Lessons from the Field

Overview

Adolescence is defined by significant socio-emotional changes and vulnerability. Adolescents and youth living with HIV (AYLHIV) experience worse clinical HIV outcomes—adherence, retention and viral load suppression—compared to adults. Novel approaches to implement evidence-based interventions to address their unique needs and life-stage are needed.

Undetectable = Untransmittable (U = U) is important in the comprehensive care of AYLHIV. U = U is a community-driven, evidence-based movement embodying the message that a person living with HIV who has reached and sustained an undetectable viral load (<200 copies/ml) will not transmit HIV to a sexual partner. As AYLHIV navigate friendships, sexual and romantic relationships, and parenthood, U = U may be a powerful tool for safe relationships and motivation for maintaining viral suppression. Limited U = U interventions exist for AYLHIV, especially in Eastern and Southern Africa, where nearly 80% of AYLHIV reside.

Promoting U = U to address self-stigma and accurate knowledge sharing between sexual partners has the power to shape AYLHIV’s ability to live full and healthy lives.

Despite global support and conclusive evidence for U = U, varying levels of awareness, reception and integration in standard clinical practice remain. There is a critical gap in the literature and knowledge regarding how to message and use U = U to empower AYLHIV across sub-Saharan Africa (SSA). We embarked on creating a tool to address this gap and subsequently aimed to understand how this tool is being used and whether it is relevant to AYLHIV around U = U.

U=U Graphic Novel

The Elizabeth Glaser Pediatric AIDS Foundation’s (EGPAF) Committee of African Youth Advisors (CAYA) developed an innovative U = U tool in partnership with researchers at the University of Cape Town.

CAYA engages 15- to 29-year-old youth from 11 SSA countries. CAYA identified U = U as a priority in their 2022 prioritization survey. Members completed initial surveys on U = U knowledge and awareness, informing skill-building sessions. CAYA previously developed cartoon-based tools on HIV-treatment literacy, which are routinely used in AYLHIV programming and positively received. In discussions on format, CAYA preferred the tool to be visually appealing, relevant, youth-friendly and use simple language. CAYA, therefore, decided to create a U = U graphic novel. Graphic novels and comic books can be effective in delivering clinical information to youth and can be integrated into individual/group-based programming. A graphic novel, compared to a video, can be utilized in various ways—role plays, individual/group reads, play-acting and so on, for participatory-based learning. Paper-based tools are useful as not all health facilities and adolescents have access to reliable technology or connectivity for standardized use of video-based learning.