HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 16 of 42.

PrEP and adolescents — a complex issue discussed in the fifteenth lecture of the PrEParing course by Dr. Renata Arrington Sanders, Assistant Professor of Pediatrics and Adolescent Therapy at the Johns Hopkins University.

The first part of the lesson was for the PrEP providers and consultants, the second part — for young patients. Here and further we will use the word youth, which we will refer to people of all sexes 13 to 24 years old.

PrEP for teenagers — a provider-focused talk

In 2014 scientists conducted a study among American youth, where they found that every fifth HIV case happens among young people, while 40-60 percent of them do not even know about their positive status. Also, researchers found an 87% increase in the incidence of HIV among young gay and bisexual Latino-American men. The researchers also proposed a mathematical model of epidemic growth, where demonstrated that the risk among young Afro-American MSM to become HIV-positive by 30 years is about 40%.

Adolescents are highly susceptible to HIV, so it is worthwhile to consider expanding in PrEP providing among young people. An important step, Renata Sanders said, was done by the UNAIDS when an “Oral pre-exposure prophylaxis. Questions and Answers” brochure was published in 2015. In this document, the demand for PrEP provided for youth was raised. The proportion of young people among all population on PrEP is 7.6%, and Renata Sanders notes that doctors tend to prescript PrEP to young people who identify themselves as “white” disproportionately more often than for young Afro-American people.

To start a conversation with a client, Sanders recommends the HEEADSSS survey recommended by the CDC:

• Home Environment;
• Education or Employment;
• Eating habits;
• Activities;
• Drugs;
• Sexuality;
• Sexual Health;
• Suicide, Depression, Safety spirituality, and Strength;

Renata Sanders recommends adding to the survey HEEADSSS questions about a possible sexual trauma, a history of possible sexual violence.

After careful questioning, the counselor proceeds to a psychological consultation, educating about ways to maintain sexual health, and the need to use condoms. The consultant also talks about PrEP and how PrEP can help a teenager to stay healthy.

Dr. Sanders also emphasizes the legal aspects of the consultation. It is important for the consultant to understand local legislation, what laws allow to talk about with a teenager, and what is explicitly forbidden. Perhaps local laws will require informed consent of the adolescent’s parents for a consultation.

The first part of the lecture finishes with an emphasis on the need for an interdisciplinary approach to counseling on PrEP for a teenager. For a consultant, it is important to focus not only on the pill and pill-related details but also on psychological, social and legal issues. Sometimes a team of PrEP consultants will expect a social worker or a “PrEP navigator” to be involved, as many adolescents face stigma, shame, and racism. After PrEP is prescribed, it is advisable to assign visits once every two or three weeks.

It is also important not to lose contact with the young patient and use phone calls, SMS messages, mobile instant messengers and social networks to support a trusting relationship between a counselor and a teenager. It is possible to use mobile applications and special chat-bots engaging an adolescent in the dialogue about PrEP and adherence to treatment in an accessible and fascinating form.

PrEP for teenagers — a patient-focused talk

In a patient-centered lecture about providing PrEP for a youth audience, Dr. Renata Sanders talks about PrEP in a straightforward and youth-friendly way. We will not retell this lecture, as the most important points have already been covered on the blog. It is important to understand the speech that adolescents and young people need an individual approach, they need to be interested, carried away, explained that the risk of HIV transmission could concern their lives, and modern methods can prevent this risk.

The growth of new HIV cases among young people aged 13 to 24 years remains high and in many countries are still growing, and up to 60 percent of adolescents and youth are not even aware of their HIV-positive status and are not aware of current strategies for preventing HIV transmission.

Therefore, regular HIV testing is necessary, and if you are young and often practice unprotected sex, or often change partners, or take injecting drugs, you should think about pre-exposure pre-exposure HIV prophylaxis — PrEP.

As for the PrEP providers, they should pay more attention to such electronic communication channels as social networks, mobile messengers, applications for online dating, video blogs of Internet stars, interactive chat-bots, augmented virtual reality systems and even computer games.

For today, the review is completed, if the information you read in the article seems to be important — please, share it on a social network or send it to friends by email or via Whatsapp, Viber, Telegram or another messenger.

Tomorrow we are waiting for the third day of the third module. If you have not already signed up for the PrEParing course on the Coursera platform, it’s never too late to do it, just follow the link https://www.coursera.org/learn/prep.

Stay with us and stay healthy!