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Uganda: Adolescents Living With HIV/Aids Find Solace

October 1, 2009: The Transition Clinic, also called Young Adults Clinic, provides specialised HIV/Aids or psychosocial support to young adults living with HIV. Eunice Rukundo visited the clinic to find out about their activities and also spoke to two adolescents on how they are coping.

Wednesday is Transition Clinic day at Mulago Hospital's Infectious Diseases Institute (IDI). The majority of patients making the rounds in the institute corridors that day are the youth. A few sit forlornly and look really ill, but the majority eagerly cluster in groups, intimately chattering away. Occasionally, they break into suspicious giggles, just like normal children their age group.

There is a feeling of being in family among these healthy looking youth, you wonder what they are doing at a hospital. What you would never suspect is that these adolescents are living the HIV/Aids nightmare in its ugliest state. Transition clinic, also called Young Adults Clinic (YAC), provides specialised HIV/Aids care and psychosocial support to adolescents or young adults living with HIV/Aids (YALWHIV). Wednesday is when they meet for medical reviews, free ART replenishments and counselling or peer support discussions and activities.

Currently registered to its full capacity of 480 youths, YAC was opened by the Infectious Disease Institute (IDI) in July 2008 with a Shs2m grant from Civil Society Fund (CSF). "Needs assessment surveys done continuously highlighted a need for specialised care for this age group that they don't get from the paediatric or adult HIV care centres," explains Dr Timothy Muwonge, one of the volunteering doctors at the clinic.

It is this specialised care that the clinic was meant to provide; it was meant to cater for the unique needs of the YALWHIV from their late adolescence through adulthood. Only 16-24 year olds are admitted to the clinic, most of them on reference from where they do the HIV tests. Here, these youth can feel at home with each other, united by a common problem, which is not the case when they have to share adult clinics.

The IDI surveys reveal that YALWHIVs don't for instance want to blend into the adult centres because they are ashamed of their status, or have kept their status secret. A 19-year-old YALWHIV also tells me he is so far the only one that knows his positive status and wouldn't go there in case he met a family friend or relative who would later disclose his secret.

Others say they feel stigmatised by the condemning looks from adults, some even openly asking how they come to be infected so young. "They also find the centres congested and will most likely miss out on appointments dodging their relatives and friends at the clinics," adds Dr Muwonge.

You can't help but notice that there are more females than males, actually 81.4 per cent females compared to 18.6 percent males of the total number of adolescents at the clinic. "It is a natural tendency for women to readily seek help unlike men who would rather keep to themselves until it is unbearable but there are more males also infected out there," the doctor says.

Activities at the clinic

According to Julius Nkurayija, the YAC project coordinator, the youth get advice and information material on family planning, get counselled and hold regular peer support group meetings to address issues like disclosure and stigmatisation or any other issues and problems.

"We also set aside every second Saturday after two months to address any social issues they may be facing," he adds. Of course sex-related issues are common, especially concerning sexual relations with uninfected partners, since most say they don't want to be engaged with fellow PLHAs. "I would like to know that when I die, my children will have at least one parent alive to care for them. You can't guarantee that with an infected partner," argues one 21-year-old at the clinic.

Finances are the next biggest problem, especially since most who come to this clinic are semi or illiterate adolescents without parents or decent means to fend for themselves, most depending on men. "You will not find the typical urban youth here because those don't need the free treatment; they can afford private treatment," explains Muwonge.

One of the girls, a 22-year-old with a three-year-old daughter, tells about how she sometimes fails to make it from Kisaasi, a Kampala suburb, to Mulago on Wednesday because she can't afford the transport fare. Nkurayija says to address this problem, the clinic has endeavoured to equip the adolescents with skills like carpentry and catering services, which would enable them to become financially independent.

The clinic uses the peer support and education approach for positive prevention. The young adults, other than being encouraged to play a role in limiting the spread of the virus, are taught to become peer educators. As the doctor explains, they will be better placed to reach their fellow youth.
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The clinic unfortunately complains about a shortage of internal capacity to train young adults as agents of Behavior Change Communication, alongside an increasing number of YALWHIVs. There is also a problem with continuity as there is nowhere specific to send the youth that outgrow the clinic, hence the few 25-year-olds still lurking about the place. "But we want them to move on so we can help others, since our maximum capacity is only 480 youth at a time. We hope to grow bigger though and maybe provide a continuity facility but it will take some time," says Muwonge.

In the meantime though, the clinic's achievements to the YALWHIVs are clearly expressed by one 19-year-old senior six vacist; "From here, I have gained the strength to move on. I know that I'm not the only one and the whole world is not against me because I'm sick; there are people who would actually genuinely like to help me."

 

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