In India, adolescents younger than 18 years old need parental consent to access human immunodeficiency virus (HIV) testing [1]. Studies show that healthcare provisions and facilities for teenagers in Tamil Nadu need to be improved [2].
Introduction
In India, adolescents younger than 18 years old need parental consent to accesshuman immunodeficiency virus(HIV) testing [1]. Studies show that healthcare provisions and facilities for teenagers in Tamil Nadu need to be improved [2]. Indeed, only 26.17% of young Indians know about HIV prevention [1]. However, according to UNICEF, “primary prevention among young people is the greatest hope to change the course of HIV epidemic in India” [3]. Thus, adolescents are identified as a priority by the National AIDS Control Organization (NACO) in its strategic plan for 2017–2024 [4]. These disparities led us to ask the following question: What is the current level of awareness and prevention of HIV among adolescents in Coimbatore, Tamil Nadu?
Methods
We conducted a literature review and two semi-directed interviews in Switzerland with a physician and a nurse specialised in HIV. In India, 14 semi-directed qualitative interviews were conducted. Our sample consisted of one governmental officer, four non-governmental organisation (NGO) actors in public health, two physicians, one faith leader, two independent prevention volunteers, three teachers and one school assistant director. The sample was selected by our academic partners in India, according to our plan. In addition, we had five informal discussions and twice participated as observers during an awareness programme, and we did an ethnographic study of condom accessibility and information found in the media. In accordance with ethical requirements, we did not interview teenagers under 18 or patients.
Results
Our results on the HIV prevention system among adolescents are summarised in figure 1. All the interviewees agreed that Tamil Nadu is a reference in terms of prevention. Indeed, the incidence and prevalence of HIV are decreasing in the state [1]. Active HIV prevention programmes start in colleges when students are above 18 years old. Nevertheless, school-based measures to raise HIV awareness are provided from around 13 years old. Schools are the main places where the subject is discussed. We identified two categories of actors engaged in HIV awareness in schools. The first is those directly involved in education. Their programmes focus mostly on blood and parent-to-child transmission, but the sexual aspects are left out. Although sexuality is not directly addressed, teachers try to promote caution by talking about the difference between “good and bad touch” or through videos, but without context this may be confusing for adolescents. In addition, the 10th grade science book includes a chapter on HIV, but the terms used are too technical for adolescents, and it contains misleading information regarding the transmission of HIV (e.g., that the virus spreads through contact of body fluids). The second category of actors is external institutions, which address HIV in more depth, including sexual transmission, through child-friendly approaches. However, this kind of programme is not implemented in every school and is rather rare.
The following barriers to teaching HIV prevention in school were noted: lack of time due to the academic burden; the fact that it is not mandatory in syllabuses; reluctance of some schools and parents; inaccurate information in the media, which can lead to misconceptions or even risky behaviours; social and cultural taboo of sexuality; stigmatisation and fear of being branded; and low funding.
Figure 1: Prevention system among adolescents in Tamil Nadu.
Finally, the interviewees made various suggestions to improve teenagers’ knowledge and empower them, such as starting education on HIV prevention earlier, including prevention in school syllabuses, making contact with out-of-school youth a priority, decreasing the stigmatisation with impactful people such as peers, parents and religious leaders, and providing anonymous HIV consultations without parental consent from 16 years old.
Discussion
Our results show that good material for prevention and awareness is available, but in practice the message does not really seem to reach its target due to the lack of contextualisation and the taboo surrounding the topic. Indeed, current educational content is generally based upon abstinence model because of the belief that talking about safe sexual practices may lead to curiosity and thus to bad sexual behaviours. This is in contradiction to the literature on the topic [5], which shows that comprehensive prevention programmes leads to significantly greater HIV knowledge, self-efficacy related to refusing sex, fewer sexual partners, and lower prevalence of early sexual activity. On the other hand, awareness of HIV transmission through blood is more discussed and this may be an advantage because it gives at least,the possibility to talk about HIV.
Korrespondenz
Jacques Gaume Responsable de recherche Privat-docent Service de médecine des addictions Département de psychiatrie Rue du Bugnon 23A CH-1011 Lausanne Jacques.Gaume[at]chuv.ch
2 Vaidyanathan G. Commentary: Sexual and reproductive health services in Tamil Nadu: Progress and way forward. 2014. NCBI. 10(2): 177-179. doi: 10.1080/17441692.2014.986165. [Accessed 2nd March 2019].
4 NACO. National Strategic Plan for HIV/AIDS and STI 2017-2024. 2017. Available from: http://naco.gov.in/ [Accessed 2nd June 2019].
5 Khubchandani J, Clark J, Kumar R. Beyond Controversies: sexuality education for adolescents in India. 2014. J Family Med Prim Care. 3(3): 175-179. doi:10.4103/2249-4863.141588.
