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Addressing the Needs of HIV Infected Youth IAS 2011 – Rome, Italy

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

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  1. 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

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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)

  14. 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

  15. 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

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