“Madam, I have been tossed out of the children’s clinic, went to the adult’s clinic and was thrown out too. That I am neither a child nor an adult. Should I go and die with my HIV?” The 15-year-old teenager was struggling to keep calm, but the desperation in his voice was heartbreaking.
“I had counseled the teenager, who was actually a ‘street kid’, and referred him to the children’s clinic for treatment after he had tested HIV-positive,” Rachael Abenakyo recalls the game-changing 2010 incident. It was under those circumstances of being tossed from clinic to clinic because of his age that the boy went back to Rachael expressing his disappointment. He was carrying the result slip which showed that the nurse had adjusted his age for him to qualify to be enrolled in an adult clinic. That was the turning point in Rachael’s career as a counselor. “I was inspired to take it upon myself to identify every young person seeking care at the clinic and offer them personal attention at every visit.”
A year earlier, Rachael Abenakyo had started working with Mulago ISS clinic as an ART counselor. It was a very busy clinic handling majorly adult clients. While the clinic served 300 to 400 adults daily, only 10 young people or fewer would be served. At that time, HIV care centers were conventionally either adult or children (pediatric) centered. Access to HIV prevention information and services for adolescents was absent or at best inadequate. Adolescent friendly services were limited to very few HIV clinics which were basically handling children who had contracted HIV vertically from their mothers.
A gifted listener, since the teenager incident, Rachael actively listens to adolescents at the clinic. They open up to her and share their challenges ranging from the clinic environment, drug adherence, home and school challenges for which she offers relevant counsel. “I have learned that sometimes all these young people need is a listening ear so I listen to them,” Rachael says.
She goes an extra mile to offer her personal telephone contacts to adolescents so that they can contact her at any time for any consultation or counsel. With the support of the Clinic Management, Abenakyo designed a problem tree to identify the gaps hindering adolescents from adhering to treatment and later came up with the solutions to these problems. The Clinic team has acquired knowledge and skills in youth-friendly HIV services and operates a special clinic for the HIV-positive young adults, provides young adults with friendly activities that empower and promote HIV prevention, provides counseling on HIV prevention and positive living, and friendly family planning services to young adults.
These efforts have greatly reduced loss to follow-up of young adults. Currently, the clinic has a total of 813 children, adolescents and young adults seeking HIV care at the clinic. This has been achieved through support from MJAP management which has facilitated a youth friendly environment comprised of: knowledgeable health providers on provision of adolescent friendly services; a Wednesday special clinic day for young people; peer adolescents offering peer to peer counseling and support as well as adolescent tailored health education; adolescent tailored sexual and reproductive health information and services; and quarterly psychosocial forums to meet their psychosocial needs along with their chronic HIV care and treatment.
“Making 90-90-90 a reality by 2020 greatly depends on ensuring that this population that is neither pediatric nor adult is taken care of. I believe I am doing my bit. I look forward to a day when health services will be streamlined at all facilities to meet the needs of young people and that this generation will be the one to usher in an AIDS- free generation,” Abenakyo says.
Through funding from PEPFAR and technical assistance from US Centers for Disease Control and Prevention, MJAP provides comprehensive HIV services at the Mulago and Butabika National Referral Hospitals, Mbarara Regional Referral Hospital, Makerere University Hospital and health center IVs, IIIs and high volume IIIs in Mbarara district.