Date Published: March 28, 2018
Publisher: BioMed Central
Author(s): Graham Toth, Gitau Mburu, Sovannary Tuot, Vohith Khol, Chanrith Ngin, Pheak Chhoun, Siyan Yi.
Understanding the circumstances of adolescents living with HIV is critical in designing adolescent-friendly services that will facilitate successful transition from pediatric to adult care. This study describes access, utilization and ongoing social support needs among adolescents living with HIV aged 15–17 in transition from pediatric to adult HIV care in Cambodia.
A cross-sectional study was conducted among 328 adolescents, randomly selected from 11 antiretroviral therapy (ART) clinics across the country. Descriptive analyses were conducted to summarize their characteristics, access to social support and ongoing support needs among male and female adolescents.
Mean age of the study participants was 15.8 (SD = 0.8) years. Just over half (55.2%) were male. Most had at least one deceased parent (mother 50.9%; father 60.5%), and majority were living with biological parents (40.8%) or relatives (49.3%). A third came from families with an ID poor card, and 21.0% were working for pay. Almost half (46.6%) reported that their family had received social support for their health care, including food support (76.5%), school allowance (62.1%), transport allowance to ART clinics (53.6%), psychosocial counseling (35.3%), vocational training (22.9%) or home visits (11.1%). Several ongoing social support needs were identified, including ongoing inability to cover health expenses unless they are supported by health insurance or health equity fund (55.0%). In addition, adolescents reported having been asked to come back earlier than their scheduled appointment (13.7%), having had to purchase their own drugs (2.7%), experiencing HIV stigma (32.0%), having been denied housing or food due to HIV (8.2%) or failing to attend school within the past month partly because of HIV (16.8%). Two-thirds did not have access to peer support groups.
Social protection mechanisms are reaching some adolescents in need, while other remain without social support due to discontinuities in health and social care. Multi-sectoral interventions, supporting school attendance, adolescent-friendly clinic scheduling, reductions in child employment, mitigation of HIV-related stigma and strengthening of peer-to-peer support are required to improve coverage of social protection interventions for adolescents in transition.
Adolescents, defined as people aged 10–19 years, undergo rapid psychological, sexual and physical maturity . Adolescents experience marked changes in sexuality , mental capacity , self-efficacy and independence . At the same time, adolescents are one of the most affected populations by HIV. Globally, over two million adolescents are living with HIV . Given the dynamic changes during adolescence, studies exploring outcomes of HIV care tend to distinguish adolescents living with HIV from both pediatric and adult populations.
Our cross-sectional study describes the dynamic social circumstances unique to Cambodian adolescents living with HIV as they transition to adult clinics. We found that social protection mechanism are reaching some adolescents living with HIV in need. Almost half reported that their family had received at least one element of social support for their health care, ranging from food support, school allowance, transport allowance to ART clinics, psychosocial counseling, vocational training, or home visits. Of these, food support and school allowance had the highest coverage.
The considerable advancements made in reducing new infections from mother-to-child transmission indicates that a focused worldwide effort, robust political commitment and leadership at the national level can produce substantial results. The same type of concentrated focus must now be shifted to adolescents. Our study reports that social protection mechanisms are reaching a number of adolescents living with HIV in need, but others remain without support. Multi-sectoral interventions, boosting school attendance, mitigating HIV-related stigma, and expanding coverage of social protection mechanisms are necessary to improving the health and quality of life of all adolescents living with HIV in Cambodia.