“Let's Talk about Sex”: A Qualitative Study of Rwandan Adolescents' Views on Sex and HIV

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Abstract

Objective

This qualitative study explored the views and experiences of adolescents with perinatally acquired HIV in Kigali, Rwanda, regarding sex, love, marriage, children and hope for the future.

Design

The study enrolled 42 adolescents who had received combination antiretroviral therapy for at least 12 months, and a selection of their primary caregivers. Study methods included 3 multiple day workshops consisting of role-playing and focus group discussions (FGDs) with adolescents, 8 in-depth interviews with adolescents, and one FGD with caregivers.

Results

The adolescents reported experiencing similar sexual needs and dilemmas as most other adolescents, but with an added layer of complexity due to fears related to HIV transmission and/or rejection by partners. They desired more advice from their parents/caregivers on these topics. Although they struggled with aspects of sex, love, marriage and having children, most agreed that they would find love, be married and have children in the future. The two most discussed HIV-related anxieties were how and when to disclose to a (potential) sex/marriage partner and whether to have children. However, most adolescents felt that they had a right to love and be loved, and were aware of prevention-of-mother-to-child-transmission (PMTCT) options in Rwanda. Adolescents generally spoke about their future role in society in a positive manner.

Conclusion

Strengthening the life skills of HIV-positive adolescents, especially around HIV disclosure and reduction of HIV transmission, as well as the support skills of parents/caregivers, may not only reduce onward HIV transmission but also improve quality of life by reducing anxiety.

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Most cited references 13

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Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

Webster Mavhu, Jessica Berwick, Petronella Chirawu … (2013)

Background There is a recognized gap in the evidence base relating to the nature and components of interventions to address the psycho-social needs of HIV positive young people. We used mixed methods research to strengthen a community support group intervention for HIV positive young people based in Harare, Zimbabwe. Methods A quantitative questionnaire was administered to HIV positive Africaid support group attendees. Afterwards, qualitative data were collected from young people aged 15–18 through tape-recorded in-depth interviews (n = 10), 3 focus group discussions (FGDs) and 16 life history narratives. Data were also collected from caregivers, health care workers, and community members through FGDs (n = 6 groups) and in-depth interviews (n = 12). Quantitative data were processed and analysed using STATA 10. Qualitative data were analysed using thematic analysis. Results 229/310 young people completed the quantitative questionnaire (74% participation). Median age was 14 (range 6–18 years); 59% were female. Self-reported adherence to antiretrovirals was sub-optimal. Psychological well being was poor (median score on Shona Symptom Questionnaire 9/14); 63% were at risk of depression. Qualitative findings suggested that challenges faced by positive children include verbal abuse, stigma, and discrimination. While data showed that support group attendance is helpful, young people stressed that life outside the confines of the group was more challenging. Caregivers felt ill-equipped to support the children in their care. These data, combined with a previously validated conceptual framework for family-centred interventions, were used to guide the development of the existing programme of adolescent support groups into a more comprehensive evidence-based psychosocial support programme encompassing caregiver and household members. Conclusions This study allowed us to describe the lived experiences of HIV positive young people and their caregivers in Zimbabwe. The findings contributed to the enhancement of Africaid’s existing programme of support to better promote psychological well being and ART adherence.

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Living Situation Affects Adherence to Combination Antiretroviral Therapy in HIV-Infected Adolescents in Rwanda: A Qualitative Study

Philippe R. Mutwa, Jennifer Van Nuil, Brenda Asiimwe-Kateera … (2013)

Introduction Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), and in-depth interviews (IDI)) to better understand adherence barriers for Rwandan adolescents. Forty-two HIV positive adolescents (ages 12–21) and a selection of their primary caregivers were interviewed. All were perinatally-infected and received (cART) for ≥12 months. Topics discussed during FGDs and IDIs included learning HIV status, disclosure and stigma, care and treatment issues, cART adherence barriers. Results Median age was 17 years, 45% female, 45% orphaned, and 48% in boarding schools. We identified three overarching but inter-related themes that appeared to influence adherence. Stigma, perceived and experienced, and inadvertent disclosure of HIV status hampered adolescents from obtaining and taking their drugs, attending clinic visits, carrying their cARTs with them in public. The second major theme was the need for better support, in particular for adolescents with different living situations, (orphanages, foster-care, and boarding schools). Lack of privacy to keep and take medication came out as major barrier for adolescents living in congested households, as well the institutionalization of boarding schools where privacy is almost non-existent. The third important theme was the desire to be ‘normal’ and not be recognized as an HIV-infected individual, and to have a normal life not perturbed by taking a regimen of medications or being forced to disclose where others would treat them differently. Conclusions We propose better management of HIV-infected adolescents integrated into boarding school, orphanages, and foster care; training of school-faculty on how to support students and allow them privacy for taking their medications. To provide better care and support, HIV programs should stimulate caregivers of HIV-infected adolescents to join them for their clinic visits.

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Successful paediatric HIV treatment in rural primary care in Africa

N Janssen, J Ndirangu, M-L Newell … (2009)

Objective Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme. Design Clinical cohort. Setting KwaZulu-Natal, South Africa. Patients HIV-infected children aged ≤15 years on ART, June 2004–2008. Main outcome measures Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan–Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6–12 months' treatment were calculated. Results 477 HIV-infected children began ART at a median age of 74 months (range 4–180), median CD4 count (CD4%) of 433 cells/mm3 (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p 60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1). Conclusions Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.

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Author and article information

Contributors

Rashida A. Ferrand: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 5 August 2014

Volume: 9

Issue: 8

Electronic Location Identifier: e102933

Affiliations

[1 ]Rinda Ubuzima, Kigali, Rwanda

[2 ]Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands

[3 ]Department of Pediatrics, Kigali University Teaching Hospital, Kigali, Rwanda

[4 ]Department of Obstetrics and Gynecology, King Faisal Hospital, Kigali, Rwanda

[5 ]Center for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands

[6 ]Treatment and Research on HIV/AIDS Center, Kigali, Rwanda

[7 ]Utrecht University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

[8 ]Biomedical Research, Epidemiology Unit, Royal Tropical Institute, Amsterdam, The Netherlands

London School of Hygiene and Tropical Medicine, United Kingdom

Author notes

* E-mail: Jennifer.Van-Nuil@ 123456liverpool.ac.uk

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: PRM EK JV RP PR SPG JVDW KRB. Performed the experiments: PRM JR CK KRB. Analyzed the data: JIVN PRM BAK EK KRB. Wrote the paper: JIVN PRM BAK EK JV RP PR SPG JVDW KRB.

[¤a]

Current address: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom

[¤b]

Current address: Department of Anthropology, Wayne State University, Detroit, Michigan United States of America

[¤c]

Current address: Grants and Research Support and Training Center, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

¶ JVDW and KRB are joint senior authors on this work.

Article

Publisher ID: PONE-D-14-04622

DOI: 10.1371/journal.pone.0102933

PMC ID: 4122382

PubMed ID: 25093572

SO-VID: 68f66b09-ebcc-4e7c-bc01-ce58e160239b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 30 January 2014

Date accepted : 26 June 2014

Page count

Pages: 6

Funding

This study was funded by The Netherlands-African partnership for Capacity development and Clinical interventions against Poverty-related diseases (NACCAP) and the European Developing Countries Clinical Trials Partnership (EDCTP). NACCAP: http://www.nwo.nl/en/research-and-results/programmes/NACCAP. EDCTP: http://www.edctp.org/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

“Let's Talk about Sex”: A Qualitative Study of Rwandan Adolescents' Views on Sex and HIV

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Abstract

Objective

Design

Results

Conclusion

Related collections

PLOS Climate

Most cited references 13

Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

Living Situation Affects Adherence to Combination Antiretroviral Therapy in HIV-Infected Adolescents in Rwanda: A Qualitative Study

Successful paediatric HIV treatment in rural primary care in Africa

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