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART. Results From the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor. Conclusion Our findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in recognizing and addressing challenging situations related to ART taking. PMID:28207891

Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure.

PubMed

Boerma, Ragna S; Bunupuradah, Torsak; Dow, Dorothy; Fokam, Joseph; Kariminia, Azar; Lehman, Dara; Kityo, Cissy; Musiime, Victor; Palumbo, Paul; Schoffelen, Annelot; Sophan, Sam; Zanoni, Brian; Rinke de Wit, Tobias F; Calis, Job C J; Sigaloff, Kim C E

2017-09-15

The number of HIV-infected children and adolescents requiring second-line antiretroviral treatment (ART) is increasing in low- and middle-income countries (LMIC). However, the effectiveness of paediatric second-line ART and potential risk factors for virologic failure are poorly characterized. We performed an aggregate analysis of second-line ART outcomes for children and assessed the need for paediatric third-line ART. We performed a multicentre analysis by systematically reviewing the literature to identify cohorts of children and adolescents receiving second-line ART in LMIC, contacting the corresponding study groups and including patient-level data on virologic and clinical outcomes. Kaplan-Meier survival estimates and Cox proportional hazard models were used to describe cumulative rates and predictors of virologic failure. Virologic failure was defined as two consecutive viral load measurements >1000 copies/ml after at least six months of second-line treatment. We included 12 cohorts representing 928 children on second-line protease inhibitor (PI)-based ART in 14 countries in Asia and sub-Saharan Africa. After 24 months, 16.4% (95% confidence interval (CI): 13.9-19.4) of children experienced virologic failure. Adolescents (10-18 years) had failure rates of 14.5 (95% CI 11.9-17.6) per 100 person-years compared to 4.5 (95% CI 3.4-5.8) for younger children (3-9 years). Risk factors for virologic failure were adolescence (adjusted hazard ratio [aHR] 3.93, p  < 0.001) and short duration of first-line ART before treatment switch (aHR 0.64 and 0.53, p  = 0.008, for 24-48 months and >48 months, respectively, compared to <24 months). In LMIC, paediatric PI-based second-line ART was associated with relatively low virologic failure rates. However, adolescents showed exceptionally poor virologic outcomes in LMIC, and optimizing their HIV care requires urgent attention. In addition, 16% of children and adolescents failed PI-based treatment and will require integrase inhibitors to construct salvage regimens. These drugs are currently not available in LMIC.

Adolescent and Adult HIV Providers' Definitions of HIV-Infected Youths' Successful Transition to Adult Care in the United States.

PubMed

Philbin, Morgan M; Tanner, Amanda E; Ma, Alice; Chambers, Brittany D; Ware, Samuella; Kinnard, Elizabeth N; Hussen, Sophia A; Lee, Sonia; Fortenberry, J Dennis

2017-10-01

It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.

Male circumcision at different ages in Rwanda: a cost-effectiveness study.

PubMed

Binagwaho, Agnes; Pegurri, Elisabetta; Muita, Jane; Bertozzi, Stefano

2010-01-19

There is strong evidence showing that male circumcision (MC) reduces HIV infection and other sexually transmitted infections (STIs). In Rwanda, where adult HIV prevalence is 3%, MC is not a traditional practice. The Rwanda National AIDS Commission modelled cost and effects of MC at different ages to inform policy and programmatic decisions in relation to introducing MC. This study was necessary because the MC debate in Southern Africa has focused primarily on MC for adults. Further, this is the first time, to our knowledge, that a cost-effectiveness study on MC has been carried out in a country where HIV prevalence is below 5%. A cost-effectiveness model was developed and applied to three hypothetical cohorts in Rwanda: newborns, adolescents, and adult men. Effectiveness was defined as the number of HIV infections averted, and was calculated as the product of the number of people susceptible to HIV infection in the cohort, the HIV incidence rate at different ages, and the protective effect of MC; discounted back to the year of circumcision and summed over the life expectancy of the circumcised person. Direct costs were based on interviews with experienced health care providers to determine inputs involved in the procedure (from consumables to staff time) and related prices. Other costs included training, patient counselling, treatment of adverse events, and promotion campaigns, and they were adjusted for the averted lifetime cost of health care (antiretroviral therapy [ART], opportunistic infection [OI], laboratory tests). One-way sensitivity analysis was performed by varying the main inputs of the model, and thresholds were calculated at which each intervention is no longer cost-saving and at which an intervention costs more than one gross domestic product (GDP) per capita per life-year gained. Neonatal MC is less expensive than adolescent and adult MC (US$15 instead of US$59 per procedure) and is cost-saving (the cost-effectiveness ratio is negative), even though savings from infant circumcision will be realized later in time. The cost per infection averted is US$3,932 for adolescent MC and US$4,949 for adult MC. Results for infant MC appear robust. Infant MC remains highly cost-effective across a reasonable range of variation in the base case scenario. Adolescent MC is highly cost-effective for the base case scenario but this high cost-effectiveness is not robust to small changes in the input variables. Adult MC is neither cost-saving nor highly cost-effective when considering only the direct benefit for the circumcised man. The study suggests that Rwanda should be simultaneously scaling up circumcision across a broad range of age groups, with high priority to the very young. Infant MC can be integrated into existing health services (i.e., neonatal visits and vaccination sessions) and over time has better potential than adolescent and adult circumcision to achieve the very high coverage of the population required for maximal reduction of HIV incidence. In the presence of infant MC, adolescent and adult MC would evolve into a "catch-up" campaign that would be needed at the start of the program but would eventually become superfluous. Please see later in the article for the Editors' Summary.

Cross-cultural adaptation of an adolescent HIV prevention program: social validation of social contexts and behavior among Botswana adolescents.

PubMed

St Lawrence, Janet S; Seloilwe, Esther; Magowe, Mabel; Dithole, Kefalotse; Kgosikwena, Billy; Kokoro, Elija; Lesaane, Dipuo

2013-08-01

An evidence-based HIV prevention intervention was adapted for Botswana youth with qualitative interviews, input from an adolescent panel, and social validation. Qualitative interviews were conducted with 40 boys and girls ages 13-19. An adolescent panel then drafted scenarios reflecting social situations described in the interviews that posed risk for HIV. A social validation sample (N = 65) then indicated the prevalence and difficulty of each situation. Youth described informational needs, pressures to use alcohol and drugs, peer pressure for unprotected sex, and intergenerational sex initiations as risk-priming situations. From 17% to 57% of the social validation sample had personally experienced the situations drafted by the adolescent panel. There were no differences in the ratings of boys versus girls, but youth over age 16 more often reported that they had experienced these risky situations. The results were embedded into the intervention. Major changes to the intervention resulted from this three-phase process.

Urban Adolescent Girls’ Perspectives on Multiple Partners in the Context of the Sexual Double Standard and Intimate Partner Violence

PubMed Central

Teitelman, Anne M.; Tennille, Julie; Bohinski, Julia; Jemmott, Loretta S.; Jemmott, John B.

2013-01-01

This article describes the influence of abusive and non-abusive relationship dynamics on the number of sex partners among urban adolescent girls. Focus groups were conducted with 64 sexually active adolescent girls ages 14 to 17 years. General coding and content analyses identified patterns, themes, and salient beliefs. More than one third (37.5%) reported having experienced physical, intimate partner violence; 32.8% had 2 or more recent sex partners, and 37.5% had ever had a sexually transmitted infection (STI) or HIV. Although some girls in abusive relationships feared retribution if they had more than one partner, others sought additional partners for solace or as an act of resistance. Adolescent HIV/STI prevention programs need to address the influence of gender norms such as the sexual double standard as well as partner pressure and partner abuse on adolescent decision-making about safer sex, and also promote healthy relationships as integral to advancing HIV/STI risk reduction. PMID:23790274

Use of Technology for HIV Prevention among Adolescent and Adult Women in the United States

PubMed Central

Patel, Viraj V.; Cunningham, Chinazo O.

2015-01-01

Although the proportion of new HIV infections in the United States among women has decreased over the last few years, still, approximately 20% of new infections occur annually among adolescent and adult women. The development of effective evidence-based prevention interventions remains an important approach to further decreasing these numbers. Technology-delivered prevention interventions hold tremendous potential due, in part, to their ability to reach beyond the walls of brick-and-mortar intervention sites to engage individuals where they are. While most technology-delivered interventions have focused on adolescents and men who have sex with men, much fewer have specifically targeted adolescent or adult women despite evidence showing interventions tailored to specific target populations are most effective. We summarize the recently published literature on technology-delivered HIV prevention interventions for U.S. adolescent and adult women and provide suggestions for next steps in this nascent but emergent area of prevention research. PMID:26412086

Barber-led sexual health education intervention for Black male adolescents and their fathers.

PubMed

Randolph, Schenita D; Pleasants, Terrence; Gonzalez-Guarda, Rosa M

2017-11-01

To explore barbers' attitudes and beliefs regarding the feasibility and acceptability of a barber- led STI/HIV risk reduction intervention for fathers and their preadolescent and adolescent sons. A qualitative descriptive design was used. Twenty-two barbers were recruited from barbershops and a barber school in central North Carolina. A combination of five focus groups and two key informant interviews were conducted. The following themes were generated: (1) The barbershop was embraced as a venue for an adolescent sexual health father-son intervention, (2) Barbers desired more information about STIs and HIV among Black male youth, (3) The use of incentives to engage barbers and fathers was important, and (4) Time commitment of barbers for a barber-led intervention varied. The trust established between barbers and the Black community presents an opportunity for pre-adolescent and adolescent STI/HIV risk reduction programs that include the role of fathers. Intervention programs can be tailored to address this important intervention opportunity. © 2017 Wiley Periodicals, Inc.

Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention.

PubMed Central

Jemmott, J B; Jemmott, L S; Fong, G T

1992-01-01

BACKGROUND. The number of reported cases of acquired immune deficiency syndrome (AIDS) is increasing disproportionately among Blacks in the United States. The relatively high incidence of sexually transmitted diseases among Black adolescents suggest the need for AIDS prevention programs to reduce their risk of sexually transmitted human immunodeficiency virus (HIV) infection. METHODS. Black male adolescents (n = 157) were randomly assigned to receive an AIDS risk reduction intervention aimed at increasing AIDS-related knowledge and weakening problematic attitudes toward risky sexual behavior, or to receive a control intervention on career opportunities. RESULTS. The adolescents who received the AIDS intervention subsequently had greater AIDS knowledge, less favorable attitudes toward risky sexual behavior, and lower intentions to engage in such behavior than did those in the control condition. Follow-up data collected 3 months later revealed that the adolescents who had received the AIDS intervention reported fewer occasions of coitus, fewer coital partners, greater use of condoms, and a lower incidence of heterosexual anal intercourse than did the other adolescents. CONCLUSIONS. These results suggest that interventions that increase knowledge about AIDS and change attitudes toward risky sexual behavior may have salutary effects on Black adolescents' risk of HIV infection. PMID:1536352

Rates and Types of Psychiatric Disorders in Perinatally Human Immunodeficiency Virus-Infected Youth and Seroreverters

ERIC Educational Resources Information Center

Mellins, Claude Ann; Brackis-Cott, Elizabeth; Leu, Cheng-Shiun; Elkington, Katherine S.; Dolezal, Curtis; Wiznia, Andrew; McKay, Mary; Bamji, Mahrukh; Abrams, Elaine J.

2009-01-01

Background: The purpose of this study was to examine 1) the prevalence of psychiatric and substance use disorders in perinatally HIV-infected (HIV+) adolescents and 2) the association between HIV infection and these mental health outcomes by comparing HIV+ youths to HIV exposed but uninfected youths (HIV-) from similar communities. Methods: Data…

Sexual Abuse and Adolescent HIV Risk: A Group Intervention Framework

ERIC Educational Resources Information Center

Lescano, Celia M.; Brown, Larry K.; Puster, Kristie L.; Miller, Paul M.

2004-01-01

Adolescents with a history of sexual abuse are at particular risk for HIV because of difficulties with affect regulation and dysfunctional thinking that are thought to be sequelae of the abuse. These difficulties can lead to impulsivity and failure to assertively set limits in sexual situations. Cognitive behavior therapy (CBT) has frequently been…

Recruiting and Retaining High-Risk Adolescents into Family-Based HIV Prevention Intervention Research

ERIC Educational Resources Information Center

Kapungu, Chisina T.; Nappi, Carla N.; Thakral, Charu; Miller, Steven A.; Devlin, Catharine; McBride, Cami; Hasselquist, Emily; Coleman, Gloria; Drozd, Derek; Barve, Chinmayee; Donenberg, Geri; DiClemente, Ralph; Brown, Larry

2012-01-01

The purpose of this study was to examine the effectiveness of evidence-based recruitment and retention strategies for a longitudinal, family-based HIV prevention intervention study targeting adolescents in psychiatric care by (1) determining consent rate (recruitment), rate of participation at the first intervention session (retention), and…

Correlates of Adolescent Assertiveness with HIV Avoidance in a Four-Nation Sample

ERIC Educational Resources Information Center

Onuoha, Francis N.; Munakata, Tsunetsugu

2005-01-01

Adolescents are frequently admonished to be socially assertive in order to confront negative interpersonal peer influences. Since the advent of HIV/AIDS in human social chemistry, the admonition has become more critical than ever. But the warning is often proffered in the misguided presumption that social assertiveness is the all-required…

A photo voice perspective on factors contributing to the resilience of HIV positive Yoruba adolescent girls in Nigeria.

PubMed

Adegoke, Catherine O; Steyn, Miemsie G

2017-04-01

There is a growing discourse worldwide on the impact of the Human Immunodeficiency Virus (HIV) on "at risk youths". In response, five HIV-positive Nigerian adolescent girls were qualitatively investigated in collaboration with a non-governmental organisation (NGO) in Ibadan, an urban settlement in Nigeria in 2013. Using a secondary data analysis from a photo voice component of the research, combined with narratives, we show that participants possess the capacity to overcome their adversities from the effects of HIV infection and remain resilient. Few studies have used photovoice - a visual participatory approach - and its impact on this group. The theories of Bourdieu, Piaget and Erikson were used as tools to interpret and document, resilience, social capital and coping among participants. Findings reveal participants frame positive goals, use social competence, coping skills, and express personal challenges. These have serious implications for policy makers, researchers and programmer in strengthening adolescents' resilience. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

HIV Risk Behavior among Youth in the Dominican Republic: The Role of Alcohol and Other Drugs.

PubMed

Guilamo-Ramos, Vincent; Jaccard, James; Lushin, Viktor; Martinez, Roberto; Gonzalez, Bernardo; McCarthy, Katharine

2011-01-01

Existing literature related to HIV in the Dominican Republic has tended to neglect the unique role of tourism areas as distinct ecologies facilitative of sexual risk behavior, particularly HIV vulnerability and transmission. Furthermore, limited attention has focused on Dominican adolescents living in close proximity to tourism areas who have become increasingly exposed to alcohol due to the expanding tourism industry in the Dominican Republic. While most previous analyses of the effects of alcohol on adolescent sexual risk behavior have focused on the transient effects of alcohol on judgment and decision making, the effects of chronic alcohol use on sexual behavior has been a neglected area of research. Our study explores the relationship between chronic alcohol use, the parent-adolescent relationship, affective factors such as self-esteem, and intentions to engage in sex. We examine the above factors within the context of tourism areas which represent a unique ecology of alcohol availability and consumption and HIV risk. We discuss implications for developing applied family-based programs to target Dominican adolescent alcohol use and sexual risk behavior in tourism areas of high alcohol exposure.

Low CD4+ T-cell levels and B-cell apoptosis in vertically HIV-exposed noninfected children and adolescents.

PubMed

Miyamoto, Maristela; Pessoa, Silvana D; Ono, Erika; Machado, Daisy M; Salomão, Reinaldo; Succi, Regina C de M; Pahwa, Savita; de Moraes-Pinto, Maria Isabel

2010-12-01

Lymphocyte subsets, activation markers and apoptosis were assessed in 20 HIV-exposed noninfected (ENI) children born to HIV-infected women who were or not exposed to antiretroviral (ARV) drugs during pregnancy and early infancy. ENI children and adolescents were aged 6-18 years and they were compared to 25 age-matched healthy non-HIV-exposed children and adolescents (Control). ENI individuals presented lower CD4(+) T cells/mm(3) than Control group (control: 1120.3 vs. ENI: 876.3; t-test, p = 0.030). ENI individuals had higher B-cell apoptosis than Control group (Control: 36.6%, ARV exposed: 82.3%, ARV nonexposed: 68.5%; Kruskal-Wallis, p < 0.05), but no statistical difference was noticed between those exposed and not exposed to ARV. Immune activation in CD4(+) T, CD8(+) T and in B cells was comparable in ENI and in Control children and adolescents. Subtle long-term immune alterations might persist among ENI individuals, but the clinical consequences if any are unknown, and these children require continued monitoring.

Decisional Capacity among Minors with HIV: A Model for Balancing Autonomy Rights with the Need for Protection

PubMed Central

Chenneville, Tiffany; Sibille, Kimberly; Bendell-Estroff, Debra

2015-01-01

The purpose of this paper is threefold: (1) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV; (2) to provide a framework for assessing the decisional capacity of children and adolescents with HIV; and (3) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum. PMID:26568667

Decisional Capacity among Minors with HIV: A Model for Balancing Autonomy Rights with the Need for Protection.

PubMed

Chenneville, Tiffany; Sibille, Kimberly; Bendell-Estroff, Debra

The purpose of this paper is threefold: (1) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV; (2) to provide a framework for assessing the decisional capacity of children and adolescents with HIV; and (3) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum.

Adolescent female sex workers: invisibility, violence and HIV.

PubMed

Silverman, Jay G

2011-05-01

A large number of female sex workers are children. Multiple studies demonstrate that up to 40% of women in prostitution started this work prior to age 18. In studies across India, Nepal, Thailand and Canada, young age at entry to sex work has been found to heighten vulnerability to physical and sexual violence victimisation in the context of prostitution, and relates to a two to fourfold increase in HIV infection. Although HIV risk reduction among adult female sex workers has been a major focus of HIV prevention efforts across the globe, no public health interventions, to date, have addressed the increased hazards and HIV risk faced by adolescent female sex workers. Beyond the structural barriers that limit access to this vulnerable group, historical tensions between HIV prevention and child protection agencies must be overcome in order to develop effective strategies to address this large scale yet little recognised human rights and HIV-related crisis.

Disco funerals, a risk situation for HIV infection among youth in Kisumu, Kenya

PubMed Central

Njue, Carolyne; Voeten, Helene ACM; Remes, Pieter

2009-01-01

Objective We investigated the so called ‘disco funeral’ phenomenon in Kisumu, Kenya, whereby community members including adolescents congregate at the home of the deceased for several days, accompanied by music and dancing. We explored whether disco funerals are a risk situation for HIV/STI infection among youth. Design Cross-sectional qualitative study. Methods We conducted 44 in-depth interviews with male and female adolescents aged 15 to 20 in Kisumu municipality in Nyanza Province, Kenya. We also made observations during 6 disco funerals. Results Disco funerals were an important place for young people to hang out; they increased the opportunities to meet and engage in (risky) sexual activities. Many adolescents reported having casual sex on these occasions, sometimes with multiple partners, and mostly without condoms. Some girls were forced into sex, and there were several accounts of gang rape. Sex in exchange for money was reported frequently. Drugs and alcohol seemed to facilitate unprotected, multiple-partner, coerced, and transactional sex. Conclusions In Kisumu, a town with a generalized HIV/AIDS epidemic, the high AIDS mortality leads to frequent disco funerals. Because many adolescents are having unprotected, transactional, or coerced sex at these occasions, disco funerals might contribute to the high HIV prevalence among youth, especially among adolescent girls. HIV interventions urgently need to include outreach actions to youth who hang out at disco funerals, and link up with parents and funeral organizers to reduce risk situations. PMID:19165086

Exploring Factors Associated with Nonchange in Condom Use Behavior following Participation in an STI/HIV Prevention Intervention for African-American Adolescent Females

PubMed Central

Sales, Jessica M.; Brown, Jennifer L.; DiClemente, Ralph J.; Rose, Eve

2012-01-01

To enhance future STI/HIV prevention efforts, this study examined factors associated with adolescents' failure to improve their condom use behaviors after participating in an STI/HIV prevention intervention. African-American adolescent females (N = 205; M age = 17.9) in an STI/HIV prevention intervention trial completed ACASI interviews and provided self-collected vaginal swabs to assess two prevalent STIs at baseline and 6 months after intervention. Analyses compared those who increased condom use after intervention (change group) to those whose condom use did not increase (nonchange group). 43.4% did not increase their condom use after the intervention and were more likely to have an STI at followup (χ 2 = 4.64, P = .03). In a multivariate logistic regression model, the nonchange group was more likely to have (a) higher sensation seeking (AOR = .91, P = .023), (b) a boyfriend (AOR = .32, P = .046), and/or (c) a physical abuse history (AOR = .56, P = .057). There were also differences in the extent to which psychosocial mediators changed between the two groups. Findings highlight the need to tailor STI/HIV interventions to adolescents with a greater degree of sensation seeking and address key relationship characteristics and trauma histories to bolster intervention efficacy. PMID:22690331

Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial.

PubMed

Jemmott, John B; Jemmott, Loretta S; Fong, Geoffrey T; Morales, Knashawn H

2010-04-01

We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.

Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial

PubMed Central

Jemmott, Loretta S.; Fong, Geoffrey T.; Morales, Knashawn H.

2010-01-01

Objectives. We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). Methods. In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Results. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (β = 0.06; 95% CI = 0.00, 0.12) than did the control group. Conclusions. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established. PMID:20167903

Executive summary and recommendations from WHO/UNAIDS and AAVP consultation on: 'The inclusion of adolescents in HIV vaccine trials', 16-18 March 2006 in Gaborone, Botswana.

PubMed

Osmanov, Saladin

2007-09-12

This report summarizes the discussions and recommendations from a consultation held in Gaborone, Botswana (16-19 March 2006), organized by the joint World Health Organization (WHO)/United Nations Programme on HIV/AIDS (UNAIDS) HIV Vaccine Initiative (HVI) and the African AIDS Vaccine Programme (AAVP). The consultation considered key challenges and strategies in enrolling adolescents into HIV vaccine clinical trials, relevant to developing countries, in particular in eastern and southern Africa. Approaches were identified that might address and resolve country-specific challenges related to scientific, legal, ethical, regulatory and community aspects of the involvement of adolescents in HIV vaccine trials. This executive summary is formulated for a broader dissemination of the outcomes of the meeting to the general clinical, scientific and regulatory community involved in the review, approval and monitoring of clinical trials and potential licensing of HIV vaccine candidates. Four major topics were discussed and recommendations developed with regard to: (i) criteria for products selection and clinical trial design; (ii) ethical and legal issues; (iii) community acceptance and participation; and (iv) regulatory considerations. The recommendations of this meeting were further discussed and endorsed by the WHO/UNAIDS HIV Vaccine Advisory Committee.

Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study.

PubMed

Okawa, Sumiyo; Mwanza-Kabaghe, Sylvia; Mwiya, Mwiya; Kikuchi, Kimiyo; Jimba, Masamine; Kankasa, Chipepo; Ishikawa, Naoko

2018-03-27

Adolescents living with HIV face challenges, such as disclosure of HIV status, adherence to antiretroviral therapy, mental health, and sexual and reproductive health (SRH). These challenges affect their future quality of life. However, little evidence is available on their sexual behaviors and SRH needs in Zambia. This study aimed at assessing their sexual behaviors and SRH needs and identifying factors associated with marriage concerns and a desire to have children. This cross-sectional study was conducted at the University Teaching Hospital from April to July 2014. We recruited 200 adolescents aged 15-19 years who were aware of their HIV-positive status. We collected data on their first and recent sexual behavior, concerns about marriage, and desire to have children. We used the Generalized Linear Model to identify factors associated with having concerns about marriage and desire to have children. We performed thematic analysis with open-ended data to determine their perceptions about marriage and having children in the future. Out of 175 studied adolescents, 20.6% had experienced sexual intercourse, and only 44.4% used condoms during the first intercourse. Forty-eight percent had concerns about marriage, and 87.4% desired to have children. Marriage-related concerns were high among those who desired to have children (adjusted relative risk [ARR] = 2.51, 95% CI = 1.02 to 6.14). Adolescents who had completed secondary school were more likely to desire to have children (ARR = 1.35, 95% CI = 1.07 to 1.71). Adolescents who had lost both parents were less likely to want children (ARR = 0.80, 95% CI = 0.68 to 0.95). Thematic analysis identified that major concerns about future marriage were fear of disclosing HIV status to partners and risk of infecting partners and/or children. The reasons for their willingness to have children were the desire to be a parent, having children as family assets, a human right, and a source of love and happiness. Zambian adolescents living with HIV are at risk of engaging in risky sexual relationships and have difficulties in meeting needs of SRH. HIV care service must respond to a wide range of needs.

HIV-1 drug resistance prevalence, drug susceptibility and variant characterization in the Jacobi Medical Center paediatric cohort, Bronx, NY, USA.

PubMed

de Mulder, M; York, V A; Wiznia, A A; Michaud, H A; Nixon, D F; Holguin, A; Rosenberg, M G

2014-03-01

With the advent of combined antiretroviral therapy (cART), perinatally HIV-infected children are surviving into adolescence and beyond. However, drug resistance mutations (DRMs) compromise viral control, affecting the long-term effectiveness of ART. The aims of this study were to detect and identify DRMs in a HIV-1 infected paediatric cohort. Paired plasma and dried blood spots (DBSs) specimens were obtained from HIV-1 perinatally infected patients attending the Jacobi Medical Center, New York, USA. Clinical, virological and immunological data for these patients were analysed. HIV-1 pol sequences were generated from samples to identify DRMs according to the International AIDS Society (IAS) 2011 list. Forty-seven perinatally infected patients were selected, with a median age of 17.7 years, of whom 97.4% were carrying subtype B. They had a mean viral load of 3143 HIV-1 RNA copies/mL and a mean CD4 count of 486 cells/μL at the time of sampling. Nineteen patients (40.4%) had achieved undetectable viraemia (< 50 copies/mL) and 40.5% had a CD4 count of > 500 cells/μL. Most of the patients (97.9%) had received cART, including protease inhibitor (PI)-based regimens in 59.6% of cases. The DRM prevalence was 54.1, 27.6 and 27.0% for nucleoside reverse transcriptase inhibitors (NRTIs), PIs and nonnucleoside reverse transcriptase inhibitors (NNRTIs), respectively. Almost two-thirds (64.9%) of the patients harboured DRMs to at least one drug class and 5.4% were triple resistant. The mean nucleotide similarity between plasma and DBS sequences was 97.9%. Identical DRM profiles were present in 60% of plasma-DBS paired sequences. A total of 30 DRMs were detected in plasma and 26 in DBSs, with 23 present in both. Although more perinatally HIV-1-infected children are reaching adulthood as a result of advances in cART, our study cohort presented a high prevalence of resistant viruses, especially viruses resistant to NRTIs. DBS specimens can be used for DRM detection. © 2013 British HIV Association.

Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda.

PubMed

Mbalinda, Scovia Nalugo; Kiwanuka, Noah; Kaye, Dan K; Eriksson, Lars E

2015-10-21

With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10-19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24-3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22-6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86-15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05-3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40-0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18-0.62) were associated with poorer mental health. Among perinatally HIV-infected adolescents in Uganda, being on ART was associated with better physical and mental health while lack of communication with guardians on sexuality or dissatisfaction with SRH services was associated with poor mental health. Adolescents with pregnancy intentions were more likely to have a better mental health.

Cultural conceptions of HIV/AIDS among teenagers in Bolivia, Chile and Mexico.

PubMed

Torres López, Teresa Margarita; Reynaldos Quinteros, Carolina; Lozano González, Aldo Favio; Munguía Cortés, Jazmín Aranzazú

2010-10-01

To understand the cultural dimensions of HIV/AIDS among adolescent students. A cognitive anthropological study was undertaken in Cochabamba (Bolivia), Talca (Chile) and Guadalajara (Mexico), during 2007 and 2008. A total of 184 teenagers (from 14 to 19 years old) were selected by purposeful sampling at secondary schools in each country. Free association lists and pile sorts were utilized. Terms associated with the concept of HIV/AIDS and groups of conceptual dimensions were investigated. Subsequently, consensus analysis was performed using factorial principal components and dimensional analysis through hierarchical clusters and multidimensional scales. The differences between the country contexts were in the degree of consensus in relation to the term HIV/AIDS, which was greater in Cochabamba. In Talca and Guadalajara the youths mentioned metaphors of fighting against HIV/AIDS, while in Cochabamba participants talked about help, support and love that infected people should receive. The similarities among conceptions by youth from the three countries were: the risk factors (unprotected sexual practice and contact with specific population groups), the consequences (physical and social death, being the latter understood as social rejection of people living with HIV/AIDS) and the prevention of illness (based on information and condom use). For adolescent students, HIV/AIDS is a disease caused by sexual practices and drug use and involves harm, pain and death. HIV/AIDS prevention programs for adolescents should promote science based information on the topic and not concentrate only on the emotional and social consequences of HIV/AIDS.

The Adolescent HIV Disclosure Cognition and Affect Scale: Preliminary Reliability and Validity.

PubMed

Evangeli, Michael

2017-07-01

Globally, there are 2 million HIV-positive 10-19-year-olds. One challenge for this population is sharing their HIV status with others (onward HIV disclosure). There are no multi-item, multidimensional scales of HIV disclosure cognitions and affect for young people living with HIV. An 18-item measure of HIV disclosure cognition and affect was developed, administered to 65 adolescents living with HIV (aged 12-16 years). Data were explored using principal component analysis and preliminary construct and criterion validity assessed. Three factors were revealed: negative disclosure attitudes and feelings, self-efficacy, and positive disclosure attitudes and feelings. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV disclosure in the past 6 months, HIV disclosure intention and self-perception. Preliminary evidence of the measure's good psychometric properties suggests it may be helpful in future clinical and research work. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Parents' and teachers' communication about HIV and sex in relation to the timing of sexual initiation among young adolescents in Tanzania.

PubMed

Kawai, Kosuke; Kaaya, Sylvia F; Kajula, Lusajo; Mbwambo, Jessie; Kilonzo, Gad P; Fawzi, Wafaie W

2008-11-01

Early sexual debut is associated with increased HIV risk among young adolescents in sub-Saharan Africa. Our study examines parents' and teachers' communication about sexual matters in relation to the timing of sexual initiation among students aged 12-14 years old in Dar es Salaam, Tanzania. Virgin primary school students were followed prospectively for 6 months to assess sexual initiation. Socio-demographic, psychosocial, and behavioural factors were assessed with a structured questionnaire. Univariate and multivariate logistic regression analyses were performed. Of 2477 adolescents, 26.9% of students reported communicating about HIV and sex with parents and 35.6% communicated with teachers. Communication with teachers about HIV and sex was associated with delayed sexual initiation among adolescents after adjusting for potential confounding factors (OR=0.59, 95%CI=0.40-0.89, p=0.01). However, parental communication was not associated with the timing of sexual initiation. The perception that most peers are sexually active was a significant predictor of early sexual debut (test for linear trend, p=0.002). Students who do not live with a biological mother were marginally more likely to initiate sex compared to those who live with a biological mother (OR=1.39, 95%CI=0.97-1.99, p=0.08). Teachers can play an effective role in discussing HIV and sex with young adolescents. Our study highlights the necessity of responsible adults discussing sexual matters with young adolescents in sub-Saharan Africa. More research is required to better understand the role of parental communication about sexual matters and strategies for improving the quality of parental communication.

HIV Risk Among Displaced Adolescent Girls in Ethiopia: the Role of Gender Attitudes and Self-Esteem.

PubMed

Bermudez, Laura Gauer; Yu, Gary; Lu, Lily; Falb, Kathryn; Eoomkham, Jennate; Abdella, Gizman; Stark, Lindsay

2018-05-16

Adolescent girls in sub-Saharan Africa have been deemed one of the most critical populations to address in the campaign for an HIV-free generation. Experiences of intimate partner violence (IPV), harmful gender norms, diminished personal agency, and age-disparate sex have been identified as factors in the increasing rate of new infections among this population. Using baseline data from a cluster-randomized controlled trial in three refugee camps in Benishangul-Gumuz Regional State in Ethiopia, our study quantitatively examined the associations between HIV risk factors, attitudes on gender inequality, IPV acceptability, and self-esteem for female adolescent refugees primarily from Sudan and South Sudan (n = 919). In multivariate models, adjusting for age and education, results showed girls who were more accepting of gender inequitable norms and IPV had greater odds of ever experiencing forced (OR 1.40, CI 1.15-1.70; OR 1.66, CI 1.42-1.94) or transactional sex (OR 1.28, CI 1.05-1.55; OR 1.59, CI 1.37-1.85) compared to girls who demonstrated less approval. Higher self-esteem was associated with increased odds of condom use (OR 1.13, CI 1.02-1.24) as well as decreased odds of adolescent marriage (OR 0.93, CI 0.90-0.95), age-disparate sex (OR 0.90, CI 0.86-0.94), and transactional sex (OR 0.96, CI 0.93-0.99). The findings suggest acceptance of inequitable gender norms (including those that perpetuate violence against women) and low self-esteem to be associated with common HIV risk factors among refugee adolescents living in Ethiopia. Greater attention towards the intersections of gender equality and self-valuation is needed when seeking to understand HIV risk among refugee adolescent girls in sub-Saharan Africa.

Humoral and cell-mediated immune responses after a booster dose of HBV vaccine in HIV-infected children, adolescents and young adults.

PubMed

Giacomet, Vania; Masetti, Michela; Nannini, Pilar; Forlanini, Federica; Clerici, Mario; Zuccotti, Gian Vincenzo; Trabattoni, Daria

2018-01-01

HBV vaccine induces protective antibodies only in 23-56% of HIV-infected children. The aim of our study is to evaluate the immunologic effects of a booster dose of HBV vaccine in HIV-infected youth. 53 young HIV-infected patients in whom HBV vaccination did not elicit protective Ab titers were enrolled. All patients were on ART with optimal immunological and viral response. All patients received a booster dose of HBV vaccine (HBVAXPRO 10 μg i.m.). HBV-specific Ab titer, viral load and CD4+ T cells were measured at baseline (T0), T1, T6 and T12 months. In a subgroup of 16 patients HBV-specific cell mediated immune responses were evaluated at baseline, at T1 and T6. The booster dose induced seroconversion in 51% of patients at T1, 57% at T6, and49% at T12; seroconversion rate was significantly correlated with CD4+T cells at T0 and to the CD4 nadir. The booster dose induced HBV-specific cell mediated immunity at T6 mainly in Responders (Rs): Effector Memory CD8+T cells, HBV-specific TNFα-, IFNγ-, granzyme secreting CD8+ T cells and IL2-secreting CD4+ T cells were significantly increased in Rs compared to T0. In Non Responders (NRs), HBV-specific IL2-secreting CD4+ T cells, Central and Effector Memory CD8+ T cells were the only parameters modified at T6. Seroconversion induced by a booster dose of vaccine correlates with the development of T cell immunological memory in HIV-infected patients who did not respond to the standard immunization. Alternate immunization schedules need to be considered in NRs.

The association between adolescent entry into the trucking industry and risk of HIV among long-distance truck drivers in India.

PubMed

Mishra, Ram Manohar; Dube, Madhulika; Saggurti, Niranjan; Pandey, Arvind; Mahapatra, Bidhubhusan; Ramesh, Sowmya

2012-01-01

This study examines the relationship between entry into the trucking industry during adolescence and both sexually transmitted infections (STIs) and infection by the human immunodeficiency virus (HIV) among long-distance truck drivers in India. Data were sourced from a cross-sectional survey (sample size: 2066) undertaken in 2007 among long-distance truck drivers. The survey spread across major transshipment locations covering the bulk of India's transport volume along four routes. Participants were interviewed about sexual behaviors and were tested for HIV and STIs. The present authors constructed two synthetic cohorts based on the participants' duration of employment in the trucking industry: (1) low (duration ≤ 6 years) and (2) high experience (duration ≥ 7 years). Based on age at entry into the trucking industry, participants were termed as either adolescent (age at entry < 18 complete years) or adult entrants (age at entry ≥ 18 complete years). In the low-experience cohort, the adolescent entrants were more likely than the adult entrants to have sex with paid female partners (42.6% versus 27.2%, respectively; adjusted odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.3-2.9) and to practice inconsistent condom use with such partners (69.1% versus 26.8%, respectively; adjusted OR: 5.3; 95% CI: 2.4-11.6). However, no significant differences were found in STI and HIV prevalence between the adolescent and the adult entrants in this cohort. In the high-experience cohort, the adolescent entrants were about two times more likely than the adult entrants to practice inconsistent condom use with paid female partners (38.5% versus 26.7%, respectively; adjusted OR: 1.7; 95% CI: 1.1-2.8) and to test positive for HIV (7.4% versus 4.0%, respectively; adjusted OR: 1.9; 95% CI: 1.2-3.1) and syphilis (5.7% versus 3.5%, respectively; adjusted OR: 1.8; 95% CI: 1.1-3.1). These results suggest the need for focused behavioral change programs in HIV prevention interventions for adolescent truckers in India and elsewhere.

Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya

PubMed Central

2012-01-01

Background Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15–19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. Methods Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. Results Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8–2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1–0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6–4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1–0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5–3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5–1.5). Conclusions The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes. PMID:23039966

HIV/AIDS and Children in the English Speaking Caribbean.

ERIC Educational Resources Information Center

Dicks, Barbara A., Ed.

This collection of papers addresses the HIV/AIDS situation among English-speaking children in the Caribbean. Papers include: "Preface" (C. James Hospedales); "Introduction"; (Barbara A. Dicks); "HIV/AIDS: Challenging a Monster" (Brendan Bain); "HIV/AIDS in Caribbean Children and Adolescents" (Noreen Jack);…

Evaluation of HIV/AIDS Secondary School Peer Education in Rural Nigeria

ERIC Educational Resources Information Center

van der Maas, Frank; Otte, Willem M.

2009-01-01

In this study, we assessed whether peer education is an effective method of HIV/AIDS awareness, in terms of knowledge, misconception and behavior, among adolescents in the rural area of Nigeria. A comparative case series (n = 250), cross-sectional structured survey (n = 135) and focus group discussions (n = 80) were undertaken among adolescents.…

Feasibility and Acceptability of a Web-Based HIV/STD Prevention Program for Adolescent Girls Targeting Sexual Communication Skills

ERIC Educational Resources Information Center

Widman, L.; Golin, C. E.; Kamke, K.; Massey, J.; Prinstein, M. J.

2017-01-01

Adolescent girls are at substantial risk of sexually transmitted diseases including HIV. To reduce these risks, we developed Health Education And Relationship Training (HEART), a web-based intervention focused on developing sexual assertiveness skills and enhancing sexual decision-making. This study assessed the feasibility and acceptability of…

HIV-Positive Mothers' Communication about Safer Sex and Std Prevention with Their Children

ERIC Educational Resources Information Center

Murphy, Debra A.; Roberts, Kathleen Johnston; Herbeck, Diane M.

2012-01-01

Mothers play an important role in promoting the sexual health of their adolescent children. Fifty-seven HIV-positive mothers with adolescent children participated in an in-depth, qualitative interview regarding whether they have talked to their children about safer sex and sexually transmitted disease (STD) prevention, including at what age they…

Teaching Gender to Younger and Less Sexually Experienced Adolescents in the Context of HIV/STD Prevention

ERIC Educational Resources Information Center

Sclafane, Jamie Heather; Perry, Deidrea L.; Lolacono, Marni L.; Fryer, Craig S.; Adair, Elissa Schuler; Silver, Ellen Johnson; Bauman, Laurie J.

2005-01-01

Gender beliefs affect adolescents' sexual motivations, perceptions, and actions (Moss, 1994) and can endanger sexual health (Haffner, 1998). We believe that teaching youth about gender norms will increase the efficacy of HIV/STD preventive interventions. We were funded by the National Institute of Child Health and Human Development to develop and…

Fathers Are Important People: A Study of Father-Son Sexual Communication

ERIC Educational Resources Information Center

DiIorio, Colleen; Lehr, Sally; Wasserman, Jill L.; Eichler, Michelle; Cherry, Chauncey; Denzmore, Pamela

2006-01-01

The purpose of this study was to examine the perceived role of African-American fathers in educating their sons about sex and HIV prevention. Given that some studies have shown a relationship between parent-adolescent sexual communication and adolescent sexual behavior, and the disproportionately high rates of teen pregnancy and HIV (and other…

Comprehension of a simplified assent form in a vaccine trial for adolescents.

PubMed

Lee, Sonia; Kapogiannis, Bill G; Flynn, Patricia M; Rudy, Bret J; Bethel, James; Ahmad, Sushma; Tucker, Diane; Abdalian, Sue Ellen; Hoffman, Dannie; Wilson, Craig M; Cunningham, Coleen K

2013-06-01

Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. 123 youth completed the questionnaire (mean age=15 years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking.

Factors influencing social self-disclosure among adolescents living with HIV in Eastern Africa.

PubMed

Nöstlinger, Christiana; Bakeera-Kitaka, Sabrina; Buyze, Jozefien; Loos, Jasna; Buvé, Anne

2015-01-01

Adolescents living with HIV (ALHIV) face many psychosocial challenges, including HIV disclosure to others. Given the importance of socialization during the adolescent transition process, this study investigated the psychological and social factors influencing self-disclosure of own HIV status to peers. We examined social HIV self-disclosure to peers, and its relationship to perceived HIV-related stigma, self-efficacy to disclose, self-esteem, and social support among a sample of n = 582 ALHIV aged 13-17 years in Kampala, Uganda, and Western Kenya. Data were collected between February and April 2011. Among them, 39% were double orphans. We conducted a secondary data analysis to assess the degree of social disclosure, reactions received, and influencing factors. Interviewer-administered questionnaires assessed medical, socio-demographic, and psychological variables (Rosenberg self-esteem scale; self-efficacy to disclose to peers), HIV-related stigma (10-item stigma scale), and social support (family-life and friends). Descriptive, bivariate, and logistic regression analyses were performed with social self-disclosure to peers with gender as covariates. Almost half of ALHIV had told nobody (except health-care providers) about their HIV status, and about 18% had disclosed to either one of their friends, schoolmates, or a boy- or girlfriend. Logistic regression models revealed that having disclosed to peers was significantly related to being older, being a paternal orphan, contributing to family income, regular visits to the HIV clinic, and greater social support through peers. Low self-efficacy to disclose was negatively associated to the outcome variable. While social self-disclosure was linked to individual factors such as self-efficacy, factors relating to the social context and adolescents' access to psychosocial resources play an important role. ALHIV need safe environments to practice disclosure skills. Interventions should enable them to make optimal use of available psychosocial resources even under constraining conditions such as disruptive family structures.

Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda.

PubMed

Nabukeera-Barungi, Nicolette; Elyanu, Peter; Asire, Barbara; Katureebe, Cordelia; Lukabwe, Ivan; Namusoke, Eleanor; Musinguzi, Joshua; Atuyambe, Lynn; Tumwesigye, Nathan

2015-11-14

Adolescents have gained increased attention because they are the only age group where HIV related mortality is going up. We set out to describe the level and factors associated with adherence to antiretroviral therapy (ART) as well as the 1 year retention in care among adolescents in 10 representative districts in Uganda. In addition, we explored the barriers and facilitators of adherence to ART among adolescents. The study involved 30 health facilities from 10 representative districts in Uganda. We employed both qualitative and quantitative data collection methods in convergent design. The former involved Focus group discussions with adolescents living with HIV, Key informant interviews with various stakeholders and in depth interviews with adolescents. The quantitative involved using retrospective records review to extract the last recorded adherence level from all adolescents who were active in HIV care. Factors associated with adherence were extracted from the ART cards. For the 1 year retention in care, we searched the hospital records of all adolescents in the 30 facilities who had started ART 1 year before the study to find out how many were still in care. Out of 1824 adolescents who were active on ART, 90.4 % (N = 1588) had ≥95 % adherence recorded on their ART cards at their last clinic visit. Only location in rural health facilities was independently associated with poor adherence to ART (P = 0.008, OR 2.64 [1.28 5.43]). Of the 156 adolescents who started ART, 90 % (N = 141) were still active in care 1 year later. Stigma, discrimination and disclosure issues were the most outstanding of all barriers to adherence. Other barriers included poverty, fatigue, side effects, pill burden, depression among others. Facilitators of adherence mainly included peer support groups, counseling, supportive health care workers, short waiting time and provision of food and transport. Adherence to ART was good among adolescents. Being in rural areas was associated with poor adherence to ART and 1 year retention in care was very good among adolescents who were newly started on ART. Stigma and disclosure issues continue to be the main barriers to adherence among adolescents.

HIV/STI Prevention Among Heterosexually Active Black Adolescents With Mental Illnesses: Focus Group Findings for Intervention Development.

PubMed

Brawner, Bridgette M; Jemmott, Loretta Sweet; Wingood, Gina; Reason, Janaiya; Mack, Niya

Heterosexually active Black adolescents with mental illnesses are at increased risk for sexually transmitted infections (STIs), including HIV. However, few HIV/STI prevention interventions exist for this demographic. We held seven focus groups (N = 33) to elucidate social, cultural, and psychological factors that influence HIV/STI risk-related sexual behaviors in this understudied population. Seven themes emerged: (a) Blackness and media portrayals, (b) Blackness as a source of cultural resilience and pride, (c) psychosocial determinants of condom use, (d) consequences of engaging in sexual activity, (e) attitudes and beliefs toward sexual behaviors, (f) benefits of sexual activity, and (g) coping mechanisms. Participants also supported the feasibility of and interest in HIV/STI prevention programs integrated with mental health treatment. Transportation, potential breaches of confidentiality, and time were noted barriers to participation. Psychoeducational, skills-based programs are needed to address the sequelae of mental illnesses as they relate to the sexual decision-making process in adolescents. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa.

PubMed

Cluver, Lucie; Meinck, Franziska; Toska, Elona; Orkin, F Mark; Hodes, Rebecca; Sherr, Lorraine

2018-05-15

HIV-positive adolescents have low-ART adherence, with consequent increased risks of mortality, morbidity, and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART adherence with adolescent violence victimization by caregivers, teachers, peers, community members, and healthcare providers. HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10-19-year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between nonadherence and nine violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects. Past-week self-reported ART nonadherence was 36%. Nonadherence correlated strongly with virologic failure (OR 2.3, CI 1.4-3.8) and symptomatic pulmonary tuberculosis (OR 1.49, CI 1.18-2.05). Four violence types were independently associated with nonadherence: physical abuse by caregivers (OR 1.5, CI 1.1-2.1); witnessing domestic violence (OR 1.8, CI 1.22-2.66); teacher violence (OR 1.51, CI 1.16-1.96,) and verbal victimization by healthcare staff (OR 2.15, CI 1.59-2.93). Past-week nonadherence rose from 25% with no violence to 73.5% with four types of violence exposure. Violence exposures at home, school, and clinic are major and cumulating risks for adolescent antiretroviral nonadherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.

Modelling adverse treatment outcomes of HIV-infected adolescents attending public-sector HIV clinics in Lusaka.

PubMed

Fwemba, I; Musonda, P

2017-06-01

In resource-limited setting, there is scarce evidence comparing antiretroviral therapy (ART) outcomes among HIV-infected adolescents to that of other age groups. We analysed data from 25 ART facilities in Lusaka District, comparing treatment-naïve ART-eligible young adolescents (10-14 years), older adolescents (15-19) and young adults (20-24 years) initiating first-line ART to those aged 24 years or older. The adjusted relative risk (RR) of failure to achieve an adequate CD4 response (defined as failure to increase CD4 count by ≥ 50 cells/mm 3 at 6 months or by ≥ 100 cells/mm 3 ) at 6 or 12 months after ART initiation was modelled using log-binomial regression. The effect of age group on mortality and loss to follow-up (LTFUP; ≥60 days since scheduled visit date) was estimated using adjusted Cox proportional hazards models, respectively. This was a routine retrospective design using program data. Of the 94,023 patients initiating ART from May 2004 to February 2011, 1303 (1.4%) were young adolescents, 1440 (1.5%) were older adolescents and 5825 (6.2%) were young adults. 85,455 (90.9%) were 24 years or older at the time of ART initiation. Compared with adults, both young adolescents (RR: 0.88, 95% confidence interval [CI]: 0.76-1.01 at 6 months and RR: 0.80, 95% CI: 0.69-0.93 at 12 months) and older adolescents (RR: 0.82, 95% CI: 0.71-0.95 at 6 months) were less likely to achieve adequate CD4 response. No evidence of a difference in mortality risk was observed among older adolescents (hazard ratio [HR] 1.20, 95% CI: 0.93-1.56) compared with adults; however, there was a reduced risk of mortality in young adolescents compared with adults (HR: 0.61, 95% CI: 0.40-0.92). Young adolescents were less likely to be LTFUP following ART initiation (HR: 0.74, 95% CI: 0.59-0.92), while older adolescents and young adults were reported to be more likely to drop out of care (HR: 1.54 95% CI: 1.33-1.78; HR: 1.51 95% CI: 1.40-1.63 respectively). Older adolescents and young adults had poorer ART treatment outcomes, including failure to achieve adequate CD4 recovery and failure to remain in long-term care, when compared with adults. Interventions are necessary to help increase outcomes and retention in care. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model.

PubMed

Whiteley, Laura; Brown, Larry; Lally, Michelle; Heck, Nicholas; van den Berg, Jacob J

2018-04-23

Highly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment. The aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment. Game development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form. A number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors' visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were "satisfied with the game activities," and 9 out of 11 "would recommend it to a friend." On the session evaluation form, 9 out of 11 agreed that they "learned a lot from the game." We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment. ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1). ©Laura Whiteley, Larry Brown, Michelle Lally, Nicholas Heck, Jacob J van den Berg. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 23.04.2018.

A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model

PubMed Central

2018-01-01

Background Highly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment. Objective The aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment. Methods Game development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form. Results A number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors’ visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were “satisfied with the game activities,” and 9 out of 11 “would recommend it to a friend.” On the session evaluation form, 9 out of 11 agreed that they “learned a lot from the game.” Conclusions We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment. Trial Registration ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1) PMID:29685863

Facilitators and barriers to discussing HIV prevention with adolescents: perspectives of HIV-infected parents.

PubMed

Edwards, Laura L; Reis, Janet S; Weber, Kathleen M

2013-08-01

We examined HIV-infected parents' conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. Eighty-one percent of parents reported "sometimes" or "often" communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one's child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents.

Childhood experiences and psychosocial influences on HIV risk among adolescent Latinas in southern California.

PubMed

Newcomb, Michael D; Locke, Thomas F; Goodyear, Rodney K

2003-08-01

This study determined how adverse childhood experiences influenced risky sexual behavior in a community sample of Latina adolescents in Los Angeles (N = 904) within a modified ecodevelopmental perspective. Psychosocial, sociocultural, and environmental mediators of the relations between childhood experiences and risky sexual behavior were tested. Many direct and mediated paths were revealed using structural equation modeling. Childhood maltreatment was associated with risk sexual practices, including more partners, less condom use, more frequent intercourse, and less HIV testing. Drug use and general self-efficacy mediated several relationships. Reducing childhood maltreatment reduced HIV risk and improved psychosocial functioning. Many factors tested did not influence HIV risk. Much of what is known about HIV risk among other populations may not apply to young Latina women.

Adolescent Gender-Related Abuse, Androphilia, and HIV Risk Among Transfeminine People of Color in New York City

PubMed Central

Hwahng, Sel J.; Nuttbrock, Larry

2014-01-01

Public health research has indicated extremely high HIV seroprevalence (13–63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This paper combines two data sets. One set is based on an ethnographic study (N=50, 120 hours of participant observation). The other set longitudinal quantitative study (baseline N=600, N=275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes towards a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk. PMID:24294927

Family-based HIV prevention and intervention services for youth living in poverty-affected contexts: the CHAMP model of collaborative, evidence-informed programme development

PubMed Central

2010-01-01

Family-based interventions with children who are affected by HIV and AIDS are not well established. The Collaborative HIV Prevention and Adolescent Mental Health Program (CHAMP) represents one of the few evidence-based interventions tested in low-income contexts in the US, Caribbean and South Africa. This paper provides a description of the theoretical and empirical bases of the development and implementation of CHAMP in two of these countries, the US and South Africa. In addition, with the advent of increasing numbers of children infected with HIV surviving into adolescence and young adulthood, a CHAMP+ family-based intervention, using the founding principles of CHAMP, has been developed to mitigate the risk influences associated with being HIV positive. PMID:20573290

Health promotion strategies for families with adolescents orphaned by HIV and AIDS.

PubMed

Peu, M D

2014-06-01

This paper aims to explore and describe health promotion strategies for adolescents orphaned by human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), as well as the evaluation thereof. Among the Sub-Saharan countries, such as Swaziland, Botswana and Lesotho, South Africa is rated as fourth in the list of countries with the highest number of people living with HIV and AIDS. The study employed phenomenological qualitative design. The population consisted of the purposively selected health promoters working in the Hammanskraal region, directly and indirectly involved with families with adolescents orphaned by HIV and AIDS. Following the focus group interviews, data were analysed using the seven steps of Colaizzi. Four categories and eight subcategories were concluded as the strategies for adolescents orphaned by HIV and AIDS as well as the evaluation thereof. The main categories identified were: the door-to-door outcome, workshop outputs, statistical data and community projects. It is evident that the health promotion strategies informed by the four themes will be implemented. The outcomes may raise an awareness in the community, support families and provide statistics on the impact of HIV and AIDS on families. The study was limited to one subdistrict and to health promoters in a rural area, therefore the results cannot be generalized to all other subdistricts including health promoters, especially those in urban areas. The successful evaluation programme will pin out the strong points and challenges while assisting in improving the quality of work provided in the communities. Continuing professional and practice development are required to maintain the standard of health care in South Africa. Therefore the policymakers need to include relevant information regarding health promotion strategies in reducing the statistics of people living with HIV and AIDS. © 2014 International Council of Nurses.

Interaction between 5-HTTLPR Polymorphism and Abuse History on Adolescent African-American Females’ Condom Use Behavior Following Participation in an HIV Prevention Intervention

PubMed Central

Sales, Jessica M.; DiClemente, Ralph J.; Brody, Gene H.; Philibert, Robert A.; Rose, Eve

2013-01-01

Not everyone exposed to an efficacious HIV intervention will reduce sexual risk behaviors, yet little is known about factors associated with “failure to change” high risk sexual behaviors post-intervention. History of abuse and polymorphisms in the serotonin transporter gene (5-HTT) may be associated with non-change. The current study sought to identify genetic, life history, and psychosocial factors associated with adolescents’ failure to change condom use behaviors post-participation in an HIV prevention intervention. A sub-set of participants from a clinic-based sample of adolescent African-American females (N = 254) enrolled in a randomized trial of an HIV-prevention was utilized for the current study. 44.1% did not increase their condom use from baseline levels 6 months after participating in the STI/HIV prevention intervention. In multivariable logistic regression analysis, an interaction between abuse and 5-HTTLPR group was significantly associated with non-change status, along with partner communication frequency scores at follow-up. Follow-up tests found that having a history of abuse was significantly associated with greater odds of non-change in condom use post-intervention for only those with the s allele. For those with ll allele, participants with higher partner communication frequency scores were at decreased odds of non-change in condom use post-intervention. Thus, STI/HIV interventions for adolescent females may consider providing a more in-depth discussion and instruction on how to manage and overcome fear or anxiety related to being assertive in sexual decisions or sexual situations. Doing so may improve the efficacy of STI/HIV prevention programs for adolescent women who have experienced abuse in their lifetime. PMID:23479192

HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV.

PubMed

Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska

2017-08-21

Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed ( n  = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV-related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs.

HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

PubMed Central

Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska

2017-01-01

Abstract Introduction: Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. Methods: From 2013 to 2015, a survey using total population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Results: Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). Conclusions: These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV-related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs. PMID:28853517

Family Routines and Parental Monitoring as Protective Factors Among Early and Middle Adolescents Affected by Maternal HIV/AIDS

PubMed Central

Murphy, Debra A.; Marelich, William D.; Herbeck, Diane M.; Payne, Diana L.

2011-01-01

The influence of parenting skills on adolescent outcomes among children affected by maternal HIV/AIDS (N = 118, M age = 13) was investigated. Among families with more frequent family routines, over time adolescents showed lower rates of aggression, anxiety, worry, depression, conduct disorder, binge drinking, and increased self-concept. Among families with higher levels of parental monitoring, adolescents showed significant declines in anxiety and depression, conduct disorder, and binge drinking, along with increased self-concept. Mothers’ level of illness was associated with parenting. Greater variability in parental monitoring resulted in higher levels of problem behaviors. PMID:19930345

The impact of a national poverty reduction program on the characteristics of sex partners among Kenyan adolescents.

PubMed

Rosenberg, Molly; Pettifor, Audrey; Thirumurthy, Harsha; Halpern, Carolyn Tucker; Handa, Sudhanshu

2014-02-01

Cash transfer programs have the potential to prevent the spread of HIV, particularly among adolescents. One mechanism through which these programs may work is by influencing the characteristics of the people adolescents choose as sex partners. We examined the four-year impact of a Kenyan cash transfer program on partner age, partner enrollment in school, and transactional sex-based relationships among 684 adolescents. We found no significant impact of the program on partner characteristics overall, though estimates varied widely by gender, age, schooling, and economic status. Results highlight the importance of context in exploring the potential HIV preventive effects of cash transfers.

Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis.

PubMed

Bigna, Jean Joel R; Nansseu, Jobert Richie N; Um, Lewis N; Noumegni, Steve Raoul N; Simé, Paule Sandra D; Aminde, Leopold Ndemngue; Koulla-Shiro, Sinata; Noubiap, Jean Jacques N

2016-08-23

Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa. A systematic review and meta-analysis. HIV-infected African people residing in Africa. Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation. Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction. Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%-23%). Only 3 studies were found eligible from 3 regions of the African continent. The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa. Review registration number PROSPERO CRD42016033863. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Prevention of HIV/AIDS Education in Rural Communities III.

ERIC Educational Resources Information Center

Torabi, Mohammad R., Ed.

1998-01-01

This third special issue of the Health Education Monograph Series on HIV/AIDS Prevention in Rural Communities presents 9 articles on: "Rural Adolescent Views of HIV Prevention: Focus Groups at Two Indiana Rural 4-H Clubs" (William L. Yarber and Stephanie A. Sanders); "Implementing HIV Education: Beyond Curriculum" (Susan…

Storytelling for Empowerment for Latino Teens: Increasing HIV Prevention Knowledge and Attitudes

ERIC Educational Resources Information Center

Nelson, Annabelle; Cordova, David; Walters, Andrew S.; Szecsy, Elsie

2016-01-01

Latino adolescents are disproportionately impacted by HIV, but researchers have documented few programs to prevent and reduce HIV risk. The Storytelling for Empowerment (SFE) "HIV StoryBook" was designed with an innovative ecodevelopment approach combining empowerment, family communication, and positive cultural identity. A mixed method…

Retention of HIV-Positive Adolescents in Care: A Quality Improvement Intervention in Mid-Western Uganda.

PubMed

Izudi, Jonathan; Mugenyi, John; Mugabekazi, Mary; Muwanika, Benjamin; Tumukunde Spector, Victor; Katawera, Andrew; Kekitiinwa, Adeodata

2018-01-01

Low retention of HIV-positive adolescents in care is a major problem across HIV programs. Approximately 70% of adolescents were nonretained in care at Katooke Health Center, Mid-Western Uganda. Consequently, a quality improvement (QI) project was started to increase retention from 29.3% in May 2016 to 90% in May 2017. In May 2016, we analyzed data for retention, prioritized gaps with theme-matrix selection, analyzed root causes with fishbone diagram, developed site-specific improvement changes and prioritized with countermeasures matrix, and implemented improvement changes with Plan-Do-Study-Act (PDSA). Identified root causes were missing follow-up strategy, stigma and discrimination, difficult health facility access, and missing scheduled appointments. Interventions tested included generating list of adolescents who missed scheduled appointments, use of mobile phone technology, and linkage of adolescents to nearest health facilities (PDSA 1), Adolescent Only Clinic (PDSA 2), and monthly meetings to address care and treatment challenges (PDSA 3). Retention increased from 17 (29.3%) in May 2016 to 60 (96.7%) in August 2016 and was maintained above 90% until May 2017 (with exception of February and May 2017 recording 100% retention levels). Context specific, integrated, adolescent-centered interventions implemented using QI significantly improved retention in Mid-Western Uganda.

Domestic violence among adolescents in HIV prevention research in Tanzania: Participant experiences and measurement issues

PubMed Central

Baumgartner, Joy Noel; Kaaya, Sylvia; Karungula, Happy; Kaale, Anna; Headley, Jennifer; Tolley, Elizabeth

2014-01-01

Objectives Under-representation of female adolescents in HIV clinical trials may inhibit their access to future prevention technologies. Domestic violence, broadly defined as violence perpetrated by intimate partners and/or family members, may affect trial participation. This study describes violence in the lives of adolescents and young women in Tanzania, explores use of the Women’s Experience with Battering (WEB) Scale to measure battering, and examines the associations between battering and socio-demographic and HIV risk factors. Methods Community formative research (CFR) and a mock clinical trial (MCT) were conducted to examine the challenges of recruiting younger (15-17) versus older (18-21) participants into HIV prevention trials. The CFR included qualitative interviews with 23 participants and there were 135 MCT participants. The WEB was administered in both the CFR and MCT. Results Nineteen CFR participants experienced physical/sexual violence and 17% scored positive for battering. All married participants reported partner-related domestic violence, and half scored positive for battering. Many believed beatings were normal. None of the single participants scored positive on battering, but one-third reported abuse by relatives. Among MCT participants, 15% scored positive for battering; most perpetrators were relatives. Younger participants were more likely to report battering. Conclusions Adolescents experienced high rates of domestic violence and the WEB captured battering from both partners and relatives. The level of familial violence was unexpected and has implications for parental roles in study recruitment. Addressing adolescent abuse in HIV prevention trials and in the general population should be a public health priority. PMID:24740725

Short-term evaluation of a skill-development sexual education program for Spanish adolescents compared with a well-established program.

PubMed

Espada, José P; Morales, Alexandra; Orgilés, Mireia; Jemmott, John B; Jemmott, Loretta S

2015-01-01

The Centers for Disease Control and Prevention highlights the importance of evaluating interventions rigorously and recommends evaluating new interventions against interventions with established efficacy. Competencias para adolescentes con una sexualidad saludable (COMPAS) is a school-based HIV prevention program that has been shown to be effective in reducing sexual risk behaviors among adolescents in Spain. This study evaluates the efficacy of COMPAS program compared with a Spanish-culture adapted version of ¡Cuídate! (Take Care of Yourself), an evidence-based HIV prevention curriculum designed for Latino adolescents in the US. This cluster randomized controlled trial involved 1,563 adolescents attending 18 public high schools located in 5 provinces of Spain. The schools invited to participate were enrolled and randomly assigned to the three experimental conditions: COMPAS, ¡Cuídate!, and control group (CG; no intervention). Generalized estimating equation analyses revealed that both interventions improved attitudes toward people living with human immunodeficiency syndrome (HIV)/AIDS and the HIV test and increased HIV/sexually transmitted infection knowledge and intention to engage in safer sex behaviors compared with the CG. Although only COMPAS increased participants' sexual risk perception and attitude toward condom use compared with the CG, the two interventions did not significantly differ on any outcome. When compared with an established program, COMPAS was at least as effective at increasing the intention to engage in safer sex behaviors as the evidence-based intervention. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa.

PubMed

Njuguna, Christine; Swart, Annoesjka; Blockman, Marc; Maartens, Gary; Chisholm, Briony; Stewart, Annemie; Uys, Anri; Cohen, Karen

2016-01-01

Gynaecomastia is associated with exposure to antiretroviral therapy (ART), in particular efavirenz. There is limited data on clinical characteristics of patients with ART-associated gynaecomastia in resource-limited settings and little guidance on the optimal management of this adverse drug reaction (ADR). We describe the clinical characteristics, management and outcomes of gynaecomastia cases reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa. We identified all gynaecomastia cases in adolescent boys and men on ART reported to the hotline between June 2013 and July 2014. We collected follow up data telephonically at monthly intervals to document clinical management and outcomes. We received 51 reports of gynaecomastia between June 2013 and July 2014; 11% of the 475 patient-specific ADR queries to the hotline. All patients were on efavirenz-based ART. Mean age was 34 years (standard deviation 12) and seven were adolescents. The median onset of gynaecomastia was 15 months after efavirenz initiation (interquartile range 6-42). Gynaecomastia was bilateral in 29 patients (57%) and unilateral in 16 (31%). Serum testosterone was quantified in 25 of 35 patients with follow up data, and was low in 2 (8%). Efavirenz was replaced with an alternative antiretroviral in 29/35 patients (83%) and gynaecomastia improved in 20/29 (69%). Gynaecomastia was a frequently reported ADR in our setting, occurring with prolonged efavirenz exposure. Testosterone was low in the minority of tested cases. Most clinicians elected to switch patients off efavirenz, and gynaecomastia improved in the majority.

Sexual health issues in adolescents and young adults.

PubMed

Forsyth, Sophie; Rogstad, Karen

2015-10-01

Adolescence is a time of sexual risk-taking and experimentation but also vulnerability. Young people may present to general physicians with systemic symptoms of sexually transmitted infections (STIs), such as arthritis, hepatitis or rash, but may not necessarily volunteer information about sexual activity. It is important for physicians to ask directly about sexual risks and if appropriate test for STIs and pregnancy. Knowing how to take a sexual history and consent a patient for an HIV test are core medical skills that all physicians should be trained to competently perform. Safeguarding young people is the responsibility of all healthcare professionals who come into contact with them, and young victims of abuse may present with physical symptoms such as abdominal pain or deliberate self-harm. We must all be aware of indicators of both child sexual exploitation and HIV infection and not be afraid to ask potentially awkward questions. If we don't we may miss vital opportunities to prevent or minimise harm to young people. © Royal College of Physicians 2015. All rights reserved.

Qualitative Evaluation of the Relevance and Acceptability of a Web-Based HIV Prevention Game for Rural Adolescents

PubMed Central

Enah, Comfort; Piper, Kendra; Moneyham, Linda

2017-01-01

African Americans in the rural Southern United States continue to experience disproportionate increases in new HIV/AIDS infections. Electronic gaming interventions hold promise but the use of HIV prevention games is limited. The purpose of this study was to assess the acceptability and relevance of a web-based HIV prevention game for African American rural adolescents. Findings from focus groups conducted with 42 participants suggested that the game was educational and somewhat entertaining but lacking in real-life scenarios and player-control. Findings are congruent with self-efficacy literature and constructivist approaches to learning. Findings have implications for gaming intervention development and further research. PMID:25245160

The "Healthy Teen Girls Project": Comparison of Health Education and STD Risk Reduction Intervention for Incarcerated Adolescent Females

ERIC Educational Resources Information Center

Robertson, Angela R.; St. Lawrence, Janet; Morse, David T.; Baird-Thomas, Connie; Liew, Hui; Gresham, Kathleen

2011-01-01

Adolescent girls incarcerated in a state reformatory (N = 246) were recruited and assigned to an 18-session health education program or a time-equivalent HIV prevention program. Cohorts were assigned to conditions using a randomized block design separated by a washout period to reduce contamination. Post intervention, girls in the HIV risk…

Standing between Two Worlds in Harlem: A Developmental Psychopathology Perspective of Perinatally Acquired Human Immunodeficiency Virus and Adolescence

ERIC Educational Resources Information Center

Kang, Ezer; Mellins, Claude Ann; Ng, Warren Yiu Kee; Robinson, Lisa-Gaye; Abrams, Elaine J.

2008-01-01

Perinatal HIV infection in the US continues to evolve from a fatal pediatric illness to a chronic medical condition of childhood and adolescence. Although navigating this period is influenced by multi-leveled deprivations commonly experienced by low-income minority families, HIV alters the timing and experience of developmental milestones for many…

The Concerns of School Counselors-in-Training about Working with Children and Adolescents with HIV Disease: Training Implications.

ERIC Educational Resources Information Center

Carney, Jamie S.; Cobia, Debra C.

2003-01-01

Study assessed the knowledge, beliefs, and social comfort of school counselors-in-training, as related to working with children and adolescents who have or are affected by HIV, and these students' concerns and perceptions about their preparedness. Participants reported high levels of general knowledge and positive beliefs; however, they also…

Understanding Cultural Influence on Health Behaviors of Latino Adolescent Parents. Latino Policy & Issues Brief. Number 12

ERIC Educational Resources Information Center

Gonzalez-Figueroa, Evelyn; Koniak-Griffin, Deborah

2006-01-01

Overall, Latino immigrants may be at greater risk for HIV due to lack of information, health services, and culturally relevant resources. Unfortunately, low levels of acculturation and traditional values combined with high levels of poverty and unemployment can negatively influence the risk for HIV. Non-US-born adolescents and those born to…

HIV/AIDS Knowledge and Health-Related Attitudes and Behaviors among Deaf and Hearing Adolescents in Southern Brazil

ERIC Educational Resources Information Center

Bisol, Claudia Alquati; Sperb, Tania Mara; Brewer, Toye H.; Kato, Sergio Kakuta; Shor-Posner, Gail

2008-01-01

HIV/AIDS knowledge and health-related attitudes and behaviors among deaf and hearing adolescents in southern Brazil are described. Forty-two deaf students attending a special nonresidential public school for the deaf and 50 hearing students attending a regular public school, ages 15-21 years, answered a computer-assisted questionnaire. (There was…

"You Can Exercise Your Way out of HIV" and Other Stories: The Role of Biological Knowledge in Adolescents' Evaluation of Myths

ERIC Educational Resources Information Center

Keselman, Alla; Kaufman, David R.; Patel, Vimla L.

2004-01-01

A primary objective for science education is to impart robust knowledge that has applicability to real-world problems. This article presents research investigating the relationship between adolescents' conceptual understanding of the biological basis of HIV and critical reasoning. Middle and high school students were interviewed about their…

HIV Risk Behavior among Youth in the Dominican Republic: The Role of Alcohol and Other Drugs

PubMed Central

Guilamo-Ramos, Vincent; Jaccard, James; Lushin, Vincent; Martinez, Roberto; Gonzalez, Bernardo; McCarthy, Katharine

2012-01-01

Existing literature related to HIV in the Dominican Republic has tended to neglect the unique role of tourism areas as distinct ecologies facilitative of sexual risk behavior, particularly HIV vulnerability and transmission. Furthermore, limited attention has focused on Dominican adolescents living in close proximity to tourism areas who have become increasingly exposed to alcohol due to the expanding tourism industry in the Dominican Republic. While most previous analyses of the effects of alcohol on adolescent sexual risk behavior have focused on the transient effects of alcohol on judgment and decision making, the effects of chronic alcohol use on sexual behavior has been a neglected area of research. Our study explores the relationship between chronic alcohol use, the parent–adolescent relationship, affective factors such as self-esteem, and intentions to engage in sex. We examine the above factors within the context of tourism areas which represent a unique ecology of alcohol availability and consumption and HIV risk. We discuss implications for developing applied family-based programs to target Dominican adolescent alcohol use and sexual risk behavior in tourism areas of high alcohol exposure. PMID:21911848

HIV infection in male adolescents: a qualitative study.

PubMed

Taquette, Stella Regina; Rodrigues, Adriana de Oliveira; Bortolotti, Livia Rocha

2015-07-01

`The gradual reduction in the incidence of AIDS among men who have sex with men has not occurred in the youngest age group; on the contrary, it is growing. This paper examines the vulnerabilities of adolescent males at risk of HIV infection. This is a qualitative study conducted through interviews with HIV positive young men undergoing treatment, whose diagnosis was made during adolescence. The interviews were recorded and transcribed in full. They were analyzed by intensive reading, classified by issues, and interpreted from a hermeneutic-dialectic perspective in dialogue with the literature. We interviewed 16 young men whose diagnosis occurred between the ages of 11 and 19 and for all of them the method of HIV transmission was sexual; 12 of the men were homosexual and 4 were heterosexual. It was evident that vulnerable situations included disbelief in the possibility of contamination, subjection to sex, homophobia and commercial sexual exploitation. This study demonstrates the importance of the formulation of public policies on sexual and reproductive health, which include adolescents and young men. These policies should embody the perspective of masculinity in all its widest aspects, as well as actions in favor of sexual diversity.

Adolescent experiences of discrimination, harassment, connectedness to community and comfort with sexual orientation reported by adult men who have sex with men as a predictor of adult HIV status.

PubMed

Raymond, H Fisher; Chen, Yea-Hung; Stall, Ron D; McFarland, Willi

2011-04-01

Using data from a probability based sample of adult men who have sex with men (MSM) we examined the association of negative life factors during adolescence and adult HIV status. 521 MSM reported on experiences of connectedness to community, comfort with sexuality, harassment and discrimination due to their sexual orientation at ages 12-18 years. HIV status was determined by serological testing. Overall, men reported moderate levels of being harassed, being discriminated against and high levels of feeling disconnected from gay communities while reporting high levels of being uncomfortable with their sexuality at those ages. However, in analyses of scores on these factors, higher experiences of harassment, higher levels of discrimination and more discomfort with sexuality at these ages are associated with HIV-negative status as adults. This study suggests that the relationship between negative adolescent experiences among MSM and adult HIV infection may not be straightforward, but may also dependent upon aspects of the intensity of the negative experiences, the relationship of the victim and the perpertrator(s), the sexual identity of the victim at the time and/or the number of these experiences or the length of time over which they occurred. Studies investigating specific multiple stressors in adolescent gay development and their effect on adult health outcomes are needed.

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

PubMed Central

Bailey, Heather; Cruz, Maria Letícia Santos; Songtaweesin, Wipaporn Natalie; Puthanakit, Thanyawee

2017-01-01

Abstract Introduction: The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities. Methods: We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes. Results and discussion: The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed. Conclusions: Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions. PMID:28530040

Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa.

PubMed

Fatti, G; Shaikh, N; Eley, B; Jackson, D; Grimwood, A

2014-12-01

South Africa (SA) has the highest burden of childhood HIV infection globally, and has high rates of adolescent and youth pregnancy. To explore risks associated with pregnancy in young HIV-infected women, we compared mother-to-child transmission (MTCT) of HIV and maternal and infant health outcomes according to maternal age categories. A cohort of HIV-positive pregnant women and their infants were followed up at three sentinel surveillance facilities in the Nelson Mandela Bay Metropolitan (NMBM) district, Eastern Cape Province, SA. Young women were defined as 24 years old and adolescents as 19 years. The effect of younger maternal age categories on MTCT and maternal and child health outcomes was assessed using log-binomial and Cox regression controlling for confounding, using women aged > 24 years as the comparison group. Of 956 mothers, 312 (32.6%) were young women; of these, 65 (20.8%) were adolescents. The proportion of young pregnant women increased by 24% between 2009/10 and 2011/12 (from 28.3% to 35.1%). Young women had an increased risk of being unaware of their HIV status when booking (adjusted risk ratio (aRR) 1.37; 95% confidence interval (CI) 1.21 - 1.54), a reduced rate of antenatal antiretroviral therapy (ART) uptake (adjusted hazard ratio 0.46; 95% CI 0.31 - 0.67), reduced early infant HIV diagnosis (aRR 0.94; 95% CI 0.94 - 0.94), and increased MTCT (aRR 3.07; 95% CI 1.18 - 7.96; adjusted for ART use). Of all vertical transmissions, 56% occurred among young women. Additionally, adolescents had increased risks of first presentation during labour (aRR 3.78; 95% CI 1.06 - 13.4); maternal mortality (aRR 35.1; 95% CI 2.89 - 426) and stillbirth (aRR 3.33; 95% CI 1.53 - 7.25). An increasing proportion of pregnant HIV-positive women in NMBM were young, and they had increased MTCT and poorer maternal and infant outcomes than older women. Interventions targeting young women are increasingly needed to reduce pregnancy, HIV infection and MTCT and improve maternal and infant outcomes if SA is to attain its Millennium Development Goals.

Safe sext: adolescents' use of technology to communicate about sexual health with dating partners.

PubMed

Widman, Laura; Nesi, Jacqueline; Choukas-Bradley, Sophia; Prinstein, Mitchell J

2014-05-01

This study examined adolescents' technology-based sexual communication with dating partners, and evaluated associations between technology-based communication and condom use. Participants were 176 high school students who indicated their use of technology to communicate with partners about condoms, birth control, sexually transmitted infections (STIs), HIV/AIDS, pregnancy, and sexual limits. Sexually active youth also reported their frequency of condom use. Many adolescents (49%) used technology to discuss sexual health with partners, with rates varying by topic. Girls were more likely than boys to discuss HIV, pregnancy, and sexual limits. Ethnic minorities were more likely than whites to discuss condoms, STIs, HIV, pregnancy, and birth control. Importantly, rates of consistent condom use were three times higher among youth using technology to discuss condoms and birth control. Results provide novel preliminary evidence regarding adolescents' use of technology to discuss sexual health and demonstrate links between technology-based communication and condom use among sexually active youth. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Shout-It-Now: A Mobile HCT Model Employing Technology and Edutainment in South Africa.

PubMed

Daniels, Joseph; Komarek, Arnost; Forgreive, Bruce; Pahl, Kathryn; Stafford, Stephen; Bruns, Laurie Campbell; Coates, Thomas

Mobile HIV counseling and testing (HCT) has been effective in reaching men, women, and adolescents in South Africa. However, there is limited understanding of effective mobile HCT programs utilizing tools like technology and edutainment to increase HIV counseling and testing rates. The authors examine data from the Shout-It-Now (S-N) program that uses such tools in South Africa. The S-N program utilizes various forms of technology and ongoing telephonic counseling within a 6-step program of HIV testing and linkage-to-care support, and program data were analyzed over an 18-month period. Data were analyzed from women, men, and adolescent program participants. Summative statistics was conducted on participant registration, HIV risk assessment, and HIV testing profiles. HIV prevalence were estimated along with the related 95% confidence intervals using the Clopper-Pearson method. Over an 18-month period, there were 72 220 program participants with high representation of men, women, and adolescents and 40% of the participants being men at each site. There were 3343 participants who tested HIV positive, and a higher proportion of women tested positive. Integrating technology, quality assurance measures, and edutainment with mobile HCT has the potential to increase the number of those who test within communities. Research is needed to understand the effectiveness of this model in facilitating regular testing and linkage to care.

HIV-1 infection and pregnancy in young women in Brazil: socioeconomic and drug resistance profiles in a cross-sectional study.

PubMed

Lima, Yanna Andressa Ramos; Reis, Mônica Nogueira Guarda; Cardoso, Ludimila Paula Vaz; Stefani, Mariane Martins Araújo

2016-07-05

To describe socioeconomic and antiretroviral (ARV) drug resistance profiles among young pregnant women infected with HIV-1. A public health antenatal programme responsible for screening ∼90 000 pregnant women per year for nine different infectious diseases in Central Western Brazil. 96 young pregnant women (15-24 years) infected with HIV-1. Standard interviews and blood samples were taken at the time of recruitment, at the first medical appointment after confirmation of diagnosis of HIV-1 infection, and before ARV prophylaxis initiation. Clinical and laboratory data were retrieved from medical files. HIV-1 pol gene sequences (entire protease/PR, partial reverse transcriptase/RT) were obtained from plasma RNA. ARV resistance mutations (CPR/Stanford HIV-1; International AIDS Society-USA databases) were identified. The median age was 21 years; most reported <8 years education; 73% were recently diagnosed. Approximately 20% (19/96) presented late for antenatal care (after 26 gestational weeks), while 49% reported ≥2 previous pregnancies. Possible heterosexual transmission by an HIV-1 infected partner (17%) and commercial sex work (2%) were reported. The median of CD4 cell count was 526 cells/mm(3); the median viral load was: 10 056 copies/mL in ARV-naïve (48/96) patients and 5881 copies/mL in ARV-exposed (48/96) patients. Two probable seroconversion cases during pregnancy were identified in adolescents. One mother-to-child transmission case (1.0%) was observed. Transmitted drug resistance among ARV-naïve patients was 9.3% (CI 95% 3.3% to 19.6%); secondary drug resistance among ARV-exposed patients was 12.5% (CI 95% 4.7% to 25.6%). Despite high access to antenatal care, the low socioeconomic-educational profiles seen in these young HIV-1-infected women highlight the necessity of improved public health educational and preventive strategies regarding HIV infection and early unplanned pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Efficacy of an HIV/STI Sexual Risk-Reduction Intervention for African American Adolescent Girls in Juvenile Detention Centers: A Randomized Controlled Trial

PubMed Central

DiClemente, Ralph J.; Davis, Teaniese L.; Swartzendruber, Andrea; Fasula, Amy M.; Boyce, Lorin; Gelaude, Deborah; Gray, Simone C.; Hardin, James; Rose, Eve; Carry, Monique; Sales, Jessica M.; Brown, Jennifer L.; Staples-Horne, Michelle

2014-01-01

Background Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. Objective The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. Methods We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N=188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. Intervention The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment and counseling. Results At the 6-month assessment (3-months post-intervention) Imara participants reported higher condom use self-efficacy (p<0.001), HIV/STI knowledge (p<0.001), and condom use skills (p<0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Conclusions Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains. PMID:25190056

Are traditional body fat equations and anthropometry valid to estimate body fat in children and adolescents living with HIV?

PubMed

Lima, Luiz Rodrigo Augustemak de; Martins, Priscila Custódio; Junior, Carlos Alencar Souza Alves; Castro, João Antônio Chula de; Silva, Diego Augusto Santos; Petroski, Edio Luiz

The aim of this study was to assess the validity of traditional anthropometric equations and to develop predictive equations of total body and trunk fat for children and adolescents living with HIV based on anthropometric measurements. Forty-eight children and adolescents of both sexes (24 boys) aged 7-17 years, living in Santa Catarina, Brazil, participated in the study. Dual-energy X-ray absorptiometry was used as the reference method to evaluate total body and trunk fat. Height, body weight, circumferences and triceps, subscapular, abdominal and calf skinfolds were measured. The traditional equations of Lohman and Slaughter were used to estimate body fat. Multiple regression models were fitted to predict total body fat (Model 1) and trunk fat (Model 2) using a backward selection procedure. Model 1 had an R 2 =0.85 and a standard error of the estimate of 1.43. Model 2 had an R 2 =0.80 and standard error of the estimate=0.49. The traditional equations of Lohman and Slaughter showed poor performance in estimating body fat in children and adolescents living with HIV. The prediction models using anthropometry provided reliable estimates and can be used by clinicians and healthcare professionals to monitor total body and trunk fat in children and adolescents living with HIV. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

[Objective and subjective knowledge of HIV/AIDS as predictor of condom use in adolescents].

PubMed

Villaseñor-Sierra, Alberto; Caballero-Hoyos, Ramiro; Hidalgo-San Martín, Alfredo; Santos-Preciado, José Ignacio

2003-01-01

To evaluate the association between objective and subjective knowledge on HIV/AIDS and condom use. Analysis of a database from an anonymous, self-applied, randomized survey conducted between 1995 and 1996. Study subjects were 1,410 adolescents of four socioeconomic strata from Guadalajara, Mexico. Objective knowledge was assessed with 24 questions regarding HIV/AIDS, and subjective knowledge with the question "how much do you think you know about HIV/AIDS?" The variables associated with condom use were identified using logistic regression analysis and by calculating odds ratios with a 95% confidence interval. The degree of objective knowledge was "average", differentiated by socioeconomic strata (p < 0.001), and was higher in adolescents from medium and high socioeconomic strata (p < 0.008). Regarding subjective knowledge, adolescents from the low, medium, and high socioeconomic strata claimed to know "a little", and the ones from the lowest stratum claimed to know "very little". Condom use was higher in males (35.4%), and in adolescents from high socioeconomic strata (p < 0.005), than in females (15.3%) (p < 0.001). Although there was a correlation between objective and subjective knowledge (r = 0.37, p < 0.001), a higher degree of subjective knowledge was associated with condom use (p < 0.001). Subjective knowledge, belonging to medium and high socioeconomic strata and being male, were predictors of condom use.

AIDS and adolescents: why should we be concerned?

PubMed

1987-11-01

AIDS most often strikes people aged 20-40 years old. However, due to the long period of incubation from initial infection with HIV to the development of AIDS, many young adults with AIDS may have been infected with the virus while they were teenagers. Many adolescents could be unsuspecting carriers of the virus. It is normal for developing adolescents to experiment with their bodies and those of their peers. Inherent to this experimentation and growth is risk taking with sex and drugs. Sexual intercourse without condom use and IV drug use with non-sterile injecting equipment are risk factors for contracting and transmitting HIV. Without creating undue fear, teenagers must be taught how AIDS is spread, how it is not spread, and how they can protect themselves from HIV. They need to understand that certain behaviors are risky, not belonging to a certain population subgroup. This article describes efforts underway in Finland, Mexico, Chile, the US, and Thailand to teach adolescents about AIDS. At the start of Finland's AIDS education campaign in early January 1987, the use of a condom was demonstrated on national television news. The country's National Board of Health also distributed a booklet on AIDS and a sample condom to all 16-21 year olds in Finland. Teens themselves can also be effective AIDS educators. Efforts to teach adolescents about HIV/AIDS and promote behavior change should be the product of comprehensive community involvement.

Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial.

PubMed

DiClemente, Ralph J; Davis, Teaniese L; Swartzendruber, Andrea; Fasula, Amy M; Boyce, Lorin; Gelaude, Deborah; Gray, Simone C; Hardin, James; Rose, Eve; Carry, Monique; Sales, Jessica M; Brown, Jennifer L; Staples-Horne, Michelle

2014-01-01

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

Psychological and behavioral interventions to reduce HIV risk: evidence from a randomized control trial among orphaned and vulnerable adolescents in South Africa

PubMed Central

Thurman, T. R.; Kidman, R.; Carton, T. W.; Chiroro, P.

2016-01-01

ABSTRACT Evidence-based approaches are needed to address the high levels of sexual risk behavior and associated HIV infection among orphaned and vulnerable adolescents. This study recruited adolescents from a support program for HIV-affected families and randomly assigned them by cluster to receive one of the following: (1) a structured group-based behavioral health intervention; (2) interpersonal psychotherapy group sessions; (3) both interventions; or (4) no new interventions. With 95% retention, 1014 adolescents were interviewed three times over a 22-month period. Intent-to-treat analyses, applying multivariate difference-in-difference probit regressions, were performed separately for boys and girls to assess intervention impacts on sexual risk behaviors. Exposure to a single intervention did not impact behaviors. Exposure to both interventions was associated with risk-reduction behaviors, but the outcomes varied by gender: boys reported fewer risky sexual partnerships (β = −.48, p = .05) and girls reported more consistent condom (β = 1.37, p = .02). There was no difference in the likelihood of sexual debut for either gender. Providing both psychological and behavioral interventions resulted in long-term changes in sexual behavior that were not present when either intervention was provided in isolation. Multifaceted approaches for reducing sexual risk behaviors among vulnerable adolescents hold significant promise for mitigating the HIV epidemic among this priority population. PMID:26886261

Career readiness and externalizing behaviors of children affected by maternal HIV/AIDS: 15-year outcomes of the PACT study.

PubMed

Murphy, Debra A; Marelich, William D; Herbeck, Diane M; Cook, Mekeila

2016-01-01

The purpose of this 15-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent career readiness and externalizing behaviors. Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning and depression) and child/adolescent outcomes (e.g., career readiness, conduct disorder, drug use, sexual behaviors, parent attachment and youth autonomy) were assessed over 20 time-points. Individual growth and GEE logistic regression models showed lower variability in maternal viral load was positively associated with better career readiness and parent attachment among adolescent/young adults. Externalizing behaviors (conduct disorder, alcohol and crystal methamphetamine use) were positively associated with maternal depression. Adolescent coping efficacy was shown to be a protective factor when applied to models on career readiness. Stability in MLH health positively affects children's career readiness over time, particularly career planning and career choices. The finding that adolescent coping efficacy may act as a protective factor against poor career planning has important implications for developing interventions to assist children in coping with parental HIV.

Career readiness and externalizing behaviors of children affected by maternal HIV/AIDS: 15-year outcomes of the PACT study

PubMed Central

Murphy, Debra A.; Marelich, William D.; Herbeck, Diane M.; Cook, Mekeila

2017-01-01

The purpose of this 15-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent career readiness and externalizing behaviors. Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning and depression) and child/adolescent outcomes (e.g., career readiness, conduct disorder, drug use, sexual behaviors, parent attachment and youth autonomy) were assessed over 20 time-points. Individual growth and GEE logistic regression models showed lower variability in maternal viral load was positively associated with better career readiness and parent attachment among adolescent/young adults. Externalizing behaviors (conduct disorder, alcohol and crystal methamphetamine use) were positively associated with maternal depression. Adolescent coping efficacy was shown to be a protective factor when applied to models on career readiness. Stability in MLH health positively affects children’s career readiness over time, particularly career planning and career choices. The finding that adolescent coping efficacy may act as a protective factor against poor career planning has important implications for developing interventions to assist children in coping with parental HIV. PMID:28983322

Psychiatric diagnosis and antiretroviral adherence among adolescent Medicaid beneficiaries diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome.

PubMed

Walkup, James; Akincigil, Ayse; Bilder, Scott; Rosato, Nancy Scotto; Crystal, Stephen

2009-05-01

Research on adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has suggested that psychiatric and substance abuse comorbidities are prevalent in this population, and that these may sometimes be associated with use of antiretroviral therapy (ART) and adherence. For adolescents with HIV/AIDS, much less is known about patterns of mental health comorbidity, and even fewer data are available that compare them to socioeconomically comparable youth without HIV/AIDS. Using medical and pharmacy data from 1999 to 2000 Medicaid claims (Medicaid Analytic Extract) from 4 states for beneficiaries aged 12 to 17 years, we identified 833 youth under care for HIV/AIDS meeting study criteria within the HIV/AIDS group, receipt of ART was less likely for youth who had diagnoses of substance abuse, conduct disorders, or emotional disorders than for others. Once ART was initiated, adherence did not significantly differ between adolescents living with a psychiatric condition, and those who were not, with the exception of an association between conduct disorder and lower adherence. Among those with HIV/AIDS, ART use and adherence were more common among youth with higher rates of service use, regardless of psychiatric status. Associations between race and adherence varied by gender: compared with their white counterparts, minority girls had lower, and minority boys had higher adherence.

Knowledge, attitudes and sexual practices of adolescents with mild retardation, in relation HIV/AIDS.

PubMed

Dawood, Naseema; Bhagwanjee, Anil; Govender, Kay; Chohan, Ebrahim

2006-05-01

This study investigates the knowledge, attitudes and sexual practices of adolescents with mild mental retardation (MMR) in relation to HIV/AIDS. Questionnaires were personally administered to a saturation sample of 90 adolescents with MMR drawn from one specialised educational institution in Durban, South Africa. The study revealed critical gaps and erroneous beliefs regarding knowledge of HIV/AIDS, especially with regard to its existence, transmission and cure. Participants indicated a high degree of exposure to various sources of information, particularly media messages. The results indicate that gender-role prescriptions and prevailing social constructions of immorality have had a negative influence on the attitudes and behaviour of participants, particularly with regard to sexual practices and preventative risk behaviours. Furthermore, the sample was found to have low levels of self-efficacy in relation to sexual negotiation and decision-making, more specifically with regard to condom use. It should be noted, however, that only a small proportion of the sample was sexually active and the use of contraceptives was accordingly found to be extremely low. The findings are discussed against the backdrop of the empirical literature on HIV/AIDS, developmental theory, and pertinent theories and models of health behaviour. This study may help to promote a better understanding of the psycho-educational dynamics of HIV infection in this special group of adolescents, and also help to inform attempts to tailor suitable educational programmes, as well as promote further research to add to our knowledge as we address the problems of HIV/AIDS among this group.

HIV-Associated Cognitive Impairment in Perinatally Infected Children: A Meta-analysis.

PubMed

Phillips, Nicole; Amos, Taryn; Kuo, Caroline; Hoare, Jacqueline; Ipser, Jonathan; Thomas, Kevin G F; Stein, Dan J

2016-11-01

Research shows, conclusively, that perinatal HIV infection has negative effects on cognitive functioning of children and adolescents. However, the extent of these cognitive impairments is unknown. Current literature does not document specific cognitive domains most affected in HIV-infected children and adolescents. To systematically review and meta-analyze the degree of cognitive impairment, and the specific cognitive domains affected, in children and adolescents with perinatally acquired HIV infection. We systematically searched 5 electronic bibliographic databases, namely: PubMed, PsychINFO, Academic Search Premier, Scopus, and WorldCat, by using a search protocol specifically designed for this study. Studies were selected on the basis of set a priori eligibility criteria. Titles, abstracts, and full texts were assessed by 2 independent reviewers. Data from included studies were extracted into Microsoft Excel by 2 independent reviewers. Twenty-two studies were identified for inclusion in the systematic review and of this, 6 studies were included in the meta-analysis. Results from the meta-analysis indicated that working memory and executive function were the domains most affected by the HIV virus. Only 27% of the included studies were suitable to enter into the meta-analysis. There was significant geographic bias in published studies, with only 32% (7/22) of included studies from sub-Saharan Africa. The evidence supports an association between HIV infection in children and adolescents and cognitive impairment in the domains of working memory, executive function and processing speed, with effect size estimates also providing some support for deficits in visual memory and visual-spatial ability. Copyright © 2016 by the American Academy of Pediatrics.

Impact of self esteem on risky sexual behaviors among Nigerian adolescents.

PubMed

Enejoh, Victor; Pharr, Jennifer; Mavegam, Bertille Octavie; Olutola, Ayodotun; Karick, Haruna; Ezeanolue, Echezona E

2016-01-01

Although improved knowledge is often the first approach in HIV prevention for adolescents, studies have shown that despite being well informed, adolescents still engage in risky sexual behavior (RSB). Low self-esteem has been considered to be a psychological explanation for behavioral problems, but little is known about the impact of self-esteem on RSB among adolescents in Nigeria. The purpose of this study was to determine whether adolescents with high self-esteem demonstrate lower RSB compared to those with low self-esteem. We conducted a cross-sectional survey of 361 adolescents in 9 secondary schools in Jos Plateau, Nigeria. The Rosenberg Self Esteem Scale was used to measure self-esteem and the Brief HIV Screener (BHS) was used to measure RSB. All data were analyzed using SPSS 21. Chi square and odds ratios were calculated to determine differences in BHS questions based on predetermined low or high self-esteem categories. Independent t-test were utilized to determine difference in mean BHS scores based on self-esteem categories. Participants were 169 male (46.8%) and 192 female (53.2%) with a mean age of 16.9. Mean self-esteem score was 27.6 with no significant difference in self-esteem scores by gender. Adolescents with low self-esteem were 1.7 times more likely to be sexually active and had a higher mean BHS scores compared to adolescents with high self-esteem. Programs aimed at reducing RSB and in-turn HIV/AIDS should consider interventions to raise adolescents' self-esteem.

Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics

PubMed Central

Decker, Michele R.; Miller, Elizabeth; McCauley, Heather L.; Tancredi, Daniel J.; Anderson, Heather; Levenson, Rebecca R.; Silverman, Jay G.

2014-01-01

Background/Objectives Adolescent and young adult women are at high risk for both STI/HIV and intimate partner violence (IPV). We evaluate the prevalence of IPV in the past three months and its associations with STI/HIV risk, STI, and related care-seeking over the same time period. Methods Female family planning clinic patients ages 16–29 (n=3,504) participated in a cross-sectional survey in 2011–2012 as a baseline assessment for an intervention study. We examined associations of recent IPV with sexual and drug-related STI/HIV risk behavior, self-reported STI, and STI-related clinical care seeking via logistic regression. Results Recent physical or sexual IPV (prevalence 11%) was associated with recent sexual and drug-related STI/HIV risk, specifically unprotected vaginal sex (AOR 1.93, 95% CI 1.52, 2.44), unprotected anal sex (AOR 2.22, 95% CI 1.51, 3.27) and injection drug use, both their own (AOR 3.39, 95% CI 1.47, 7.79) and their partner’s (AOR 3.85, 1.91, 7.75). IPV was also linked with coercive sexual risk: involuntary condom non-use (AOR 1.87, 95% CI 1.51, 2.33), and fears of requesting condoms (AOR 4.15, 95% CI 2.73, 6.30) and refusing sex (AOR 11.84, 95% CI 7.59, 18.45). STI-related care-seeking was also more common among those abused (AOR 2.49, 95% CI 1.87, 3.31). Conclusions Recent IPV is concurrent with sexual and drug-related STI/HIV risk, including coercive sexual risk, thus compromising women’s agency in STI/HIV risk reduction. Clinical risk assessments should broaden to include unprotected heterosexual anal sex, coercive sexual risk, and IPV, and should promote safety and harm reduction. PMID:24234072

Adolescent Self-Consent for Biomedical Human Immunodeficiency Virus Prevention Research.

PubMed

Gilbert, Amy Lewis; Knopf, Amelia S; Fortenberry, J Dennis; Hosek, Sybil G; Kapogiannis, Bill G; Zimet, Gregory D

2015-07-01

The Adolescent Medicine Trials Network Protocol 113 (ATN113) is an open-label, multisite demonstration project and Phase II safety study of human immunodeficiency virus (HIV) preexposure prophylaxis with 15- to 17-year-old young men who have sex with men that requires adolescent consent for participation. The purpose of this study was to examine factors related to the process by which Institutional Review Boards (IRBs) and researchers made decisions regarding whether to approve and implement ATN113 so as to inform future biomedical HIV prevention research with high-risk adolescent populations. Participants included 17 researchers at 13 sites in 12 states considering ATN113 implementation. Qualitative descriptive methods were used. Data sources included interviews and documents generated during the initiation process. A common process for initiating ATN113 emerged, and informants described how they identified and addressed practical, ethical, and legal challenges that arose. Informants described the process as responding to the protocol, preparing for IRB submission, abstaining from or proceeding with submission, responding to IRB concerns, and reacting to the outcomes. A complex array of factors impacting approval and implementation were identified, and ATN113 was ultimately implemented in seven of 13 sites. Informants also reflected on lessons learned that may help inform future biomedical HIV prevention research with high-risk adolescent populations. The results illustrate factors for consideration in determining whether to implement such trials, demonstrate that such protocols have the potential to be approved, and highlight a need for clearer standards regarding biomedical HIV prevention research with high-risk adolescent populations. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Increasing Parent Involvement in Youth HIV Prevention: A Randomized Caribbean Study

ERIC Educational Resources Information Center

Baptiste, Donna R.; Kapungu, Chisina; Miller, Steve; Crown, Laurel; Henry, David; Da Costa Martinez, Dona; Jo-Bennett, Karen

2009-01-01

This article presents preliminary findings of a randomized HIV prevention study in Trinidad and Tobago in the Caribbean. The study centers on a family HIV workshop aimed at strengthening parenting skills that are empirically linked to reducing adolescent HIV exposure and other sexual risks. These skills include parental monitoring; educating youth…

HIV/AIDS Education Program Grades 6-12.

ERIC Educational Resources Information Center

Arizona State Dept. of Education, Phoenix.

The five chapters in this manual outline a Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) education program for grades 6-12. The first chapter asks why HIV education should be taught in the primary grades, discusses who should teach HIV/AIDS education, and presents facts about adolescents and AIDS. Chapter 2 furnishes:…

The stuff that dreams are made of: HIV-positive adolescents' aspirations for development.

PubMed

Hodes, Rebecca; Doubt, Jenny; Toska, Elona; Vale, Beth; Zungu, Nompumelelo; Cluver, Lucie

2018-02-01

The Sustainable Development Goals (SDGs) commit to strengthening collaborations between governments and civil society. Adolescents are among the key target populations for global development initiatives, but research studies and programmes rarely include their direct perspectives on how to promote health and wellbeing. This article explores how both the methods and the findings of participatory research provide insights into adolescents' aspirations across the domains of health and social development. It investigates how adolescents conceive of health and social services as interconnected, and how this reflects the multisectoral objectives of the SDGs. This research was conducted within a longitudinal, mixed-methods study of HIV-positive adolescents (n = 80 qualitative participants, n = 1060 quantitative interviews). Between November 2013 and February 2014, a participatory exercise - the "dream clinic" - was piloted with 25 adolescents in South Africa's Eastern Cape. Key themes were identified based on the insights shared by participants, and through visual and thematic analysis. These findings were explored through a second participatory exercise, "Yummy or crummy? You are the Mzantsi Wakho masterchef !," conducted in January 2016. Findings are described in relation to emerging quantitative results. Mixed methods explored associations between access to food, medicines, clean water and sanitation in HIV-positive adolescents' aspirations for development. The exercises produced practicable recommendations for innovations in development, based on associations between healthcare, food security, clean water and sanitation, while illustrating the value of partnership and collaboration (the objective of SDG17). Findings capture strong interlinkages between SDGs 2, 3 and 6 - confirming the importance of specific SDGs for HIV-positive adolescents. Study results informed the objectives of South Africa's National and Adolescent and Youth Health Policy (2017). Participatory research may be used to leverage the perspectives and experiences of adolescents. The methods described here provide potential for co-design and implementation of developmental initiatives to fulfil the ambitious mandate of the SDGs. They may also create new opportunities to strengthen the engagement of adolescents in policy and programming. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Adolescent Inpatient Behavioral Health Clients: Risk Factors and Methods of Preventing an Increase in HIV Infection among Youth.

ERIC Educational Resources Information Center

Hackerman, Ann E.

2002-01-01

There has been a surge in the rates of adolescents who are becoming infected with HIV. This study of 214 at risk clients being treated on an inpatient psychiatric hospitalization basis examines why such clients continue to engage in high-risk behaviors. Results and suggestions for a psychoeducational curriculum for professionals are included.…

Sexual Sensation Seeking, Social Stress, and Coping Styles as Predictors of HIV/STD Risk Behaviors in Adolescents

ERIC Educational Resources Information Center

Teva, Inmaculada; Bermudez, Maria Paz; Buela-Casal, Gualberto

2010-01-01

The aim of this study was to assess whether coping styles, social stress, and sexual sensation seeking were predictors of HIV/STD risk behaviours in adolescents. A representative sample of 4,456 female and male Spanish high school students aged 13 to 18 years participated. A stratified random sampling procedure was used. Self-report questionnaires…

Attitudes toward Sexuality and Sexual Behaviors of Asian-American Adolescents. Implications for Risk of HIV Infection. An Occasional Paper.

ERIC Educational Resources Information Center

Chan, Connie S.

There has been a widespread perception that Asian Americans are at lower risk for HIV infection and other sexually transmitted diseases than the population as a whole. This report assesses the knowledge of Asian American adolescents about AIDS and their sexual behaviors and explores whether there is a difference between a Cambodian group (half the…

Intervening on Conflict, Parental Bonds, and Sexual Risk Acts among Adolescent Children of Mothers Living with HIV

PubMed Central

Rotheram-Borus, Mary Jane; Stein, Judith A.; Rice, Eric

2014-01-01

Objective In 1993–1994, a psychosocial intervention conducted in New York City significantly improved outcomes for parents living with HIV and their adolescent children over six years. We examine if the intervention benefits are similar for adolescents of mothers living with HIV (MLH) in 2004–2005 in Los Angeles when MLH’s survival had increased substantially. Methods Adolescents of MLH in Los Angeles (N = 256) aged 12–20 years old were randomized with their MLH to either: 1) a standard care condition (n = 120 adolescent-MLH dyads); or 2) an intervention condition consisting of small group activities to build coping skills (n = 136 adolescent-MLH dyads, 78% attended the intervention). At 18 months, 94.7% of adolescents were reassessed. Longitudinal structural equation modeling examined if intervention participation impacted adolescents’ relationships with parents and their sexual risk behaviors. Results Compared to the standard care, adolescents in the intervention condition reported significantly more positive family bonds 18 months later. Greater participation by MLH predicted fewer family conflicts, and was indirectly associated with less adolescent sexual risk behavior at the 18 month follow-up assessment. Anticipated developmental patterns were observed - sexual risk acts increased with age. Reports were also consistent with anticipated gender roles; girls reported better bonds with their mothers at 18 months, compared to boys. Conclusions Adolescents of MLH have better bonds with their mothers as a function of participating in a coping skills intervention and reduced sexual risk-taking as a function of MLH intervention involvement. PMID:25010119

Vulnerability and risk factors for sexually transmitted infections and HIV among adolescents in Kampala, Uganda.

PubMed

Råssjö, E-B; Mirembe, F M; Darj, E

2006-10-01

Three hundred and six sexually experienced adolescents participated in a study on sexually transmitted infection (STI) prevalence and associated risk factors. The prevalence of Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and syphilis was 4.5%, 9%, 8% and 4% for females and 4.7%, 5.7%, 0% and 2.8% for males. HIV-seropositivity was found in 15.2% of females and 5.8% of males. Structured face-to-face interviews were used to obtain information about social background, sexual experience and genital symptoms. Four focus-group discussions were used in order to validate the interview data. Females were more likely to be infected by the four treatable STIs and HIV, despite risky behavior being more common among males. Unemployment, little formal education, the presence of bacterial STIs and post-coital bleeding or a bad smell from the vagina was highly associated with the risk for HIV in females. The higher prevalence of STIs, including HIV, among adolescent girls cannot be explained by sexual behavior only, as boys reported more risk behavior and were still less affected by STIs. Biological and social factors are definitely of importance.

Partner violence, power, and gender differences in South African adolescents' HIV/sexually transmitted infections risk behaviors.

PubMed

Teitelman, Anne M; Jemmott, John B; Bellamy, Scarlett L; Icard, Larry D; O'Leary, Ann; Heeren, G Anita; Ngwane, Zolani; Ratcliffe, Sarah J

2016-07-01

Low relationship power and victimization by intimate partner violence (IPV) have been linked to HIV risks among adult and adolescent women. This article examines associations of IPV and relationship power with sexual-risk behaviors and whether the associations differ by gender among South African adolescents. Sexual-risk behaviors (multiple partners in past 3 months; condom use at last sex), IPV, and relationship power were collected from 786 sexually experienced adolescents (mean age = 16.9) in Eastern Cape Province, South Africa, during the 54-month follow-up of a HIV/sexually transmitted infection (STI) risk-reduction intervention trial. The data were analyzed with logistic regression models. Adolescent boys were less likely to report condom use at last sex (p = .001) and more likely to report multiple partners (p < .001). A Gender × IPV interaction (p = .002) revealed that as IPV victimization increased, self-reported condom use at last sex decreased among girls, but increased among boys. A Gender × Relationship Power interaction (p = .004) indicated that as relationship power increased, self-reported condom use at last sex increased among girls, but decreased among boys. A Gender × IPV interaction (p = .004) indicated that as IPV victimization increased, self-reports of having multiple partners increased among boys, but not among girls. As relationship power increased, self-reports of having multiple partners decreased irrespective of gender. HIV risk-reduction interventions and policies should address gender differences in sexual-risk consequences of IPV and relationship power among adolescents and promote gender equity. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.

PubMed

Maturo, Donna; Powell, Alexis; Major-Wilson, Hannah; Sanchez, Kenia; De Santis, Joseph P; Friedman, Lawrence B

2015-01-01

Advances in care and treatment of adolescents/young adults with HIV infection have made survival into adulthood possible, requiring transition to adult care. Researchers have documented that the transition process is challenging for adolescents/young adults. To ensure successful transition, a formal transition protocol is needed. Despite existing research, little quantitative evaluation of the transition process has been conducted. The purpose of the study was to pilot test the "Movin' Out" Transitioning Protocol, a formalized protocol developed to assist transition to adult care. A retrospective medical/nursing record review was conducted with 38 clients enrolled in the "Movin' Out" Transitioning Protocol at a university-based adolescent medicine clinic providing care to adolescents/young adults with HIV infection. Almost half of the participants were able to successfully transition to adult care. Reasons for failure to transition included relocation, attrition, lost to follow-up, and transfer to another adult service. Failure to transition to adult care was not related to adherence issues, X(2) (1, N=38)=2.49, p=.288; substance use, X(2) (1, N=38)=1.71, p=.474; mental health issues, X(2) (1, N=38)=2.23, p=.322; or pregnancy/childrearing, X(2) (1, N=38)=0.00, p=.627). Despite the small sample size, the "Movin' Out" Transitioning Protocol appears to be useful in guiding the transition process of adolescents/young adults with HIV infection to adult care. More research is needed with a larger sample to fully evaluate the "Movin' Out" Transitioning Protocol. Copyright © 2015 Elsevier Inc. All rights reserved.

Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV.

PubMed

Guilamo-Ramos, Vincent; Soletti, Asha Banu; Burnette, Denise; Sharma, Shilpi; Leavitt, Sarah; McCarthy, Katharine

2012-06-01

In this article, we examine parent-adolescent communication about sex among rural Indian youth and their parents. We conducted in-depth interviews (N = 40) with mothers, fathers, and adolescent boys and girls aged 14 to 18 years in a rural community in Maharashtra, India. In the context of key cultural factors, including gender-related norms, we explore issues of sexual health and critically assess widely held beliefs that Indian parents are unwilling or unable to discuss sex-related topics with their children. Our findings suggest that despite communication barriers, e.g., lack of knowledge and cultural proscriptions, Indian families are interested in and willing to communicate about sex-related topics. Future research should seek to determine the viability of family-based HIV prevention interventions for Indian adolescents.