Story by Heamakarn Sricharatchanya
Photos and video by Metee Thuentap
PETCHBURI -- Kai* was born with HIV but did not know his status until he was 15. Depressed and unsure about his future, he sometimes threw away his antiretroviral (ARV) medicine pills, took them late or did not bother taking them at all. When his doctor asked whether he had taken his medicine on time, Kai would always answer “yes.”
“When I was younger, I did not care about taking ARV,” says Kai, who is still a teenager and sports both a tattoo and a pierced ear. “Also, I did not want my friends to see me taking the pills, so I simply skipped them sometimes.”
This is an extremely dangerous practice, as antiretroviral medication helps protect people living with HIV from opportunistic infections as well as helping to suppress -- and even stop -- the progress of the virus. In short, ARV helps people with HIV remain both healthy and alive. Yet many young people like Kai fail to take their ARV medication every day, or do not to take them at the same at the time every day, which makes the medication far less effective and can lead to drug resistance.
According to Dr. Pope Kosalaraksa, project manager who leads this study to provide holistic care for adolescents living with HIV/AIDS at Khon Kaen University’s Srinakarind Hospital, 1 in 4 adolescents living with HIV have problems in adhering to their antiretroviral medication schedules. In addition, 1 in 5 adolescents have had sexual relations, most fail to use condoms regularly.
In order to address these issues, UNICEF is working with partners on an innovative model project aimed at keeping young people on their ARV medication schedules and also practicing safe sex. The adherence project is co-funded by ViiV Healthcare's Paediatric Innovation Seed Fund through TREAT Asia/amfAR. Srinakarind Hospital and HIV-NAT/ The Thai Red Cross AIDS Research Centre are the leading organizations working with UNICEF on this.
“This holistic care model is the first in Thailand that provides both clinical and psychosocial support for young people,” says Dr. Witaya Petdachai, a senior expert pediatrician at Prachomklao Hospital in Petchaburi, which is one of the partners working on the project.
Under the project, 85 young people with HIV from between 13-24 years of age are being assisted, with services being provided to them with the support of Srinakarind Hospital, Prachomklao Hospital, the Thai Red Cross AIDS Research Centre in Bangkok, the AIDS ACCESS Foundation and seven community hospitals in Chiang Rai, and the We Understand group. All of the young people taking part in the project, which began in August 2012, were born with HIV and have ARV medication adherence levels below 95 per cent.
|Som learns how HIV virus attacks the body and how antiretroviral suppresses progress of the virus.|
© UNICEF Thailand/2013/Metee Thuentap
The project is aimed at helping to improve adherence to ARV medication schedules by helping the young people better understand the HIV virus, giving them hope for the future and teaching them to manage negative attitudes about their situation.
“I volunteered to participate in this project,” says Som*, 20, who makes a living working at a factory. “It has helped improve my adherence. I used to take my ARV late, but I am more disciplined now.”
Som says has learned more about the HIV virus and how antiretroviral medicine helps protect her, which in turn has helped keep her on a regular medication schedule.
“The ARV keeps me healthy and allows me to work like anyone else,” says Som, whose paychecks from the factory are used to support herself and the aunt who raised her.
The project is using SMS technology to achieve its goals. An SMS system conceived and developed by the Thai Red Cross AIDS Research Centre has been programmed to send out an SMS to each young person taking part in the project at the time of day they are supposed to take their antiretroviral medication.
Dr. Witaya said the SMS is sent out twice a day to remind them to take their medicine. The SMS is written in such a way that if someone other than a young person involved in the project was to read the message, they would not know that it had anything to do with HIV or a medication schedule.
When the young people receive the message they are required to SMS back whether they have taken their antiretroviral medication. If they reply, “no”, the system will send them another SMS to remind them again. If the young people reply that they need even more encouragement, a nurse working on the project will call them to see what the problem is and encourage them to take the medicine. To objectively measure adherence, Thai Red Cross and TREAT Asia have organized for hair samples, collected from the adolescents every three months, to be tested at a lab in the United States. The hair samples reflect adherence levels over the past 3 to 6 months, and it is much more accurate way of measuring adherence than a pill count or other methods.
|A hair sample is collected from the youth living with HIV. It reflects adherence level over the past 3 to 6 months.|
© UNICEF Thailand/2013/Metee Thuentap
“After joining the project, I realize how important it is for us to take ARVs on time,” says Kai, who dreams of becoming a soldier and of having a family one day. “If we take them on time, it will control the virus and keep us strong. No one can tell just from looking at us that we have HIV.”
Another major focus of the project is promoting safe sex. Adolescents living with HIV are taught about the virus, sexual activities that lead to the spread of the virus, how to practice safe sex and how to go about disclosing their HIV status partners.
Mac* said he used to have limited knowledge about safe sex, but that the project has helped him understand how to use positive prevention methods and how to reveal his HIV status to his partner.
“I have a girlfriend,” says Mac, 18. “I used what I learned from the project to explain to her, little by little, about HIV. When she understood everything about the virus, I told her about my HIV status. I knew she might not be able to accept that I have HIV and that she could easily walk out of my life.
“It turned out that she accepted my status and did not leave me,” he says with a smile.
The lessons learned and experience gained by UNICEF and its partners through the project will be shared with others working on HIV so that they can be applied more widely to helping young people with HIV.
If the model proves successful in terms of improving adherence and in promoting safe sex, UNICEF and partners will advocate that it be adopted at the national level and that such services be expanded to other hospitals and communities in Thailand” said Nonglak Boonyabuddhi, HIV/AIDS officer of UNICEF Thailand.
“UNICEF firmly believes that all young people living with HIV should be able to live a normal and healthy life so that they can make sustained and positive contributions to the lives of their families and the communities they live in.” Nonglak said.
*not their real names