Systematic review of scientific literature

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1 Systematic review of scientific literature Sexual and reproductive health and reproductive rights of adolescents and youth with HIV/AIDS Neilane Bertoni - October

2 It s good for people to know that adolescents with HIV... date, kiss, joke, go the cinema... Some people think they re ill... but never mind them, life goes on! (Sara) - in Paiva et al. (2011) PAIVA, Vera et al. A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado. Ciênc. saúde coletiva [online]. 2011, vol.16, n.10

3 Ministry of Health Definition of Sexual and Reproductive Rights: Sexual Rights and Reproductive Rights relate to many aspects of life : power over one s own body, health, freedom to live one s sexuality, motherhood and fatherhood. This cannot be different for adolescents and youth living with HIV/AIDS! But these adolescents/youths require differentiated care!

4 Adolescents/youth living with HIV/AIDS * sexual transmission * vertical transmission * transmission through blood May not have started their sex lives yet In Brazil late diagnosis of cases of vertical (mother-to-child) transmission still exists. In 2010*, 31.8% of vertical transmission cases were diagnosed in adolescents aged 13 or more. Source: Boletim Epidemiológico Aids e DST. 2011

5 Proportion of AIDS cases in males aged 15-24, by exposure category and year of diagnosis. Brazil, Year of diagnosis MSM Heterosexual IDU Hemophiliac Transfusion Vertical Transmission Unknown 34,218 new cases were reported in 2010, with a national incidence rate of 17.9/100,000 inhabitants. Over the last 12 years the incidence rate has stabilized in Brazil as a whole, but regionally the rate has decreased in the Southeast Region and increased in the country s other four regions.* Source: Boletim Epidemiológico Aids e DST. 2011

6 OBJECTIVE The aim of this study is to perform a systematic review of scientific literature published between 2000 and 2013, on sites of an academic/scientific nature, such as portals, periodical publications databases, digital/virtual libraries, cyberspaces, about sexual and reproductive health and reproductive rights of adolescents and youth with HIV/AIDS. It is important to know the wishes and the rights of these individuals in order for policies to be formulated or better applied in this segment of the population.

7 WORK METHOD Theme: sexual and reproductive health and reproductive rights of adolescents and youth with HIV/AIDS Identification of databases and identification of keywords Definition of search strategy and selection criteria for articles/texts Searching in chosen databases using selected keywords Exclusion of articles/texts not meeting the selection criteria correctly Critical analysis of the results of the selected articles/texts Preparation of text (report) organizing and summarizing the results of the selected articles/texts

8 WORK METHOD Sources searched: - Medline/Pubmed - Scielo - IBICT/BDTD (Brazilian Digital Library of Theses and Dissertations) - Google Scholar Period analysed: Keywords: Combinations of the following expressions - adolescent or teenager or youth; - HIV or AIDS; - reproductive choice; - reproductive health; - sexual behavior - sexual health.

9 RESULTS Texts found: 1085 Pubmed = 846 Scielo = 103 BDTD = 23 Google Scholar = 113 Criteria adopted for exclusion: - texts duplicated in databases (n=66) - did not address adolescents/youth as the main theme (n=76) -were not in Portuguese or English (n=1) - broken link / unable to access (n=11) - were not about adolescents/youth living with HIV/AIDS (n=848) - did not directly address the sexual and reproductive health of adolescents/youth living with HIV/AIDS (n=18) Total selected for analysis: 65

10 RESULTS Of the 65 texts selected, only 5 dealt with HIV+ adolescents/youth in Brazil. Given that contexts influence individual s behaviour, reflecting on public policies taking foreign evidence as a basis might not produce the desired effect. The need exists to invest in national production. In addition, 4 of the 5 Brazilian studies used qualitative methods and one used data from the medical records of 15 adolescents. The need exists to invest in nationally representative production.

11 BRAZILIAN STUDIES As there are few studies, the themes are limited: - Sexuality and HIV/form of infection - Disclosure of HIV status - Pregnancy

12 BRAZILIAN STUDIES Sexuality and form of infection... -Citation from a Brazilian study: Sexuality for adolescents who contract HIV sexually is also related to difficulties in dealing with sexuality after finding out their HIV status. In the case of adolescents infected through mother-to-child transmission, acceptance and coming to terms with the disease were the most present elements. Camila Perini dos Santos. A sexualidade dos adolescentes que (con)vivem com HIV: implicações para as práticas de cuidado de enfermeiros. Dissertação de Mestrado. Universidade do Estado do Rio de Janeiro. 2012

13 BRAZILIAN STUDIES Disclosure of HIV status... Another Brazilian study found that out of 12 adolescents interviewed at a STD/AIDS reference centre, 5 were aware of their HIV status and 7 were not. The lack of the adolescents knowledge about their clinical and physical status arises both from the family or guardians asking for it not to be disclosed and also from health professionals being unprepared to disclose diagnosis and care for these adolescents. Maria da Graça Camargo Neves. Adolescentes infectados por transmissão vertical : percepções sobre o exercício da sexualiadade. Dissertação de Mestrado. Universidade de Brasília

14 BRAZILIAN STUDIES Another study adds: Despite the initial negative impact, disclosure [of HIV status] had positive repercussions on health care, with improved dialogue with carers and services. The adolescents also emphasized the need to receive clear and honest information. MARQUES, Heloisa Helena de Sousa et al. A revelação do diagnóstico na perspectiva dos adolescentes vivendo com HIV/AIDS e seus pais e cuidadores. Cad. Saúde Pública [online]. 2006, vol.22, n.3

15 BRAZILIAN STUDIES Sexuality and HIV+... Citation about a group of adolescents who were aware of their HIV status... The narratives describe how they learned to deal with sexuality and the anxiety of disclosing their HIV status in this context. The narratives highlight unpreparedness, lack of information about prevention and lack of support to cope with the situation, in addition to the stigma and discrimination intermingled in most of the difficulties reported. PAIVA, Vera et al. A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado. Ciênc. saúde coletiva [online]. 2011, vol.16, n.10

16 INTERNATIONAL STUDIES The themes are much broader (prevalence and behaviour studies) Comparisons between those with perinatal infection and those with sexual/blood infection; Comparison between boys and girls Sub-group analyses, like MSM; HIV+ youth perception regarding sexuality and fertility; Longitudinal studies; etc.

17 INTERNATIONAL STUDIES Behaviours... Adolescents behaviour is influenced by their network of friends. One study found association between adolescents having an active sex life and their friends considering this to be cool or because it made them more popular. As such, prevention programmes should always address the issue of adolescents social networks. Standing out in this study was the finding that the HIV+ adolescents were less likely to be sexually active or to have sex with penetration. Bauermeister JA, Elkington K, Brackis-Cott E, Dolezal C, Mellins CA. Sexual behavior and perceived peer norms: comparing perinatally HIV-infected and HIV-affected youth. J Youth Adolesc Sep;38(8):

18 INTERNATIONAL STUDIES Relationships... Study conducted in the United States with 35 HIV+ young adults. The majority of those who disclosed their HIV status to a partner experienced rejection, although some did receive support. Some individuals had never disclosed their status and had found ways to get round the situation: postponing dates, taking it easy or even bringing the relationship to an end. Fair C, Albright J. "Don't tell him you have HIV unless he's 'the one'": romantic relationships among adolescents and young adults with perinatal HIV infection. AIDS Patient Care STDS Dec;26(12):

19 INTERNATIONAL STUDIES Information... Study in Zambia with 11 HIV+ adolescents: Adolescents are determined not to let HIV change their lives. They want to receive information about sexual and reproductive health and information about HIV, but the services do not offer this information in the necessary and appropriate manner. The study confirmed that people s social networks have a significant impact on treatment adherence. Hodgson I, Ross J, Haamujompa C, Gitau-Mburu D. Living as an adolescent with HIV in Zambia -- lived experiences, sexual health and reproductive needs. AIDS Care. 2012;24(10):

20 INTERNATIONAL STUDIES Pregnancy... Study in the United Kingdom and Ireland with perinatally infected young people: Out of 252 young females being treated by health services, 30 became pregnant (16%). These 30 women had 42 pregnancies. Around 80% stated that the pregnancy was not planned; Half of them said their partners did not know their HIV status; Half of them aborted (14% miscarriages and 36% abortions) Kenny J, Williams B, Prime K, Tookey P, Foster C. Pregnancy outcomes in adolescents in the UK and Ireland growing up with HIV. HIV Med May;13(5):304-8.

21 To finalize... For as long as omission in the face of difficulties persists, desires will continue to emerge and will continue to be managed without the necessary information and support, causing unnecessary suffering and going against the comprehensiveness and humanization that have been sought in building the Unified Health System (Sistema Único de Saúde). - Paiva et al., 2011 Additional studies are therefore necessary, principally in Brazil. Essential information contained in: Recomendações para a Atenção Integral a Adolescentes e Jovens Vivendo com HIV/Aids (Ministério da Saúde, 2013) (Recommendations for Comprehensive Care for Adolescents and Youth Living with HIV/AIDS, Brazilian Ministry of Health, 2013).

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