Adolescents, a neglected population group
In South Africa, we celebrate Youth Day on 16 June. This is also a time for policy-makers and managers to reflect on whether existing health services address the specific needs of adolescents living with HIV/AIDS.
Facts on adolescents (WHO, 2014a)
- Worldwide adolescents form the largest population group, with 1.2 billion people between ages 10-19 years, forming 16.4% of the global population;
- Some of their health issues include teenage pregnancy and childbirth, which is the second leading cause of death among girls in this age group;
- Over 2 million adolescents are living with HIV/AIDS;
- In sub-Saharan Africa only 10% of adolescents know that they are HIV infected, therefore this region contributes to the worldwide rise in AIDS deaths among adolescents;
- Violence is one of the top causes of death among adolescents and about 30% of girls undergo partner violence;
- Alcohol and drug abuse threatens the health and safety of adolescents; while 1 in 10 adolescents use tobacco;
- Adolescents are undernourished, overweight and lack the recommended daily physical activity.
In the African region, 22.6% (n=213 million) of the population constitutes adolescents (United Nations, 2013). Many of those born with HIV are now entering adolescence, and have to cope with physical and emotional changes as well as HIV stigma. Often governments do not provide youth-friendly HIV services, reducing the probability for adolescents to seek HIV care, testing and counselling services or to remain in treatment. More important than ever is the need to adapt health services according to their needs.
World Health Organisation guidelines aimed at adolescents living with HIV/AIDS
Recently, the World Health Organisation (WHO) led an international workgroup in the development of guidelines on HIV care, testing and counselling of adolescents living with HIV (WHO, 2013). These guidelines specifically focus on the needs of adolescents and providers of services not previously developed on a global level. Consequently, among adolescents there is lower uptake of services, late diagnosis of HIV infection and delayed entry into antiretroviral therapy. One aspect of the guidelines is expanded upon below:
Consent to undergo HIV testing and counselling
The extent of adolescents' rights regarding consent for HIV testing and counselling (HCT) varies among countries. For instance, in South Africa, a "child" is considered a person 18 years old and younger. According to the Children's Act of 2005, a child in South Africa may consent to an HIV test if he/she is: 1) older than 12 years or 2) aged younger than 12 years but has sufficient understanding of the benefits and risks involved. A parent or guardian may give consent for a child to undergo HIV testing if the child is younger than 12 years old and not mature enough to understand the benefits or risks. Most countries apply these biological (physical age) and cognitive maturity criteria for HCT consent by adolescents (WHO, 2013).
The developers of these guidelines held ten workshops with 98 adolescents from communities in South Africa, the Philippines and Zimbabwe; they conducted a survey among 655 participants from 92 countries to establish the values and preferences of adolescents on HCT (WHO, 2013). Most participating adolescents perceived HCT as beneficial to know their HIV status, while many recognised that this step implied taking control of their own lives. Reasons adolescents gave to undergo HCT included starting a new relationship (15%), being offered HCT while accessing other health services (40%) and importantly, encouragement from others.
By far, the greatest barrier to HCT was the fear of being HIV-positive, and if so, the reactions of family and friends, and of death. A critical barrier to undergoing HCT was subjection to stigma, discrimination and all the consequences of a HIV-positive test. In addition, distance to testing facilities, costs, waiting times and inconvenient clinic hours added to the list of barriers.
Evidently, many of the health system challenges experienced with adults are applicable to adolescent health services. Policy-makers and managers should consider the following:
- Existing policy regulations should enable adolescents who have the legal right to undergo HCT with autonomous access to HIV prevention and treatment as part of comprehensive care;
- Clear regulations should be in place to provide access to HCT as part of the care of orphans, street children, child-headed households and adolescent girls exposed to sexual abuse;
- Counselling of adolescents should include sexuality education including the use of contraception with a friendly, positive and non-judgemental approach;
- Engaging youth communities to encourage and motivate HCT among adolescents using strategies they recommend; and
- Improving the health system to increase the number of youth-friendly HCT facilities at reduced costs and with provision of condoms.
Approaching Youth Day, the health needs of adolescents deserve our attention for a brighter tomorrow. View these global guidelines online for an in-depth understanding to customise adolescent-friendly and comprehensive HCT services.
"Health is the basis for everything; if you want to study or work, you need to be in good physical and mental health" - adolescent South Africa
"The proper functioning of one person is crucial for the society, because our problems affect our behaviour, which will sooner or later affect the whole society" - adolescent Argentina
Source: (WHO, 2014b)
- United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Prospects: The 2012 Revision.
- WHO. (2013) HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV: recommendations for a public health approach and considerations for policy-makers and managers. [Online] (Accessed 21 May 2014).
- WHO. (2014a) Adolescents: health risks and solutions. Fact sheet N°345. [Online] Accessed 20 May 2014.
WHO (2014b) Health for the World's adolescents. A second chance in the second decade. [Online] (Accessed 22 May 2014).
Author: Hendra van Zyl (MPH)
Reviewed by: Jean Fourie (M.Phil) and Michelle Moorhouse (MBBCh, DA)
Date: June 2014
Van Zyl, H. (2014) Adolescents, a neglected population group, AfroAIDSinfo. Issue 14 no. 6, Policy (Open access).
Last updated: 31 May, 2014