Teens' Unplanned Pregnancies
posted: 04/05/2010
Around one in seven adolescent females with HIV became pregnant, according to a recent check at UK HIV clinics. Most of the pregnancies were unplanned and a quarter were ended. Although there were problems with adherence to HIV treatments medication among many of the young women, none of the women transmitted HIV to their baby.
These pregnancies highlight the need for sexual health education for young people who acquired HIV from mother-to-child transmission in the 1980s and 1990s. To help health professionals with this work, the HIV in Young People Network (HYPNET) and the Children’s HIV Association (CHIVA) have just produced a draft guide for managing the sexual and reproductive health of HIV+ adolescents.
19 clinics responded to a survey of all mother-to-baby infected young women aged twelve or over. There were 172 young women, and 27 young women had a total of 36 pregnancies.
Of the 36 pregnancies:
- 75% were unplanned
- 86% involved regular partners
- 39% of partners were not aware of the woman’s HIV status
- 25% of the pregnancies were terminated
- 14% ended in miscarriage
- 50% resulted in a live birth and
- 11% were still pregnant at the time of the report.
Most mothers had detectable HIV
Of the 18 live births, 89% of the mothers were on combination therapy at the time of delivery.
In only 8 (44%) of the live births did the mother have an undetectable viral load of <50 copies/ml before delivery. 80% of mothers had poor adherence to treatment during pregnancy, with two being given Directly Observed Therapy (DOT).
One third of the babies were premature and five required neonatal intensive care. Three had a low birth weight. No congenital anomalies were reported. No cases of HIV transmission were recorded.
Two-thirds of the young mothers were reported as having complex social needs, with one quarter of their babies requiring foster care.
Draft guidelines
The first ever guidance for managing the sexual and reproductive health of HIV-positive adolescents has been produced. The document makes it clear that, even if the issue is not raised by the young person, then paediatricians should take responsibility for covering sexual health education and needs during consultations, with the process starting well before sexual maturity is reached. The guidance states that HIV-positive adolescents require the same sexual health information as their HIV-negative peers, as well as further help on applying it while living with HIV.
Topics which need to be discussed include preventing the transmission of HIV and other sexually transmitted infections; contraception; symptoms and treatment of sexually transmitted infections; vaccinations; HIV disclosure; post-exposure prophylaxis; conception options and fertility issues; pregnancy and avoiding mother-to-child transmission; options if there is an unplanned pregnancy; sexual exploitation and sexual violence; sexual difficulties; psychological support for negotiating safe sex, self-assertion, bullying or other issues.
How to work with young people with HIV
The guidance explores some of the issue involved in delivering sexual health work with this age group. Sexual health services for young people should be confidential (without disclosure to a parent or guardian), provided that the young person is assessed as being ‘Gillick competent’ (has the maturity to make their own decisions and to understand the implications of them). For under 16s, Gillick competence needs to be assessed at each clinical visit as it can change over time.
The guidance notes that adolescents value consultations that are non-judgemental, give them correct information and which maintain confidentiality. Professionals are encouraged to use simple language, check understanding and not overload adolescents with too much information. They should not make assumptions about whether the young person is sexually active or what their sexuality is.
The draft guidance is open for comments and feedback until May 28.
Source with references
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