Providers Caring for Adolescents with Perinatally-Acquired HIV: Current Practices and Barriers to Communication About Sexual and Reproductive Health

Abstract

The population of adolescents and young adults (AYA) with perinatally-acquired HIV (PHIV) present challenges to HIV healthcare providers (HHCPs). Originally not expected to survive childhood, they are now living well into young adulthood. Little is known about the type of sexual and reproductive (SRH) information/services offered to AYA with PHIV by HHCPs. HHCPs (n=67) were recruited using snowball sampling, and completed an online survey. Providers' most frequently endorsed SRH topics discussed with both male and female patients included condom use (77.3%), STD prevention (73.1%), and screening (62.1%). Providers' reports indicated that females received significantly more education about SRH topics overall. The most frequently noted barriers to SRH communication included more pressing health concerns (53.0%), parent/guardian not receptive (43.9%), and lack of time during appointment (43.9%). Provider-reported SRH conversations with HHCPs were highly focused on horizontal transmission and pregnancy prevention. Salient social aspects of SRH promotion for AYAs with PHIV (e.g., managing disclosure and romantic relationships) were less commonly discussed, though such conversations may serve to reduce secondary transmission and enhance the overall well-being of AYA with PHIV. Findings indicated that further work must be done to identify strategies to address unmet SRH needs of the aging population of AYA with PHIV.

HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub‐Saharan African countries

“…These findings reinforce reports from adolescent consultations and qualitative studies of there being a disparity between adolescent needs and the limited information and services they receive [18,28–30]. This requires urgent attention, given the importance of these services in preventing new infections and unwanted pregnancies.…”

Adolescent Human Immunodeficiency Virus Care Providers’ Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth

“…28 However, for PrEP to have an impact on the HIV epidemic, it must be made available to individuals who are at high risk of acquiring HIV infection. Similar to a prior study of clinician-reported barriers to providing sexual reproductive health counseling to HIV-infected youth, 29 clinicians in the current study identified barriers at multiple levels, including at the level of the patient, provider, organization/system, and community. These findings suggest that to facilitate access to PrEP-and thus use of PrEP by at-risk youth-barriers at multiple levels must be addressed.…”

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients

“…31 These fall in line with reported barriers to fertility-focused conversations as well as those reported by subspecialty pediatric clinicians in other disease areas such as cystic fibrosis and infectious disease. [52][53][54] Collectively, these data highlight the need for a multidisciplinary approach to SRH communication and education, as well as suggest potential for the development of intervention strategies that span subspecialty disciplines.…”