We’re to blame for surge in HIV infection among teenagers

Sabina* sat forlornly outside the comprehensive care clinic, her right elbow on her knee and her thumb rubbing her temple. To say she was devastated was an understatement. Her daughter Paula* sat next to her fidgeting on Sabina’s phone. It was Paula’s first visit to the clinic as a patient! 

Sabina had a million questions for the universe but she was getting no answers. Her little flower was seated here today, joining Sabina’s journey. She felt like a failure. 

You see, Sabina was diagnosed to be HIV positive in 2003. She had a bad bout of chronic cough and weight loss and was eventually diagnosed to have tuberculosis (TB). With the diagnosis came testing for HIV and confirmation of the HIV infection. Luckily, Sabina was able to get on treatment for both TB and HIV and she made a slow but steady recovery.

A few weeks later, Sabina learnt that she was pregnant with her second child. It was a rough ride and unfortunately, Sabina lost her unborn angel at 16 weeks. With a lot of trepidation, Sabina took her first-born son, Leonard*, who was six years old then, for testing. She was overjoyed to learn that he was HIV negative.

Sabina never had the courage to try again to have a baby. She had gone through a really difficult time with her spouse, mending things on the home front but she was not ready have a baby with their status. Unfortunately, nature had other plans and an unfortunate condom accident led to the arrival of their precious Paula.

The couple followed the doctors’ instructions to a T. Sabina faithfully took her medications and attended all her clinics. She was advised to deliver by caesarian section as back then it was highly encouraged, based on the available data. Paula never breastfed but was bottle-fed with formula for the first six months of her life. The end result was that Paula remained HIV-free, an outcome that gave her parents so much joy!

Unfortunately, when Paula was just 15, her father and older brother were involved in a tragic accident that led to loss of their lives. Sabina and Paula mourned differently, with Paula having the adolescent phase getting the better of her. She had lost the two favourite men in her life and she was at sea.

Sabina tried everything to save her baby from herself without much success. Therapy sessions did not help; family support did little to tame her rebellious streak. Sabina was bereft. She resulted to praying for her daughter. She even forgot about her own pain.

It was therefore an arrow in her heart to find out that her little one had become sexually active. Sabina, who had never disclosed to her daughter about her status, found it very hard to have sexuality conversations with her. She sought help from the doctors she knew but Paula would not agree to see them.

Paula finished high school when she was just turning 17. She ended up being even more daring. She hung out with her friends all weekend, in house parties and clubs, drinking and trying out new things. Sabina had no control over her daughter’s lifestyle.

When it was time for Paula to report to university, Sabina took her for her medical examination and requested that she gets tested for HIV too. Paula had no objection. That was until the results turned out positive. Sabina was broken while Paula was shaken.

Sabina’s biggest pain is thinking about the effort she put to protect her baby from having to live with a chronic disease, and for what? Here she was, almost an adult, having gotten the infection all by herself, throwing Sabina’s efforts right back in her face!

Sabina is quite comfortable living with her status. She long accepted that this was her life, embraced her status and lived positively. She had achieved many things in her life, but top on her list was her commitment to protecting her daughter successfully. She did not want her daughter to have to live with the commitment of daily medication and constant doctors’ visits if she could avoid it. Yet this did not come to pass.

Looking at the Kenya Demographic Health Survey, it is clear that the only time we look at health indicators for adolescents, it is always with regard to the outcomes of their sexuality: number of sexual partners, condom use, contraceptive access, adolescent pregnancy and HIV indicators.

What is concerning is that as a county, we have steadfastly ignored the key intervention required in addressing these indicators; comprehensive sexuality education. Talking to adolescents in various schools across the country, one thing is clear, the life skills curriculum implementation is not uniform, neither is it adequate to address our children’s needs.

Our children are growing in very diverse cultures and backgrounds. There is no one size that fits all in their sexuality education. The curriculum implementation must be contextualised to each cohort of children. Its mainstay should not be to empower the children about the biology of reproduction or to instil fear in them regarding sexually transmitted infection, but rather how to embrace their developing sexuality and develop a value system that they reach out to in their decision-making, with regard to sexual behaviour.

We are busy telling the children to avoid rotten fish instead of focusing them on how to identify fresh fish and keep it fresh. For our generation – Z, their curiosity to seek answers for themselves far outweighs their fears. They will put their fingers in the fire just to be sure it is hot before they believe you. It means our traditional scare tactics won’t work.

We do have to start the actual candid conversations with our children regarding sexuality. They must feel that they are part of the decision-making process so that it is a joint effort in keeping them safe. This is the only way we can save many more from going down Paula’s path. We did not fight so hard to have the born HIV-free only for them to join the rising statistic of adolescents at risk!

Dr Bosire is an obstetrician/ gynaecologist