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Treating Teen HIV Goes Beyond Medicine A DGHI professor takes a novel approach in Moshi, Tanzania

Assistant professor Dorothy Dow, a pediatric infectious diseases doctor, first went to Moshi, Tanzania, in 2011 to do research on preventing mother-to-child HIV transmission. But her focus soon shifted when she discovered a grim reality for adolescents with HIV: globally, AIDS-related deaths had declined by 30 percent in recent years, but among pre-teens and teens living with HIV, AIDS-related mortality had risen by 50 percent. And the circumstances in Moshi were no different.

Dow was determined to help turn the tide for these youth, many of whom have access to medication but aren’t taking it. She wanted to figure out why. Watch the video below to hear what Dorothy and her Tanzanian collaborators learned was at the root of this problem and how they and a group of dedicated young adults are tackling it.

Tackling HIV Disclosure in Teens

Many adolescents living with HIV struggle with telling others about their illness—and those who contracted the disease at birth may also have trouble coming to terms with how their illness was disclosed to them. In fact, it’s not uncommon for these adolescents to learn about their disease on their own.

Many of these youth found out their HIV status on the tails of a parent dying, or in an abrupt way that was really hurtful to them. And they’ve never really unpacked what that felt like. —Dorothy Dow

Fear of disclosing their HIV status to others and negative feelings about how they learned of their illness can contribute to mental health challenges. Watch the video below to hear more about these difficulties and how Sauti ya Vijana (“Voice of Youth”), a peer-led mental health intervention developed by Dow and her team, helps teens work through them.

Reaping Big Benefits from Leadership

The promising outcomes of Sauti ya Vijana—such as increased resilience and reduced viral loads among participants—prompted Dow and her collaborators to create a peer-led HIV education program. The program was designed to be delivered at Teen Club, a monthly clinical and social gathering at two clinics in Moshi for several hundred adolescents with HIV.

Adapted from a program developed by researchers at the Baylor International Pediatric AIDS Initiative, the curriculum covers basic HIV information, why it’s important to take medication, how to deal with stigma and other topics related to the experience of living with HIV.

Some of the Sauti ya Vijana group leaders are now training the new peer leaders, who are all Sauti ya Vijana graduates. Dow and her team suspected that putting peers at the helm would enhance program delivery, but they found that giving the adolescents leadership roles has also benefited the peer leaders themselves in profound ways.

Being a peer group leader has helped me become more self-confident. I’m empowered to do anything I’d like to in the community. —Goodluck Godson Mushi

Watch the video below to hear from peer leader Goodluck and others about what this opportunity has meant for him and his fellow leaders.

Breaking Down Barriers through the Arts

At Teen Club, in addition to engaging in the HIV education program and checking in with doctors, adolescents can connect with each other and express themselves through different forms of art, including dance, drama, painting and music. According to artist, social worker and longtime Teen Club volunteer Emanueli Msuya, the arts truly bring the youth together.

When we’re doing art, the Teen Club participants are really helping each other out. They ask each other questions about issues they’re dealing with in their life. —Emanueli Msuya

Watch the video below to hear more about some of the Teen Club participants’ creative projects—including a snippet from a music video you don’t want to miss!—and how the adolescents’ self-expression contributes to their well-being.

Just the Beginning

Blandina Mmbaga, a pediatrician and director of the Kilimanjaro Clinical Research Institute, has observed dramatic changes in care engagement among adolescents who have participated in Sauti ya Vijana and Teen Club, but she hopes this is just the beginning.

“Given these positive outcomes, I think it’s important for us to connect with other stakeholders and scale up this effort—first within the Kilimanjaro region and eventually to more sites within our country,” said Mmbaga, one of Dow’s key collaborators in Moshi.

And given the many adolescent HIV success stories she’s watched unfold in Moshi over the last few years, Dow is on board with that.

The biggest reward for me has been seeing a youth who’s on the brink of death, with some adherence counseling and mental health care, start to see that they can have hope and they can have a future. That’s when they really start taking their medications and getting better. —Dorothy Dow

Learn More

Check out Dow’s research publications.

Acknowledgements

  • Special thanks to Karen O’Donnell, assistant professor in the Center for Child and Family Policy and the Sanford School of Public Policy at Duke University, who co-designed Sauti ya Vijana with Dow; and Dow’s mentor, Coleen Cunningham, professor of pediatrics and global health at Duke University.
  • Funding for these projects comes from the Fogarty International Center and the Duke Center for AIDS Research.

Story by Susan Gallagher. Videos produced by Ibis Eye Images.

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