Adolescence

PERSPECTIVEFacing the challenge:Reproductive health for HIV-positive adolescentsby Nyaradzayi Gumbonzvanda,General Secretary, WorldYoung Women’s ChristianAssociation“ Most adolescentsliving with HIVstruggle forrecognition, rights,protection andsupport.”In recent years, the global community has also madegreat strides to protect children and facilitate accessto education and health services for HIV-positivechildren and orphans. Organizations such as UNICEF,faith-based organizations and women’s networkssuch as the World Young Women’s ChristianAssociation (YWCA) have directed resources to traincaregivers in social protection policies and to defendchildren’s rights to information and dignity.Many of those living with HIV are adolescents. Theseyoung people do not fit any one model: They are inschool, out of school, living with foster parents, in stablefamilies, heading families or seeking employment.But all of them deserve a nurturing environment andcoherent support to make informed decisions abouttheir particular condition. In the last two years, theWorld YWCA conducted a series of dialogues withHIV-positive adolescent girls on the particular issuesthey face. We discovered three key challenges thatadolescents living with HIV contend with: disclosure,education and developing relationships.First, in terms of disclosure, many children and youngpeople are not informed of their HIV-positive status.Caregivers may not be prepared to tell them for avariety of reasons. Parents may feel an overwhelmingguilt for unintentionally ‘infecting’ their child, forexample, or they may dread answering questionsabout how HIV is transmitted. They may also wonderwhether their child will be able to live a ‘normal’ life,knowing she or he is HIV-positive, or have fulfillingrelationships (sexual or otherwise) in the future.Counselling for both caregiver and child is indispensablewhen handling disclosure.Some adolescents know their status but do notdisclose it to others because they fear rejection orexclusion. Both circumstances put young peopleat risk of transmitting HIV to others. In order tostop the spread of this virus, we must counteractprevailing stigma. It is imperative that policiesand programmes – especially those established bygovernments – provide safe spaces for adolescentsto feel comfortable disclosing their status, secure inthe knowledge that they will be supported.The second challenge is that comprehensiveinformation on reproductive health for HIV-positiveadolescents is still scarce. Health-care systems andfamily support networks lack the means to break downsuch information to show its relevance to a particularage group or gender. “Aunt, should I stop taking themedicine now that I have started my period?” asks15-year-old Tendai from Zimbabwe. Tendai was bornHIV-positive and worries that taking medication duringher period could result in side effects or adverselyaffect the chance of her having a child later in life.Local health-care workers and caregivers need trainingto provide answers to such questions about the fertilityrisks for HIV-positive adolescents. Providing educationand accessible information to people living with HIV ispivotal to eliminating the epidemic.The third challenge is developing relationships.Whether with friends or family, relationships arefraught with difficulty for young people living withHIV. UNICEF recently organized a dialogue with HIVpositiveadolescents in Zimbabwe. These wonderful,bright voices brought painful and piercing messages.Conscious of their HIV status, adolescents fear they maynever experience a sustainable romantic relationship.If they are blessed with a loving and understandingpartner, will the partner’s family accept them? If so, howdo they go about conceiving a child? In such resourcepoorcountries, what are the risks and options?It is the duty of governments to make sure medicationand services such as counselling are available toall those living with HIV, including young people.International organizations such as Save the Childrenand community groups such as Rozaria Memorial Trustmust join hands to enable HIV-positive adolescents toenjoy all their rights, especially their right to sexualand reproductive health. Most adolescents livingwith HIV struggle for recognition, rights, protectionand support. They seek advice and information, notjudgement. The sooner these adolescents’ questionsare answered, the sooner they will be empoweredwith the confidence that only knowledge can provide.As World YWCA General Secretary, NyaradzayiGumbonzvanda leads a global network of womenin 106 countries, reaching 25 million women andgirls. She previously served as Regional Director forthe United Nations Development Fund for Women(UNIFEM) and as a human rights officer with UNICEFin Liberia and Zimbabwe.28THE STATE OF THE WORLD’S CHILDREN 2011