Source: jamaica-gleaner.com

Published: Sunday | November 11, 2018 | 12:00 AMNadine Wilson-Harris

A medical review of adolescents with sexually acquired HIV in Jamaica has found that the majority had their first sexual experience between 10 and 14 years old, but in some cases children as young as five years old have also been infected.

This reality is troubling for senior resident in paediatric medicine at the Bustamante Hospital for Children, Dr Kadene Orrigio, who conducted a clinical epidemiology of sexually acquired HIV in adolescents in Jamaica between 2003 and February 2017.

“What was significant is that most of these patients initiated sexual activity between the ages of 10 and 14 years, with the average age being 12.5,” said Orrigio.

“For those who we were able to document the age of their partner, 16 per cent reported that their partners were older males who were greater than 16 years of age,” added Orrigio during the Dr Leila Wynter Commemorative Conference last week at the Bustamante Hospital for Children.

The medical dockets of 53 adolescents who received treatment for sexually acquired HIV at the University Hospital of the West Indies and the Comprehensive Health Centre’s Paediatric and Adolescent Infectious Disease Clinic were reviewed. Of this number, 44 were females and nine were males.

“Of the total number of females that were in the study, 60 per cent had been pregnant once or more, and of note is that several of these patients were diagnosed with HIV after presenting for routine antenatal care,” she said.

“If we are seeing this number of females only presenting at this point in time, then we can be led to infer that there may be several other adolescents out there with HIV, because we don’t routinely do HIV testing in our adolescent population,” added Orrigio.

LIVING ARRANGEMENTS

Only 20 of the adolescents infected with HIV were living with their parents, 10 were living in a children’s home and 15 were living with persons who were neither considered family nor friends. Some lived with an associate of their boyfriend.
“Unprotected sex was seen in approximately 75 per cent of the population, so even though these patients were diagnosed with HIV and they were aware of their status, 75 per cent were still engaging in unprotected sexual activities,” noted Orrigio.

The study indicated that a few of those who acquired HIV had been sent out by their parents to have sex with older men for money.

“Of note is that approximately 50 per cent reported that sexual initiation was forced,” added Orrigio.

The health and well-being of the children under review was given consideration by the senior resident, given that HIV/AIDS is a primary cause of morbidity and mortality in the paediatric population.

According to Orrigio, “The psychological effects were marked in these patients with approximately 50 per cent of our patients exhibiting depressive symptoms and a quarter of the total cohort exhibiting suicidal ideation.”

Immunisation Status

A look at the immunisation status of the patients noted that only six of them had any documentation of receiving the hepatitis B vaccine and none had received the HPV vaccine.
“In reviewing the dockets, there were several persons with early cervical changes that could predispose them to cervical cancer in the long term,” she said.

The adherence of patients to their antiretroviral therapy was also of concern since a review of the clinical data showed that the majority had viral loads more than 10,000.

Only 29 per cent of those whose cases were reviewed are known to be alive while four died based on complications from HIV. About 20 patients had defaulted on their follow-ups.
This concern is compounded by the fact that many of the teens are having unprotected sex.

“In Jamaica, acquisition of condoms by teens are frowned upon as persons are seen as promiscuous and this deters adolescent from buying condom,” said Orrigio, as she noted that, “Being an adolescent, they are not at the point where they can bargain condom use with older partners because it might be seen as a sign of infidelity.”

Based on her findings, the doctor is calling for early and ongoing social intervention for teenagers living with HIV.

nadine.wilson@gleanerjm.com