November 2018

Adolescent Clinic is ‘A Home Away from Home’

Noxolo Motsoari is a 23-year-old female living in Lesotho. After the loss of her parents in 2002 and 2012, she moved to her grandmother’s village in 2015 and then later to stay with her uncle in Maseru to look for a job. In November 2016, she secured a job at a textile factory on the outskirts of Maseru, where she is still working to date.

Noxolo met the love of her life working at the textile factory. She became pregnant and attended antenatal care (ANC). At the clinic, she volunteered to test for HIV and for the first time (in August 2017), learned that she was HIV-positive. “I did not start treatment immediately,” she said. “I went to inform my partner… we were not staying together at that time and then the next day he escorted me to adolescent and youth friendly clinic at Queen Elizabeth II (QEII) hospital and we both counselled and tested for HIV. He was negative and I was HIV positive.” They were a discordant couple.

Noxolo’s partner was informed about different modes of HIV prevention and he opted for taking Pre-Exposure Prophylaxis (PrEP) and using condoms. PrEP can be highly effective for helping people at very high risk for HIV to lower their chances of getting infected by stopping HIV from taking hold and spreading throughout the body (CDC). Meanwhile, Noxolo was told about Prevention of Mother-to-Child Transmission (PMTCT) of HIV. Lesotho uses the Option B+ Guidelines, which means that Noxolo will take antiretroviral treatment to prevent HIV transmission to her infant, whilst also benefitting from lifelong ART for her own health.

Now she and her partner both take their treatments together at the same time every evening. They both seek services at QEII hospital, where she uses the adolescent and youth friendly clinic and he uses the men’s clinic. Noxolo joined the hospital’s adolescent Peer Support Group (PSG) for girls in August 2017 and she currently receives three months’ treatment via Multi-Month Dispensing (MMD). “I was happy to know that even if I am HIV-positive, my baby can be free from HIV through PMTCT,” she added.

I was happy to know that even if I am HIV-positive, my baby can be free from HIV through PMTCT.

PSGs are facilitated by EGPAF youth ambassadors and help to provide psychosocial support to adolescents living with HIV and their caregivers, assist with disclosure of HIV status to the family, ensure treatment adherence, acceptance, and viral load monitoring, and encourage self- care and healthy living. The youth ambassador responsible for Noxolo’s adolescent corner is Mats’epo Mary-Ann “Dee” Mphafi, who started in the same support group and today shares her experiences with other youth at the clinic, in the community, and at international conferences.

Noxolo attributes her positive energy to the adolescent and youth friendly clinic and peer support group. “The adolescent clinic is like a home away from home. It is like a parent who teaches HIV-positive youth on adherence to treatment and give us confidence to disclose our HIV status to families and friends without fear in order to get support.” She explained that the adolescent clinic is different from a general clinic (where clients are a mixture of adults and attended by adult health care workers). At adolescent corners, young people are attended to by young health care workers who they feel more comfortable with.

A major focus of the adolescent PSGs is disclosure. Noxolo said disclosure is not easy due to stigma and discrimination and the fear of being rejected, but added, “Myself, I am not scared to disclose. I have disclosed to my partner, my family and my co-workers and they are all supportive to me.” There are currently 429 adolescents on anti-retroviral treatment at the Queen Elizabeth hospital adolescent and youth friendly clinic (as of September 2018) and about 62% of them have disclosed their status to their parents or guardians.

The adolescent clinic is like a home away from home. It is like a parent who teaches HIV-positive youth…and gives us confidence to disclose our HIV status to families and friends without fear in order to get support.

After six months on ART, Noxolo was tested for viral load; she was told that she is virally suppressed. If taken as directed, HIV medicine can make the HIV in the body (viral load) so low that a test can’t detect it. This keeps the immune system functioning and prevents illness, which means that the HIV is under control (CDC). Having viral suppression also means that the chances of passing on HIV to another individual are greatly reduced, hence treatment is also prevention. Noxolo’s baby was delivered at the hospital. At six and 14 weeks of the baby’s age, she was tested using Early Infant Diagnosis (EID) and tested negative. “I still have a bright future ahead. I can achieve anything with or without HIV and my next step is to go back to finish my high school studies,” she said confidently.

Noxolo and many of her peers are at the stage where they need to be transitioned to adult care. This reflects the importance of having a transition plan at hand to be able to cater for the needs of young people in this age band. Many young people find it difficult to transition, as they find the adolescent and youth friendly clinics are more responsive to their need. Therefore, transitioning should start early and be a gradual process, so that the adolescent is ready when the time comes. Young people should be fully transitioned by age 25.

The adolescent and youth-friendly health services (AYFHS) were established by the Ministry of Health and implemented by staff from the Elizabeth Glaser Pediatric AIDS Foundation with the support of the President’s Emergency Plan for AIDS Relief (PEPFAR).