Transcript MEETING THE REPRODUCTIVE HEALTH NEEDS OF YOUTH LIVING WITH HIV IN TANZANIA: A qualitative study exploring the experiences and perceptions of young Home Based.

MEETING THE REPRODUCTIVE
HEALTH NEEDS OF YOUTH LIVING
WITH HIV IN TANZANIA:
A qualitative study exploring the experiences
and perceptions of young Home Based Care
clients, their caregivers, and care providers
Joanna Busza
IAC, July 2012
SRH & Adolescents living with HIV
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Adolescence as a time of transition to adulthood,
including sexual development and experimentation
Evidence from other settings shows that youth living
with HIV report the same sexual experience and
fertility preferences as others in their age group
ART adherence and retention can be lower
Use of contraception & condoms varies in studies
(when compared to youth not living with HIV)
“Disconnect” between needs and focus on
abstinence messages by providers
Study Background
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Youth (15-24) comprise about 40% of adults (1549) in Tanzania’s population
Youth account for up to 20% of HIV infections
Increasing data available on “slow progression” –
survival among vertically infected children higher
than previously thought
Young people in need of HIV treatment and
support continue to be a growing population
BUT Only 5% of Pathfinder’s HBC clients in the
15-24 age group
Study Aims
To describe perspectives of youth living with HIV on
experiences of health and illness
 To learn about youth’s expectations, attitudes and
concerns regarding sexuality, sexual development
and relationships
 To elicit study participants’ views on the HBC
programme, including its benefits and weaknesses
 To compare the perceptions of HBC clients aged
15-24 with those of their caregivers and HBC
providers.
Fieldwork conducted January-March 2011
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Study Design
Qualitative research in Dar es Salaam and Tanga
 Interviews with adolescents (15-19) and young adults
(20-24) who:
 Were receiving HBC care
 Knew their HIV status
 Consented to participate AND received permission
from a parent or guardian if aged under 18
 Brief, anonymous sexual behaviour questionnaire
administered after the interview with youth
 Youth could nominate a “carer” for interview
 Perspectives gathered from HBC providers
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Results
47 interviews in total:
 12 HBC providers
 27 HBC clients
 10 Carers
 Among clients, 14 adolescents interviewed
(including a 14-year old) and 13 young adults
 11 respondents reported sexual experience
 Mix of vertical (17) and sexual (10) HIV
acquisition
 8 girls had 1 or more child
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Findings: Stigma & Secrecy
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Adults anxious about when/how to tell youth of
their infection
Keeping it secret – family prohibitions on telling
others in the community
Some parents reluctant to admit own infections,
suggesting casual contact leads to infection
Lack of clarity on HIV transmission routes and
widespread avoidance of disclosure, including to
potential sexual partners
Fear of discrimination a dominant theme – a
preoccupation of both young people and carers
Findings: Stigma & Secrecy
My father didn’t tell me anything … I suspected that there
was something fishy about it for I was given medicine
month after month even when I felt well. (Male, 18,
Tanga)
 The way people are looking at me? Aah! I’m not
comfortable at all. …I have not told anyone, I feel bad,
truly I feel very bad, I may be walking in the street, but
upon people looking at me, I feel very miserable and
uncomfortable. (Female, 20, Dar es Salaam)
 I asked my mother where we had got HIV-positive from
she told me that she didn’t know, … later they told me that
perhaps I had used a razor-blade that someone else with
HIV had used to cut his/her nails – that infection spreads
like that. (Female, 20, Tanga)
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Findings: Sexuality & Reproductive Health
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Reluctance to discuss with any adults, including in
interviews
Marriage and childbearing desirable, but
frightening as will involve disclosure
HBC providers and carers believe that talking to
young people about sex “coaches them”
Sex viewed as dangerous to people living with
HIV and likely to speed up disease progression
Findings: Sexuality & Reproductive Health
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It has not affected me in any way for there are others
(like me) who get children as usual or get married and
live with men. … I expect to have my own home; to have
a family. (Female, 23, Dar es Salaam)
Oh, getting married? Not now, may be later after I
have got money and have got good life. Then I’ll think
of other matters. … However, I feel it will be hard for
me to get married. But listening to these providers,
getting married is possible. And it is also possible to get
children. I am not in any hurry so if I get some income,
things will settle down on their own. (Male, 18, Tanga)
Findings: Sexuality & Reproductive Health
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Truly, [making] love----I have never done it. Not
even once. I just won’t do it for I know my
weakness. I can’t do it. What to do? They tell us to
use protection if you want to make love so that you
do not get weaker. This we are told at the hospital.
That is what they tell us. (Male, 16, Tanga)
I’m trying my level best to create awareness that if
one does sex frequently; it leads to deterioration of
health, unless you use protective gears (Female
provider, Dar es Salaam)
Findings: HBC Program
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Adolescents had little contact with providers –
saw HBC as the domain of their parents/carers
Unrealistic expectations/ misconceptions for what
could be provided, especially by carers (money,
food, school fees)
Adolescents concerned about breach of
confidentiality
Providers’ reiterated difficulties of engaging
with youth, but believed they were more “open”
than the youth reported
Different advice provided to vertically vs
sexually infected youth
Findings: HBC Program
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We were not prepared to serve clients who are young
people. We were given some general knowledge/skills on
how to care for people with HIV/AIDS. That is what we
got.. (Female provider, Tanga)
There is a difference. As I’m also an adult, it is easy with
an adult person, s/he is comfortable, while with the youth –
hmmm, it’s a bit hard. (Female provider, Dar es Salaam)
The difference with the youth is that at adolescence they
want to try out all sorts of things. So I talk to them … that
they should try to contain themselves and if they come to a
point where they have to have sex, they should use
condoms (Female provider, Tanga)
Issues Raised
Challenges of communication
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Disclosure to young people and others
 Reinforcement of secrecy within families and
communities
 Discomfort discussing sex and SRH with adults
amplified by HIV
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HBC programme gaps
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Difficulties in engaging with young people
 Inaccurate information and judgmental attitudes
 Lack of clarity on the realistic role of HBC
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MANY THANKS
ASANTE SANA !!
A FULL REPORT OF THE STUDY CAN BE
DOWNLOADED FROM
HTTP://WWW.PATHFIND.ORG/