Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
Integrated Regional Information Networks - September 8, 2009
"These kids are getting older on treatment and surviving on treatment; they're becoming sexually active, they want to get married," HIV paediatrician Dr Harry Moultrie told the annual University of the Witwatersrand AIDS Research Symposium in Johannesburg last week.
"We are beginning to see data that they are not achieving the outcomes they should - we're seeing a lot of teen pregnancies, sexually transmitted diseases and poor developmental outcomes."
Studies in the United States have shown that HIV-positive teens may be more likely to engage in risky behaviour. Similar studies have yet to be carried out in South Africa, but Moultrie noted that if the findings were similar, many doctors in South Africa would not be ready to deal with the challenge.
"For a long time we took the approach in trying to promote adherence that it was about providing knowledge to adolescents," he told IRIN/PlusNews.
"If you are going to get the message to adolescents in that way, it's wrong, because the inherent developmental state of an adolescent is adversarial - what teenager ever did what they were told to do? It's not about the HIV side of things, it's about the children."
The missing link
Moultrie also works at the Harriet Shezi paediatric clinic, in one of South Africa's largest hospitals, Chris Hani Baragwanath. The clinic is one of just 12 in the country offering specialized services to HIV-positive youth, and has only recently been able to offer psychosocial support services.
The clinic has been running regular group sessions since it received funding from UNICEF in December 2008, allowing HIV-positive teens to discuss issues that affect their lives with a trained moderator.
Moultrie said such groups were crucial to helping HIV-positive teens, and could be cause for the government to re-examine the guidelines that sent children aged 14 years or older away from paediatric clinics and into adult facilities that might not be able to offer them the services they needed.
"You have to realize that a lot of these children have gone through multiple childhood traumas, including multiple changes in caregivers," he said. "They need to be able to say, 'I'm okay with who I am, and I accept my HIV status'."
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