Significant number of adolescents are sexually active. The concerns is not only about their risk for unwanted pregnancies by also their risk for HIV.
UNAIDS wrote in its document titled ‘Towards a global HIV prevention coalition and road map’ that: Despite the massive roll-out of HIV treatment in recent years—and the availability of a broad array of effective prevention tools and methods—new HIV infections among adolescents and adults have been declining far too slowly: more than 1.8 million new infections still occur every year worldwide, including more than 1.6 million among adolescents and adults. The number of new infections among adolescent girls and young women in high-prevalence countries in sub-Saharan Africa remains particularly alarming, despite signs that incidence among girls may have started to decline.
There are tools adolescents can use to prevent unwanted pregnancies and also prevent HIV infection. One of the major challenges for adolescents is access to these tools – condom for prevention of HIV infection and unwanted pregnancies; hospital access to treat sexually transmitted infections to prevention STI; hospital access to contraception; and hospital access to pre- and post-exposure prophylaxis to prevent HIV infection.
For those that have access to commodities, another major challenge is adherence to use of products. These biological tools would require that adolescents use products – medicines, tools – daily. There are many reasons why adherence is a challenge for adolescents. They have to hide to take sexual health products since they often cannot admit to having sex. Others also miss because they are away from home, they forget since they have no buddy to remind them, they are busy.
Recent reports on adherence to pre-exposure prophylaxis for the prevention of HIV show clearly that adherence to products decrease with time for adolescents irrespective of gender and sexual practice. So also is the use of condoms. A recent study published in the BMC Public Health showed that the ability of young women to negotiate sex and use of condom when they are in a relationship characterised by exchange of sex for money and gifts thereby increasing her risk for STI and HIV infection.
One of the ways to go is to produce products that reduce the need for daily adherence – injectable PrEP, PrEP as implants, PrEP as patches and similar contraceptions. While these products are being studied for HIV prevention use, the use of these products by adolescents are limited.
First, documents on contraception limits the adolescents’ use of contraception to short acting one – condoms, pills – products that require adherence. Injections and implants cannot be used. Yet, the ongoing A360 project in Nigeria show clearly that young girls prefer the long acting contraception – implants, injections.
Second, injectable contraception – specifically depo povera – comes with a possible risk of HIV infection. This is still a controversial issue but a risk that users of the product needs to know about to make informed decisions.
Third, there are health concerns with use of long acting contraception for adolescents. Concerns about impact of product with young adolescents’ growth and development. These, and of course lots of myths and misconceptions make health care providers reluctant to prescribe long acting methods for adolescents.
So where does this leave the adolescents in Nigeria. Cultural and religious bias and non-support for adolescents’ access to contraception makes the design and implementation of research with this population challenging. It therefore limits our ability to understand what works best for them.
As the world makes plans to reduce new global HIV infection by 75% in 2020, there is a risk of leaving adolescents in Nigeria behind with the current realities of the challenges and constraints they face with accessing prevention products. Public dialogues are needed. Policy support for contraception products for adolescents are needed. A lot more needs to be done for our girls that they may not be left behind.
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