The HIV Positive Adolescent in a Pandemic Year: A Point of View

*Doina-Carmen Manciuc, Cristina Sapaniuc, Alexandra Largu and Georgiana Alexandra Lacatusu*

### **Abstract**

In the HIV/AIDS Regional Center from Iasi, Romania, over 1440 patients are closely followed-up. A small percent <1% (12 patients) of cases are represented by adolescences between 14 and 18 years old. The majority of those (10 cases) are adherent and compliant with the treatment. None of the patients is a drug abuser and one patient acquired the infection through vertical transmission. The COVID-19 pandemic, paradoxically, increased the adherence and compliance to treatment, mainly because it seems that the HIV infected adolescent acknowledge the fact that good health can shield them from an unknown enemy. In these pandemic times, they experienced anxiety and depression, but they kept a closer contact through telemedicine with their physician, and most importantly, they required a sustained session, also through telemedicine, with the psychologist. The red thread of their discussion was focused on their fear, insecurities, and lack of control and the fact that they experienced the feeling of abandonment caused by the absence of interpersonal interaction with their support group.

**Keywords:** HIV, adolescent, psycho-emotional support, pandemic, COVID-19

### **1. Introduction**

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently reported that in 2020 there were 1.5 million new human immunodeficiency virus (HIV) infections globally, with approximately 700,000 AIDS-related deaths. In 2020, there were 37.7 million people living with HIV. More than 27 million people with HIV were receiving antiretroviral therapy (ART), which has substantially reduced the burden of HIV disease [1].

### **2. Adolescence and HIV**

Adolescence is one of life's critical transitions. The biological and psychosocial changes that take place during this period affect every aspect of adolescents' lives.

In 2020, about 1.75 million adolescents between the ages of 10 and 19 were living with HIV worldwide. Adolescents account for about 5 percent of all people living with HIV and about 11% of new adult HIV infections [2].

All over the world, adolescents that represent the key population groups (including gay and bisexual boys, transgender adolescents, adolescents who sell sex, and

adolescents who inject drugs) have an increased risk of contracting HIV infection. These marginalized groups face discrimination and human rights violations, and they often are excluded from services.

The epidemic among adolescents in key populations conducted the associations that were addressing them, to really understand their different life experiences and making sure that they grow up protected from discrimination and violence. Another key part is represented by the access to HIV testing, prevention, and treatment programs, and also sexual and reproductive health care services. All of this will help them to realize their rights to life and health and to freedom from discrimination [3].

All adolescents have the right to be educated about HIV and to have access to services that will enable them to protect themselves against the infection. All HIV-positive adolescents that acquired the infection whether passed from their mother or during adolescence, have unique requirements and risks. These particular patients have the same entitlement to HIV treatment and care as everyone else. HIV testing and counseling, as well as adolescent sexual and reproductive health services, remain key entry points into the continuum of HIV prevention, treatment, and care for adolescents living with HIV. Adolescents (ages 14–18) living with HIV are a vulnerable group, that statistically have a higher loss to follow-up, an increased possibility to have a virologic failure and higher mortality than adults already diagnosed with HIV/AIDS [4].

In the treatment of HIV, UNAIDS has a clear strategy in the battle against HIV/ AIDS in the United States and the United Kingdom. The 90-90-90 plan included the following objectives:


By 2020, 90 percent of individuals on antiretroviral medication will be virally suppressed.

This strategy seeks to diagnose HIV infection as quickly as is possible once it is acquired, and also to as well as to provide immediate access to HIV treatment. The most crucial thing is that the medication is properly picked and that it protects the HIV-positive patient from complications such as opportunistic infection and the development of cancers [5, 6].

In 2020, 84% of people living with HIV knew their HIV status. Among people who knew their status, 87% were accessing treatment, and among people accessing treatment, 90% were virally suppressed. Of all people living with HIV, 84% knew their status, 73% were accessing treatment [1].

Within the WHO, a dedicated department has been developed–the Department of Maternal, Newborn, Child, and Adolescent Health–that has a solid connection with the HIV lucrative section, and they work together to create guidelines and standards for each country, based on their individual needs. Access to HIV testing services, as well as socio-psychological and professional treatment for those who have been diagnosed with the disease, is necessary for young people is mandatory.

These organizations' reports contain evidence-based recommendations, as well as principles for management, health policies, and programs, in order to accomplish the UN's (United Nations) goals for the HIV pandemic and youth.

They seek to detect and identify vulnerability in the young population, expand access to services and information, and supervise intervention initiatives in schools, health services, and media, among other things. Those in charge of conducting and carrying out these intervention initiatives work as follows:


Johns Hopkins University as well as other world-renowned universities have been active in the support program for low-income states (such as Uganda), where there are significant communities of HIV-positive young people [7].

"The UNAIDS 2011–2015 Strategy: Getting to Zero, the UNAIDS Joint Action for Results: Outcome Framework 2009–2011, and the UNAIDS Business Case 2009–2011 for the priority area on young people present an opportunity to focus on and scale up effective programs for young people, and to create links between partners involved in the response" [7].

Over time, health policies and the implementation of programs, for a long period of time, appeared to have paid off, with UNAIDS reporting a decline in the prevalence of HIV infection among young people and adolescents in low-income countries.

"A trend analysis in HIV prevalence among young people in 2008 revealed that HIV prevalence declined in 15 of the 21 countries most affected by the HIV epidemic. Ten countries showed a statistically significant decline of 25% or more in HIV prevalence that occurred among young pregnant women or men in either urban or rural areas or both" [8].
