Addressing the needs of hiv infected youth ias 2011 rome italy
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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. Understanding the Landscape. 50%

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Addressing the Needs of HIV Infected Youth IAS 2011 – Rome, Italy

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Addressing the Needs of HIV Infected YouthIAS 2011 – Rome, Italy

Dr. Donna FuttermanProfessor of Pediatrics, Albert Einstein College of Medicine

Director, Adolescent AIDS Program Bronx, NY

Understanding the Landscape


New HIV infections worldwide among children and youth <24


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.

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 .

Behaviorally Infected Youth

  • Generalized epidemics:

    • Sexual transmission (Africa)

    • Prevalence not linked to differences in sexual behavior

  • Non-Generalized: Most-At-Risk Populations

    • IDUs (Asia and Eastern Europe)

    • YMSM /TG (developed and developing countries)

    • Commercial and Transactional Sex

    • Youth in juvenile detention

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

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

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.

  • 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

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

Coping/Mental Health

  • Immediate response and support

  • Disclosure to perinatally infected

  • Disclosure to friends, partners, family

  • Mental health

  • Substance abuse

  • Support: peers, counselors and groups

Adolescent HIV Care

  • Integrated care/one stop shop

  • Cohort to single day for peer support

  • Elements of care

    • CD4 count

    • Well care for HIV+ : SRH, nutrition

    • Transitioning

    • ARVs/Adherence

Antiretroviral Therapy:Youth Considerations

  • Check pubertal development for dosing

  • Address metabolic complications, body image

  • Developmental issues key

    • 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

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

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)

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


Stephen Stafford

Hannah Lane, MPHIL

Linda-Gail Bekker

Virginia de Azevedo

Adolescent AIDS Program

Children’s Hospital at Montefiore


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