HIV+ adolescents are a particularly vulnerable but often overlooked group in the HIV response – globally as well as regionally. In Myanmar, adolescents make up around 5% of the Médecins Sans Frontières total HIV cohort of nearly 35,000 people. Médecins Sans Frontières’ Fernanda Rick is the Medical Team Leader for the organisation’s HIV project in Dawei, Myanmar.
“The number of new infections and AIDS related deaths for adolescents are on the rise in the Asia and Pacific region and adolescents living with HIV have the highest rates of poor medication adherence and treatment failure. Our adolescent patients are almost three times more likely to fail on first-line anti-retroviral treatment (ART) and will need to be switched to more potent drugs (second line ART). While only about 6% of our adult patients are on second-line medication, the percentage climbs to 16% in the adolescent group. This is particularly tragic as preliminary research indicates that adolescents actually start treatment in better health once they are on therapy compared to adult patients. The last viral load results of all tested adolescents show that almost 20% of adolescent patients on ART still have a detectable viral load in their blood – an indication that suggests the treatment alone is not working.
"Our adolescent patients are almost three times more likely to fail on first-line anti-retroviral treatment (ART) and will need to be switched to more potent drugs"
In Myanmar, ART only became available in the public service a bit more than 10 years ago but even then, access remained extremely limited. Most of our young patients do not dare to disclose their status to anyone outside their family, not even their closest friends and furthermore, the majority of our young patients has been born to HIV+ parents and many of them grow up as orphans. Growing up with a chronic life-threatening disease, adolescents need to understand why they need to take their drugs rigorously. Sexual education is another major issue, as adolescence is also a time when sexuality awakens. Yet in Myanmar, like in many other societies, talking about sex is a cultural taboo.
Médecins Sans Frontières has increased efforts in HIV projects in Myanmar to better address and care for this unique group of patients. This includes research into our existing cohort, as well as closer monitoring of virological outcomes. Better adapted counselling and an increase in peer-support activities, as well as targeted outreach in testing and health education are possible next moves. HIV+ adolescents need a supportive environment that understands them and enables them to adhere to their treatment. It needs a specially tailored model of care that allows them to be normal teenagers. This includes having HIV counsellors and supportive educators that “speak their language,” do not shy away from including sexual education in their interactions and who take our young patients seriously; teachers that do not discriminate kids when they disclose their status, but pass messages of support and HIV education in their class rooms; and families and communities that understand ways of transmission and prevention. As treatment providers, caregivers and humans we need to make this a joined effort, and we need to do this urgently to make sure this generation has a future and not to let them slip away.”