Answering Questions

I have really been enjoying answering questions at Global Health Delivery Online and hearing from others working to try to take care of children in settings similar to ours in Kenya. Everyone seems to be wrestling with issues related to HIV-infected adolescents. How and when do we tell them that they have HIV? How do we support their adherence to their medicines? How can we best transition them into adulthood?



Here was one of the questions I tried to answer recently:

I think many people recognize the importance and the challenge of supporting adherence during adolescence. What are some other issues you have been addressing in this population, beyond disclosure? Do you think social media has a role to play?


My attempt at an answer...

Supporting adherence to HIV medicines during adolescence requires all of us to think creatively about what adolescents most need and how we can build flexible, age-appropriate, culturally appropriate clinical care systems around them. One of the issues that we have been addressing in the adolescent population is peer support. Our clinics have implemented peer support groups in various ways across our 25 clinical sites, and we have been learning about how to combine education, psychological and emotional support, training in life skills, and the opportunity to have fun and "feel normal." These groups can be a great place to address questions from "How do I keep my medicines a secret at boarding school?" to "How will I be able to get married?" We have found it useful to divide the groups into younger and older adolescents and try to incorporate a variety of programming for the groups. To meet adherence challenges, we are also working towards much more of a case management system, where adolescents would have specialized community health workers following them and their families, assessing their challenges with adherence, organizing a tailored case management for the adolescent, and serving as a liaison between the family and the clinic.

We have not used social media much with our adolescents, but I could imagine a helpful role for social media given adolescents' longing for peer support and connection and their strong interest in technology. I was actually thinking about this more recently after I shared with a few of the older adolescents a Huffington Post article written by two perinatally infected young women from the US and from Uganda. The adolescents in Kenya loved talking about that article and thinking about the connections they have with youth like this around the world. I think there are great possibilities there. We spent a peer group session talking about the quote: "We're both strong, young women. We were both born with HIV, and continue to live healthy lives with the virus -- but it does not define who we are." The Kenyan adolescents expressed how they wished they could talk with these two young women -- and I could imagine how social media can make things like that possible. Of course, we would need to think about privacy issues, confidentiality, stigma, and so on...


The best part about leading this discussion at GHD Online has been hearing about the interesting work that sites in places like Botswana and Uganda are doing -- and sharing our ideas for what works and what does not. A great opportunity for collaborative, community thinking about this really tough issue of how we can help our HIV-infected adolescents successfully transition into adulthood.

Posted at 10:17


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