Addressing the Needs of
HIV Infected Youth
IAS 2011 – Rome, Italy
Dr. Donna Futterman
Professor of Pediatrics, Albert Einstein College of Medicine
Director, Adolescent AIDS Program Bronx, NY
AdolescentAIDS.org
Understanding the Landscape
50%
New HIV infections worldwide among children and youth <24
920,000
15-24 y.o. infected annually: 2,500/day; 66% young women
Geographic Hotspots
- >80% HIV+ youth live in Sub-Saharan Africa
- Rapid increases in IDU infected youth in E. Europe & Asia
Concerning numbers
- HIV+ youth untested
- Perinatally-infected reaching adolescence
UNAIDS. 2010. Outlook Report.
UNAIDS. 2004. Report on the Global AIDS Epidemic 2004: 4th Global Report (UNAIDS/04.16E). Geneva, Switzerland: UNAIDS.
AdolescentAIDS.org
Perinatally Infected Youth
• PMTCT feasible but not fully implemented
– 2.5 million worldwide; 430K newly identified (2008)
– Most still unidentified (only 1/3 in care)
• Active testing programs for children needed
• More children will survive into adolescence
• Majority of HIV+ mothers are also youth
UNAIDS. 2010. Progress Report . http://www.who.int/hiv/topics/mtct/data/en/index3.html
AdolescentAIDS.org
Behaviorally Infected Youth
• Generalized epidemics:
– Sexual transmission (Africa)
– Prevalence not linked to differences in sexual
behavior
• Non-Generalized: Most-At-Risk Populations
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IDUs (Asia and Eastern Europe)
YMSM /TG (developed and developing countries)
Commercial and Transactional Sex
Youth in juvenile detention
AdolescentAIDS.org
HIV Testing/Case Finding
• Care prolongs life & reduces transmission
• Most HIV+ youth don’t know
– Majority not symptomatic
– Need routine and targeted testing
• Provider integrated in clinic sites
• Outreach-based (schools, communities, venues)
• Address consent and confidentiality with minors
• Test ALL youth: undisclosed sexual
activity/abuse and perinatally infected
AdolescentAIDS.org
Principles of Routine Testing
• TEST and Treat: Much work needed on testing
• Thousands of missed opportunities to diagnose
• Must be streamlined and integrated into
clinical care (PICT)
– Include health care workers, not just lay counselors
– Task-shifting for counselors in follow-up and support
• Empower & train providers to use existing skills
• Start services realistically: STI then FP visits
• Linkage to Care is active process
AdolescentAIDS.org
It’s Time for a
Paradigm Shift!
HIV testing has become such a huge obstacle that
many providers and patients prefer to sail around
it.
AdolescentAIDS.org
• Field-tested Implementation System
• Reduces pre-test counseling to 1-5 minutes
• Utilizes existing staff & data resources
• Adapts easily to local testing policies
• Proven to increase testing and case finding
• Scalable from facility to Provincial levels
AdolescentAIDS.org
Youth-friendly HIV care
• Providers who are knowledgeable, nonjudgmental
• Confidentiality and Consent
– See adolescents separately from parents
• Socioeconomic: poverty, work, school, housing
& transportation challenges
• Empowering youth to LIVE with HIV
– Coping/Mental Health
– HIV care
– Prevention
AdolescentAIDS.org
Coping/Mental Health
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Immediate response and support
Disclosure to perinatally infected
Disclosure to friends, partners, family
Mental health
Substance abuse
Support: peers, counselors and groups
AdolescentAIDS.org
Adolescent HIV Care
• Integrated care/one stop shop
• Cohort to single day for peer support
• Elements of care
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CD4 count
Well care for HIV+ : SRH, nutrition
Transitioning
ARVs/Adherence
AdolescentAIDS.org
Antiretroviral Therapy:
Youth Considerations
• Check pubertal development for dosing
• Address metabolic complications, body image
• Developmental issues key
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Denial of need for treatment
Concrete and present-oriented thinking
Adverse events may seem intolerable
Meds rebellion as a form of independence
• Mistrust providers yet trust misinformation
from peers
• Decreasing options for perinatally infected
AdolescentAIDS.org
Prevention with Positives
• Key element of HIV care and public health
– Importance of age-appropriate messaging
• Prevention messages
– Protect yourself/others from STIs and new HIV
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Condomize every time you have sex
Engage partners: testing/disclosure if safe
Fewer partners = less risk
Drugs and alcohol = greater risk (SEP)
Consider not having sex (other ways to express love)
Discuss safe pregnancy options (PMTCT)
AdolescentAIDS.org
AdolescentAIDS.org
Lessons From The Field
• New generation every 5 years
• Multiple realities: some youth feel invincible,
others fear HIV is inevitable
• Sex is complicated
• Vulnerable youth not well served
– Economic, racial, gender, & sexual orientation disparities
• Youth-friendly services must be scaled up
– Treatment and prevention outcomes better with
youth-targeted services
– Community outreach needed to engage youth
AdolescentAIDS.org
Acknowledgements
Stephen Stafford
Hannah Lane, MPHIL
Linda-Gail Bekker
Virginia de Azevedo
Adolescent AIDS Program
Children’s Hospital at Montefiore
718-882-0232
AdolescentAIDS.org
AdolescentAIDS.org