Reaching adolescents with the right kind of HIV and sexual health services

Pacifique, who was born HIV-positive, has finally found a safe space.

This was originally published on the ONE Blog on Dec. 4, 2014.

Pacifique is a 20-year-old student living in Bujumbura, Burundi, who found out he was born HIV-positive when he was 10 years old. He had been taking anti-retroviral medication for a year without knowing what it was for.

“My mum refused to disclose my status to me,” recalled Pacifique. “She told me I had a heart problem but that I would get better. I was frightened when I found out. I thought I would never get married. It hurt me to think I would never have children.”

Pacifique is hardly alone. There were an estimated 2.1 million adolescents living with HIV in 2012, with more than 80% of them living in sub-Saharan Africa. Many don’t know their HIV status. HIV is now the number one cause of adolescent mortality in Africa and the second biggest in the world (UNAIDS defines adolescents as ages 10-19). Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%.

Recent evidence suggests that many of these deaths are as a result of undiagnosed pediatric infections where testing and treatment has come too late. We still have an unacceptably low coverage of antiretroviral therapy (ART) where children living with HIV are one third less likely to receive ART compared to adults.

For those who do access treatment, they face many challenges not the least a lifetime of drug therapy; issues of disclosure to family, partners and friends; and managing their own treatment as they mature and transition to adult services as adolescents.  They also face a lack of tailored services that truly reflect the needs and preferences of young people and that provide quality information and commodities around sexuality, sexual health and HIV without stigma or judgment.

In Burundi, there are 2.9 million people between the ages of 10 and 24 (32% of the entire population), according to the World’s Youth 2013 Data Sheet. This interactive map on adolescents in sub-Saharan Africa, developed by Population Reference Bureau and UNFPA, shows that young people in Burundi are low in HIV testing, low in condom use during first sex and low in comprehensive knowledge of HIV/AIDS.

Pacifique wasn’t surprised to learn his status: He had already been bullied and beaten in school by classmates who suspected his status.

Eventually, he found a safe space frequented by other young people living with HIV in a project called Link Up supported by the International HIV/AIDS Alliance. The Link Up program, funded by the Dutch Ministry of Foreign Affairs, aims to improve the sexual and reproductive health of young people most affected by HIV and to promote the realization of young people’s sexual and reproductive rights. Link Up aims to reach more than 1 million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda.

In Burundi, the project is carried out by the Alliance Burundaise contre le SIDA through 15 implementing partners, including Réseau National des Jeunes Vivant avec le VIH/SIDA (RNJ+), a network of young people living with HIV. It focuses on young people living with HIV, young men who have sex with men and young women who sell sex.

“RNJ+ is my second family,” said Pacifique. “It’s where I can meet young people who share the same views, who have the same way of seeing the world. They’re the ones who support me.”

“I was very surprised when I first came to RNJ+. The people shined, so I thought it must only be me who is living with HIV. They asked me if I was HIV-positive but I was afraid to answer. They said ‘Why are you afraid to tell us even if all of us are living with HIV?’ After that, I became very open and felt I could share everything.”

RNJ+ gives a space to all young people who have had to either hide their HIV status or identity or face criminalization, discrimination and exclusion — this includes people living with HIV, young people who sell sex or lesbian, gay, bisexual, transgender or intersex young people who are not accepted by a conservative and religious society. The services offered by the RNJ+ center include:

•       HIV testing and pre- and post-test counseling (at the center and through a schools outreach service);
•       A telephone helpline;
•       Sexual and reproductive health advice and information;
•       Male and female condoms and lubricant; and
•       A space to socialize with peers.

The MTV Staying Alive Foundation has also learned the importance of talking to young people in a language they understand, giving young leaders their trust and the resources and training they need to prevent HIV among their peers. This approach has led to innovative modes of HIV prevention, from using sport to teach 12- to 14-year olds about HIV in Washington D.C. to using music and radio to broadcast safe sex messages to young people in Manipur, India.

Perhaps the Staying Alive Foundation’s most famous HIV prevention activity is Shuga, an African TV and radio series that tackles responsible sexual behavior and tolerance. The teen series, now in its third season, is syndicated free of charge to 88 channels (half of them in Africa) and has a global audience of 500 million, according to The Guardian.

Tailored and integrated youth-friendly HIV and sexual and reproductive health services for adolescents – especially adolescents living with HIV and those at most risk of HIV – must be prioritized by governments, donors, civil society and service providers if we are to bring about an end to AIDS.

Link Up has published this brief on key problems and priorities identified by Burundi young people in focus group discussions and community dialogues.