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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. AdolescentAIDS.org. 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

AdolescentAIDS.org

understanding the landscape
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.

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 . http://www.who.int/hiv/topics/mtct/data/en/index3.html

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
slide7

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.

slide8

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
slide16

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