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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

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
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
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
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
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
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
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
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
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
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
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
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