HIV Health Considerations for Adolescents and Young Children

This presentation by Prof. Lorraine Sherr and team delves into the nuances of HIV/AIDS, teen pregnancy, and motherhood among adolescents in sub-Saharan Africa. It highlights the challenges faced by adolescent mothers and their children, emphasizing the multiple risk domains they navigate, such as physical and mental health, educational experiences, and socio-economic status. The setting is depicted with statistics on HIV prevalence, pregnancy rates, and postpartum complications, shedding light on the urgent need for supporting this vulnerable population.

• HIV health
• Adolescents
• Teen pregnancy
• Sub-Saharan Africa
• Risk domains

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1. HIV HEALTH AND BROADER CONSIDERATIONS FOR ADOLESCENTS AND THEIR YOUNG CHILDREN Prof Lorraine Sherr, UCL Member Coalition for Children affected by AIDS Acknowledgements to team Dr Elona Toska, Prof Lucie Cluver, Kathryn Roberts, Christina Laurenzi

2. Rapid overview of relevant literature Pubmed Keyword Search! Toska, Roberts, Laurenzi, Cluver & Sherr 2019 180000 160000 153336 140000 120000 100000 90208 80000 60000 40000 20000 231 29 0 HIV/AIDS Teen pregnancy HIV/AIDS + Teen pregnancy Child

3. Pregnancy/childbearing during adolescence (10-19 years) Adolescent Adolescent HIV HIV motherhood motherhood Estimated 11.4 million adolescent mothers in sub-Saharan Africa Highest prevalence in the world 18.8% 1 Adolescent, Adolescent, Teen pregnancy, Teen pregnancy, HIV HIV Affected Affected High Burden High Burden Impact of HIV/HEU add a layer of complexity to the experiences of adolescents and their children

4. Multiple Multiple domains of risk domains of risk Physical health inc. sexual and reproductive health Mental health Cognitive health and development Educational experiences Socio-economic status Violence experiences Early childhood development

5. Setting the scene Adolescent mothers and their children SSA > risk of HIV and< receive or stay on treatment (Callahan et al 2017) Many adolescent mothers discover HIV status simultaneously with pregnancy confirmation (often late) (Ronen et al 2016) By age 18, 42% urban and 50% rural have become pregnant. (UNAIDS 2018) Adolescent mothers > risk postpartum complications Children of adolescent mothers are disadvantaged in nutrition and schooling (Cohorts n=22,188)( Fall et al 2015). Birth associated complications main cause of adolescent death globally. No studies on infant development of children born to HIV+ve adolescents Zero studies on HIV Adolescent mothers and postpartum risks.

6. Adolescents Adolescents infected and infected and affected by affected by HIV HIV Physical and mental health problems 4 ART non- adherence Low retention in care Neurocognitive delays 2,3 Mortality 5-9 More likely: Violence

7. Adolescents Adolescents mothers mothers with HIV with HIV Sexually-infected10 Elevated risk of HIV exposure for non-ALHIV 11 PMTCT Poor service engagement (antenatal/postnatal/ schooling/ECD) 12, 13

8. Maternal Maternal HIV & the HIV & the children of children of adolescents adolescents Structural & socio- economic issues Developmental outcomes (HIV/HEU) PMTCT Adherence

9. Mental health and adolescent pregnancy Mental health and adolescent pregnancy Anxiety, trauma, suicidal behaviours, (Casale et al 2019) isolation but +ve as well Depression elevated in adolescent pregnancy (Kenya) (Osok et al 2018). n=176, 32.9% Depression rate. Predictors HIV, young, absence of social support. Resilience, (but Borus 2019) 5 year fup none) meaning of life, coping, adjustment and fun.

10. Adolescent fathers: The forgotten half Largely excluded from the literature regarding pregnancy prevention, childbearing and HIV Limited evidence from sub-Saharan Africa Predictors of adolescent fatherhood include: lower levels of education greater number of sexual partners 14,15

11. Being a young mum is not a crime (Miriam) Focus on risk in the literature (Goossens et al 2015) Focus on negative in the literature Overall associated with low education, poorer prospects and repeated by generation But pregnancy may thwart academic achievement rather than the other way round (Wellings et al 1999). Negative outcomes may be linked to the correlates rather than the age. When the correlates are not present, the impact is ameliorated? Tackle the drivers Evidence gap go to where there is evidence, while prioritising the gathering of tailored evidence.

12. The Way forward The Way forward Age Things that work Exclusions Uncounted Unsupported Gender skew restricted access HEY Baby study Counting them Legal lens Make HIV services accessible Cash transfers/social protection Education bring them back into education Social Protection Integrated programming Mental health support Nurturing care ECD Provision Integration

13. HEY BABY STUDY TASTER FINDINGS HEY BABY STUDY TASTER FINDINGS 1,025 adolescent mothers (1/3 HIV+) and their children 51% had first child <18 years old 25% lived in rural areas 24% lived in informal housing 83% lacked basic necessities 28% did not have enough food at home in the past week for 3 meals a day 29% not in school even >1 year postpartum Higher suicidality and mental health issues potential syndemic of HIV & adolescent motherhood 6% never started ART during pregnancy 34% started after end of first trimester 10% stopped taking their ART during pregnancy/ breastfeeding

14. They Say in Africa THE LION ROARS TONIGHT DON T WAIT

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