Navigating Adolescence With HIV

USAID-supported Adolescent-Friendly Health Centers create a supportive youth-led community that can help HIV positive children navigate challenges. (Photograph courtesy ACCELERATE)

Tanisha (name changed) is a 12-year-old from Hyderabad whose life story explores the intersection of HIV with domestic violence, and the subsequent intervention of the U.S. Agency for International Development (USAID) through its flagship program, ACCELERATE. Tanisha and her parents are HIV positive. Managing HIV with limited financial resources is not easy but Tanisha and her mother found support in the Adolescent-Friendly Health Center established by USAID partners in her city. Here, Tanisha and her mother underwent a series of counseling sessions and were provided psychosocial support. The clinic staff also introduced them to the Women’s Wing of the Telangana State Police, where Tanisha’s father was counseled. Tanisha now stays in a hostel while her mother works to make ends meet.

Assisting the youth

According to estimates by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2021, 60 percent of HIV positive children and adolescents in South Asia live in India. USAID, with support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), set up Adolescent-Friendly Health Centers (AFHCs) through its flagship program, ACCELERATE, led by Johns Hopkins University School of Medicine, to support 10-17-year-old HIV positive adolescents with comprehensive health care and services.

“Adolescents living with HIV navigate challenging developmental stages and cope with HIV, stigma, orphanhood and bereavement, increased poverty and food insecurity, adherence to HIV treatment and disclosure issues, putting them at risk for poor mental health and causing significant burden to their development,” says Deepika Joshi, HIV division chief at USAID/India. To overcome this gap, while ensuring access to the entire cascade of HIV services, these centers also offer skill development resources, protection services and infotainment activities to increase engagement with HIV positive children for better treatment outcomes.

Peer support and more

The Adolescent-Friendly Health Centers create a supportive youth-led community that can help HIV positive children navigate challenges. “As adolescents make their way to AFHCs, their first interactions with health care professionals often steer clear of HIV-related questions,” says Aditya Singh, deputy chief of party, ACCELERATE. “Instead, conversations focus on their interests, preferred recreational activities, hobbies and talents. Our team members use these entry points to build rapport and interest to ensure ART (antiretroviral therapy) adherence retention and viral load suppression.”

For Bonny (name changed), an adolescent living with HIV who initially struggled with acceptance and adherence to antiretroviral therapy, these services are invaluable. He felt ashamed and fearful of disclosing his status to friends and classmates. At the center, Bonny gradually became more comfortable, interacting with peers and participating in support group meetings and music classes. He also began to take responsibility for his own health, including adhering to his medication and attending viral load testing and lab investigations. He advocates for the rights and well-being of adolescents living with HIV and became a role model for them, sharing his experiences of disclosure and treatment. Through his involvement with the Youth Plus Network, a voluntary collective of young people and adolescents living with HIV, Bonny has continued to support his peers and raise awareness about HIV and related issues.

“The AFHCs established in Imphal, Guntur and Hyderabad in 2021, have served more than 1,000 adolescents living with HIV through June 2023,” says Singh. “Of these, 749 are currently served on ART, and 95 percent (up from 69 percent at the time of registration) have been virally suppressed (as of June 2023). This highlights the importance of regular viral load testing in managing HIV, and the critical role of Adolescent-Friendly Health Centers in providing optimal care and support to adolescents living with HIV.”

Future plans

USAID plans to scale up the centers and integrate them with government, private, public and civil society organizations. For instance, the partnership between the Hyderabad center and the community-based organization Cheyutha, which has established a model for other regions. Additionally, the Adolescent-Friendly Health Center in Pune is located within the Armed Forces Medical College, which is a step toward its integration into the government set-up.

“As this year marks PEPFAR’s 20th year of delivering unprecedented impact in the global fight against HIV,” says Singh, “I am proud to report that these centers have been effective in enhancing ART adherence and retention among children and adolescents.”

Paromita Pain is an assistant professor of Global Media Studies at the University of Nevada, Reno.

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