When I was in Form Four I belonged to a class with lofty aspirations to be entertainers and comedians. We were a bright but rowdy bunch. One day we were reprimanded by our Geography teacher who declared "Adolescence is NOT a religion!" I sigh fondly at the folly of our youth but saddened by the challenges young people of these days have to face.
There is a place in a leafy suburb of Harare. If you were not referred or invited, you will not find it because there is no signage outside. This is intentional. This clinic, that thrives in its anonymity, serves almost 6000 HIV positive adults and children of Zimbabwe. I am currently doing a training there. The last HIV training I did was in Kenya 3 years ago and I remember clearly leaving there with quite a gloomy outlook on life. Remember this The Real Picture? I am coming to the end of this training but I am feeling blessed to know this establishment, happy that there is hope in this stormy sea of HIV.
Zimbabwe's HIV prevalence has dropped to 14%. Even though this is better than the one in every three that once was a few years ago, it is still quite significant. The government hospital where I work sees staggering numbers of outpatient HIV patients coming for follow up visits for resupply and review. At the hospital we see about 20 patients per healthcare provider daily. At this clinic a doctor will see about 8 patients...spending not less than 30 minutes with each. They have all the laboraoty tests available. They are also stocked wih every ARV includng being a 3rd line roll out centre. And everything is free! Its literally an oasis in a desert. They have a nurse-led approach with specialist psychiatrists, physicians and nutritionists coming in when needed. They also have an adolescent friendly corner offering skills training and groups specific for needs such as young mums etc.
The staff are motivated and smile genuine smiles. You know the type. The training itself is an important component of the centres goal to decentralise treament by training us doctors and nurses. They keep abreast with the latest recommendations. I tell you, I am in awe of this centre.
Albeit all this medical glitz and glamour, there remains many, many challenges from which they cannot escape. One of the challenges are the growing crop of children who were born with HIV transmitted from their parents (vertical transmission), who are now adolescents and young adults and trying to lead normal lives. Adolescence is already a precarious time in a persons life. Many of these patients face issues of not adhering to medication giving rise to drug resistance and subsequent treatment failure. One study they did at the clinic with MEMS-caps revealed that even adolescents who said they were adhering were in fact not at all.Some of their reasons include that 'they are just tired'. If it is difficult to finish a 7 day course of antibiotics what more a lifetime of pills taken even when you don't feel sick? You've got to feel for these youths.
Unfortunately the poor adherence makes management of the disease difficult. They contract opportunistic infections and develop drug resistance strains. They want to have normal lives, date, fall in love, get married, have kids. Who do they marry? How do they disclose their status? How long must they keep taking this medicine? Should they dream like other kids? Can they experiment with alcohol? They have so many concerns and we find up to 60% depression prevalence in this group.
I am determined to do something about this. Adherence in adolescence will be my focus. Ideas are welcome. For now I am working on a paper to determine the underlying reasons...but most importantly trying to come up with solutions which will impact our youth.
 |
| We also used to climb trees |
There is a place in a leafy suburb of Harare. If you were not referred or invited, you will not find it because there is no signage outside. This is intentional. This clinic, that thrives in its anonymity, serves almost 6000 HIV positive adults and children of Zimbabwe. I am currently doing a training there. The last HIV training I did was in Kenya 3 years ago and I remember clearly leaving there with quite a gloomy outlook on life. Remember this The Real Picture? I am coming to the end of this training but I am feeling blessed to know this establishment, happy that there is hope in this stormy sea of HIV.
Zimbabwe's HIV prevalence has dropped to 14%. Even though this is better than the one in every three that once was a few years ago, it is still quite significant. The government hospital where I work sees staggering numbers of outpatient HIV patients coming for follow up visits for resupply and review. At the hospital we see about 20 patients per healthcare provider daily. At this clinic a doctor will see about 8 patients...spending not less than 30 minutes with each. They have all the laboraoty tests available. They are also stocked wih every ARV includng being a 3rd line roll out centre. And everything is free! Its literally an oasis in a desert. They have a nurse-led approach with specialist psychiatrists, physicians and nutritionists coming in when needed. They also have an adolescent friendly corner offering skills training and groups specific for needs such as young mums etc.
The staff are motivated and smile genuine smiles. You know the type. The training itself is an important component of the centres goal to decentralise treament by training us doctors and nurses. They keep abreast with the latest recommendations. I tell you, I am in awe of this centre.
 |
| Happy Workers. A myth? |
Albeit all this medical glitz and glamour, there remains many, many challenges from which they cannot escape. One of the challenges are the growing crop of children who were born with HIV transmitted from their parents (vertical transmission), who are now adolescents and young adults and trying to lead normal lives. Adolescence is already a precarious time in a persons life. Many of these patients face issues of not adhering to medication giving rise to drug resistance and subsequent treatment failure. One study they did at the clinic with MEMS-caps revealed that even adolescents who said they were adhering were in fact not at all.Some of their reasons include that 'they are just tired'. If it is difficult to finish a 7 day course of antibiotics what more a lifetime of pills taken even when you don't feel sick? You've got to feel for these youths.
Unfortunately the poor adherence makes management of the disease difficult. They contract opportunistic infections and develop drug resistance strains. They want to have normal lives, date, fall in love, get married, have kids. Who do they marry? How do they disclose their status? How long must they keep taking this medicine? Should they dream like other kids? Can they experiment with alcohol? They have so many concerns and we find up to 60% depression prevalence in this group.
I am determined to do something about this. Adherence in adolescence will be my focus. Ideas are welcome. For now I am working on a paper to determine the underlying reasons...but most importantly trying to come up with solutions which will impact our youth.
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