幸运飞艇计划

Ndolumingo鈥檚 work may well provide a model for use with children and adolescents living with HIV in other settings in Africa and elsewhere.

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Dilemma: Disclosure and better health vs negative stigma

Despite the fact that treatment for HIV is free, and that it results in better health, and ultimately can lead to better school results, there is a particularly strong stigma around people living with HIV in Africa. As a result, people with positive serology generally do not reveal their status to other family members. However, disclosure has been shown to lead to better adherence to the daily drug regimen that holds HIV/AIDS in check, and thus to better health. Untreated HIV/AIDS does not go away and the disease has high social and economic costs, in addition to physical and mental health challenges.

Ndolumingo quoted the 2019 edition of Fundamentals of HIV Medicine (OUP) as saying, 鈥淎dolescents or youth who are living with HIV may have multiple developmental, cognitive, social, contextual, and environmental challenges that impact their identification, linkage, and engagement with care鈥�.

He is a doctor at Kalembe Lembe Pediatric Hospital. It is the only exclusively paediatric hospital in DRC. In 2018, Africa accounted for 68% of the global burden of HIV positive individuals. Adolescents are the only age group where the number of AIDS-related deaths is actually increasing. Ndolumingo undertook a PhD research project to address aspects of this issue. He is particularly interested in the mental health of children and adolescents affected by this dilemma.

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Disclosure decisions

Disclosure is an important component in the comprehensive management of children living with HIV. Poor adherence to treatment is often the main cause of treatment failure. This poor adherence can be a result of non-disclosure or a lack of knowledge about the disease.

In their 鈥溾��, the WHO state that 鈥淒isclosure is crucial to the continuum of HIV care.鈥� The WHO Guidelines further state that:

听鈥溾�� disclosure decisions are complex because of stigma, social support concerns, family relations, parenting skills and concern about children鈥檚 emotional and maturational ability to understand and cope with the nature of the illness.鈥� In many places, clinical experience has shown that children respond better to their illness when they are given appropriate information about their condition.

It is important that Health Care Workers are informed about disclosure challenges, and that they know about and are able to use the WHO guidelines as part of their comprehensive approach to ensuring the well-being of HIV positive children. Ndolumingo鈥檚 first paper underlines the importance of involving and supporting parents in the disclosure process. The overall goal of his research is to improve morbidity and reduce mortality in HIV-positive children.

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Importance of peer-educators

Ndolumingo鈥檚 work (Paper II) shows that when peer educators were involved in positive HIV status disclosure in adolescents, there was better acceptance, better ART adherence and higher self-esteem (or fewer negative mental health effects) among the 鈥樷�漝isclosed鈥� adolescents than the 鈥渘on-disclosed鈥� ones.

A peer educator is an adolescent/young person living with HIV, who knows their own HIV status, who engages in healthy behaviours including good adherence to treatment, and who is also trained in ways of supporting of people living with HIV and how to use the tools of the disclosure process.

Ndolumingo鈥檚 research showed that peer educators helped to motivate more lasting behavioural changes in the 鈥渄isclosed鈥� adolescents. In his conclusions he writes that 鈥渢here were statistically significant differences between disclosure and non-disclosure on quality of adherence of ART therapy and psychological well-being [when peer educators were part of the process]鈥� in terms of reduced viral loads in follow-up measurements.

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Model approach

At his mid-way evaluation where he presented his results thus far, Evaluator Professor Maj-Britt Rocio Posserud, from the Department of Clinical Medicine at 幸运飞艇计划, underlined the importance of this work and said that these results could form the basis of a valuable model for health workers dealing with HIV-positive adolescents in other settings.

Ndolumingo鈥檚 results also indicated other important factors including timing, use of self-support groups, follow-up etc. However, as adolescents tend to resist dominant authority figures (parents, health workers), his results show that the effect of using peer-evaluators in the process is a 鈥済ame changer鈥�.

Ndolumingo鈥檚 work makes an important contribution to DRC coming closer to attaining goal.