By Geraldine Kauma
Do you work with youth and adolescents, especially in talking about sensitive issues such as HIV/AIDS and sexual/reproductive health?
What you’ll learn in this article:
- Important considerations when communicating with adolescents
- Practical tips for building rapport and trust with adolescents, especially when communicating sensitive issues like adherence to ARV drugs and sexual/reproductive health
- The 5 A’s strategy for assessing vulnerabilities and designing care plans individualized for each adolescent’s unique situation
- Ethical and legal issues related to HIV care and support for adolescents:
- Informed consent and HIV testing
- Confidentiality of HIV status
- Disclosure of test results at an appropriate age
- Eligibility for family planning
- Delivery of adolescent-friendly services.
Nowadays, many more children born with HIV are living into adolescence and adulthood, which creates a delicate group of young people with different needs compared to the adults and children.
An adolescent is defined as a person between the ages of 10 and 19 years who goes through a gradual process of growing and developing into an adult. In this stage, adolescents experience various stages of developing secondary sexual characteristics.
A young person is a person aged between 10 – 24 years, and according to the World Health Organization, youth are persons aged 15-24 years.
Adolescents go through a risk-taking phase, which is part of growing up. Here, an adolescent struggles to test out their individual identity through self-definition and separation from others, including caregivers. This makes them vulnerable and more likely to engage in behavior that puts them at risk of acquiring HIV.
Ministry of Health trainers came to Reach Out Mbuya Parish HIV/AIDS Initiative last week to train counselors on best practices in dealing with adolescents and young people.
Here are some important considerations while communicating with adolescents:
- Younger adolescents need time to feel safe and to trust. Try starting the session by doing something together, like playing a game.
- Younger adolescents understand concrete things that they can touch and see.
- Drawing, demonstration, or visual aids can be used to make information more concrete.
- They need some time to observe you! Do not expect that they will instantly talk. Allow plenty of time and be patient.
- Explain things in simple terms.
- Just because the adolescent is not asking questions does not mean that he or she is not thinking about what is being said
- Do not force the adolescent to share. Positively reinforce the adolescent’s effort to express him or herself.
- If a youth is rude or aggressive, remember that it may not be directed at you. He (or she) may be feeling angry with adults for treating him badly or letting him down. Be patient and don’t take it personally.
- Give young adolescents as much time as necessary.
Here are some tips for building rapport and trust with adolescents:
- Begin by talking about non-threatening issues.
- Start by asking questions about the adolescent’s home, family, school and even hobbies, before moving on to more sensitive topics, such as adherence to medication, disclosure, and sexual or reproductive health issues.
- Use a third person (indirect questions): e.g. initially ask about activities of peers and friends rather than asking direct questions about the adolescents’ own behaviour: E.g. “Do any of your friends smoke pot/dagga?” before “Have you ever joined?”
- Treat everyone equally and with respect.
- Be genuinely open to an adolescent’s questions or need for information.
- Do not use judgmental words or body language.
- Do not talk down to an adolescent by scolding, shouting, blaming, or getting angry.
- Use words and language that an adolescent can understand and which are appropriate to their age and developmental stage. Use materials, illustrations or pictures to explain complicated information.
- Do not be critical of an adolescent’s appearance or behaviour.
- If sensitive issues are being discussed, help ensure that conversations are not seen or overheard by others.
- Do not threaten to break an adolescent’s confidentiality “for their own good.”
- Adolescents may be reluctant to disclose personal information if their parents or caregivers are present. Healthcare workers should stress that information entrusted with them will not be shared, unless the client gives permission.
- Allow enough time for the adolescent client to become comfortable enough during the visit to ask questions and express concerns.
- Show an understanding of and empathize with the client’s situation and concerns. Try to put yourself “in the adolescent’s shoes.” Understand that they might be uncomfortable; be reassuring when responding to them. Explain that you “are here to help.” Reassure adolescents that their feelings and experiences are normal.
- Be honest and admit when you do not know the answer to a question.
After interacting with the adolescent, it is important to design ways to help them and offer support in this 5-step process.
The 5 A’s strategy for assessing vulnerabilities and designing care plans:
- Assess vulnerability.
Look for features that make them vulnerable. Vulnerability in adolescence refers to the degree to which an adolescent is susceptible to harm, or destruction on being exposed to hostile agent, environment or factor. Vulnerable youth may not have a choice as to whether they engage in behavior that puts them at risk of acquiring HIV. These could include social/ cultural factors and gender norms, inability to make informed decisions, location, rural / urban, low economic status, lack of social support, education status and lack of life skills.
Guide the adolescent on how to avoid risky behavior and identify their vulnerabilities. Help adolescents get involved in activities that avert them from engaging in risky behavior. It is important to include the youth in this process by identifying together the dangers of a risky behavior and coming up with possible solutions to averting them. For instance, a young man involved in drug abuse may tell you that he does drugs because of peer pressure. You can then guide him accordingly, asking about other friends or possible pastimes like playing sports that would keep him away from negative peer groups.
Conduct open dialogue and experience sharing to derive a behavior change plan to reduce risk taking.
Equip the adolescents to evaluate risks, anticipate the consequences of their choices, and develop strategies for diverting their energy into healthier activities
Support and guide the adolescent to seek help if you notice they are getting involved in risky behavior.
It is important to note that there are Ethical and Legal Issues related to dealing with adolescents in HIV care and support:
- HCT for adolescents
In order to increase access to antiretroviral therapy (ART) and support HIV prevention choices, it is essential that adolescents know their HIV status. This has implications for the prevention of new infections as well as improving their own health. HIV testing & counseling must be provided in accordance with the 5Cs, namely Counseling, Consent, Confidentiality, Correct results and Linkage to Care.
- Informed consent and HIV testing
The HIV and AIDS Prevention and Control Act 2014, in the context of HIV, define “minors” as persons less than 12 years old. Persons 12 years and above are therefore allowed to consent for HIV testing. Consent for HCT should be obtained, and evidence of this should be indicated through signing or thumbprint.
A person in possession of information relating to the HIV status of any person shall observe confidentiality in handling that information.
- Disclosure of test results
A parent/guardian of a minor shall inform the minor who tests HIV positive of his or her status as soon as it is practical. Disclosure to a child about their own HIV status should happen by the age of 10 years. The readiness for disclosure will be determined by the caregiver and the health care provider. A Parent/guardian of a minor shall ensure that before the minor is informed of his or her HIV positive results, he or she receives counseling.
- Eligibility for Family Planning
According to the 2012 national policy guidelines and service standards for sexual and reproductive health and rights, all sexually active males and females in need of contraception are eligible for Family planning services, provided that;
- They have been educated and counseled on all available family-planning methods and choices
- Attention has been paid to their current medical, obstetric contra-indications and personal preferences, in line with prevailing WHO medical eligibility criteria.
- Adolescent friendly services
Adolescents have a right to services that are accessible, acceptable, appropriate, effective and equitable to accommodate their particular needs, confidentiality, privacy and respect. It is important to make services adolescent friendly because they minimize or remove barriers to access and uptake to support them make a commitment to their own health and understand their responsibilities.
The participants in the training were awarded with certificates of completion and vowed to implement the best practices in their day to day work.
Information adapted from the Ministry of Health Adolescents HIV care, treatment and Support Training participants Manual