Factors that Influence Sexual and Reproductive Health Information Offered to Adolescents with Perinatally Acquired HIV: An Ecological Analysis of Provider Perspectives

Exploring the sexual and reproductive health knowledge, practices and needs of adolescents living with perinatally acquired HIV in Côte d'Ivoire: a qualitative study

INTRODUCTION

Adolescents face unique challenges in accessing appropriate information and services regarding sexuality and reproductive health (SRH). This poor access can lead to sexual behaviours that could put them at risk of unintended pregnancies and sexually transmitted infections. Adolescents living with HIV (ALHIV) have specific SRH needs that remain unmet. We explored the SRH knowledge, practices and needs of ALHIV in Abidjan, Côte d'Ivoire.

METHODS

Between April and September 2023, a qualitative study using semi-structured individual interviews was conducted with nine male and nine female ALHIV without previous pregnancies, and eight ALHIV who became pregnant. All consented and were ALHIV acquired perinatally, aged 15-19 years, informed of their HIV status, and followed in three paediatric HIV care centres in Abidjan. participating in the paediatric IeDEA West African Cohort and enrolled in the ANRS12390 OPTIMISE-AO project aimed at improving HIV disclosure process and adherence to antiretroviral treatment. A focus group discussion was conducted with five peer-educators, aged 23-31 years, participating in the OPTIMISE-AO project to gather their perspectives on adolescent SRH. Interviews were conducted in French, and a thematic analysis was performed.

RESULTS

All participants expressed difficulty in talking about SRH with their parents or health professionals and turned to their friends for advice. All feared transmitting HIV. One-third of female participants reported having experienced non-consensual sex and sexual violence. Participants reported low levels of condom use, despite having good knowledge of its purpose. Reasons for not using condoms included difficulties in negotiating for girls, as well as having an undetectable viral load, which was seen by adolescents as a condition for waiving condom use. As hormonal contraceptives were subject to many negative beliefs justifying their non-use, alternative methods, such as emergency contraceptive pills or traditional plants, were used to prevent pregnancy.

CONCLUSION

ALHIV reported unmet SRH needs, particularly in terms of accessing reliable information and appropriate support. Integrating SRH care into paediatric HIV care, organising SRH discussion groups led by peer-educators, and improving access to a range of contraceptives may address these needs to enhance SRH outcomes for ALHIV.

[Sexual and reproductive health of adolescents living with HIV in pediatric care programs in Abidjan : Structured provision of care and perceptions of health care workers in 2019]

INTRODUCTION

The majority of adolescents living with HIV (ALHIV) reside in sub-Saharan Africa, with sexual and reproductive health (SRH) needs to be met. The health care facilities and professionals involved have a major role to assume in the quality of SRH services offered to these teenagers.

OBJECTIVE

To investigate the SRH services offered to ALHIV subjects in pediatric facilities in Abidjan, Ivory-Coast.

METHODS

In 2019 we conducted an exploratory cross-sectional study using qualitative and quantitative methods in three pediatric facilities caring for ALHIV subjects (CIRBA, CTAP and CePReF) and participating in the IeDEA (International epidemiologic databases to Evaluate AIDS project) in Abidjan, Ivory Coast. This study included: (1) an inventory of SRH services, using a questionnaire and direct observation, describing their adaptation to the teenagers' needs and their inclusion in provision of care; (2 an assessment by means of semi-structured interviews of 14 health professionals' perceptions of the SRH needs of the ALHIV subjects with whom they worked. Quantitative data were expressed in percentages and qualitative data from the interviews were analyzed through inductive thematic analysis.

RESULTS

The care provided in the three facilities was poorly adapted to the teenagers' needs. Few SRH services were effectively provided to the ALHIV subjects in the different centers. The services essentially consisted in condom distribution and organization of SRH-based focus groups. Exceptionally, hormonal contraception was offered to teenage girls. Barriers to the services were largely due to poorly equipped facilities, particularly in terms of SRH offer, health professionals' experience, and support provided for ALHIV subjects and their parents. The health professionals were desirous of SRH skill-building programs enabling them to deliver optimal, adequately contextualized SRH services to the teenagers.

CONCLUSIONS

In pediatric programs addressed to ALHIV subjects in three Abidjan facilities, the teenagers' SRH needs remain unmet. It is urgently necessary to strengthen the health facilities by means of improved equipment, enhanced awareness of teenagers' needs, and training programs enabling the health professionals to provide more adapted sexual and reproductive health services.

US Provider Perceptions of Differences in the Sexual and Reproductive Health Needs of Adolescents with Perinatally Acquired and Behaviorally Acquired HIV: A Mixed Methods Study

This study explores health care providers' perceptions of similarities and differences in the sexual and reproductive needs of adolescents with perinatally acquired HIV (PHIV) and behaviorally acquired HIV (BHIV). Interviews (n = 13) and online surveys (n = 46) were completed by medical and social service providers (n = 30, n = 29, respectively) who care for adolescents with HIV. Eligible providers were recruited using snowball sampling. Responses to open-ended questions were coded for emergent themes. Sixty-eight percent of participants perceived differences in the sexual and reproductive health needs of adolescents with PHIV and BHIV. Differences included factors related to psychosocial, sexual, and medical needs. Providers believed adolescents with PHIV had integrated their diagnosis into their identity, were more adept at communicating with providers, and were more sexually cautious than youth with BHIV. Providers perceived adolescents with BHIV as more comfortable discussing sex-related issues, and suggested youth with PHIV were more comfortable accessing health care. Adolescents with PHIV were thought to have complex medical histories/treatment and greater knowledge of illness/medications. Existing research on adolescent-reported sexual and reproductive health knowledge and experiences in care suggests that provider and adolescent perspectives do not always align. Mode of transmission may provide some information about psychosocial functioning and sexual behavior. However, assumptions about sexual and reproductive health needs based solely on mode of transmission may contribute to gaps in sexual and reproductive health care. Future research is needed to examine whether these differing perspectives indeed lead to discrepancies in the care provided to adolescents with HIV.