ADOLESCENT HIV TESTING, COUNSELLING AND CARE
Implementation guidance for health providers and planners

Sexual and Reproductive Health

For most adolescents, sexual activity begins when physical growth and emotional development are accompanied by sexual maturation – which are often accompanied by sexual exploration and intimate relationships. These changes happen at different times for different people, and they are dependent on many individual, social and cultural factors. Whether or not they are living with HIV, adolescents have a right to a healthy, enjoyable and safe sex life. Health providers should affirm and encourage this in age-appropriate ways that are also sensitive to the personal beliefs of individual clients.

The recent WHO guidance Ensuring human rights in the provision of contraceptive information and services: guidance and recommendations supports this.

All adolescents need to understand the physical changes occurring in their bodies and how to responsibly enjoy their emerging sexuality. This period of physical change and sexual exploration is often marked by emotional immaturity and a lack of information, services and commodities for disease prevention and contraception. For adolescents living with HIV, these issues are compounded by the pressing need to protect themselves from additional harm and to prevent transmission of HIV to others. In addition, social norms that condone gender inequity and power imbalances pose major difficulties for those adolescents coerced into sexual relationships. As a consequence of all of these combined factors, some adolescents do not practice safe sex.

Sexual and reproductive health (SRH) information and services are important for all adolescents, including those living with HIV, most of who do not lose their desire for sex or their hopes to have children, but whose needs are often not addressed. Adolescents with perinatally acquired HIV may not yet be sexually active but they may have questions related to having sex. People who acquired HIV during adolescence may already be sexually active and are now considering the implications of the diagnosis on their sex lives; they may have concerns about how they can have intimate relationships and families in the future, fears related to disclosing their status to sexual partners and as well as concerns about HIV transmission.

Adolescents who acquired HIV perinatally may have additional SRH concerns due to HIV-related complications such as slow skeletal growth and delayed sexual maturation. This is due to the effect that HIV has on metabolic and endocrine functions. This may also have an impact on the psychosocial development, resulting in strong feelings of frustration and anger because they look or feel different from their HIV-negative peers.

The greatest challenge facing health providers who work with adolescents is communicating effectively, particularly when discussing sex. Workloads are heavy, which can lead to hurried consultations and avoidance of difficult topics. Providers of adolescent SRH services can also be influenced by their own views about adolescent sexual activity, which are shaped by personal values, societal and cultural norms and taboos. Unfortunately these views often create a barrier to open discussions around sex, relationships and other issues important to adolescents, resulting in missed opportunities for thorough SRH assessments and effective provision of information to promote healthy and safer sexual practices. It is important that all health providers who work with adolescents feel comfortable talking about sexuality and SRH issues with their young clients.