Young, positive and sexually active

That teenagers, and even pre-teens, become sexually active is usually kept under the blanket, especially in conservative societies, but when these young people are HIV positive the issue becomes even harder to acknowledge, and has been largely ignored.

As life-prolonging antiretroviral (ARV) drugs become more widely available, an increasing proportion of the children infected with HIV at birth are living on into adolescence, with many of them expecting to become sexually active and even have children of their own.

In Bobo-Dioulasso, in the southeast, Burkina Faso's second largest town, Rêve +, an association for people living with HIV, looks after 693 children and teenagers affected by HIV/AIDS, 140 of whom are HIV positive, and 88 on ARVs.

These young people want to have a normal sex life, which is reinforced by the fact that it is "practically inconceivable" to not have children in Africa, where "a couple who have been together two years without having a child are criticised," said Martine Somda, president of Rêve +. "People say that the man must be impotent."

Célestine Koné*, an orphan who was infected with HIV at birth, desperately wants "to live with someone despite my [HIV positive] status, but because of my situation I don't know if I'll ever get married". Her mother died of an AIDS-related illness many years ago.

Unable to overcome her fear of being left alone, she could not admit her status to her partner, who left her and her child when he came across her ARVs, which she had been taking for eight years.

Célestine is now 19 and had her second child at the end of 2007; her first child, who was born from another relationship when she was barely 16 years old, died at three months from tuberculosis.

She did not tell the father of either her first or second child she was HIV positive, even though the caregivers at Rêve + encouraged her to do so. "I did everything I could to get her to tell people, but she was scared of being alone on the street with no support," said Bernadette Paré, who runs the children's section at Rêve + and has been monitoring Célestine since she was a child.

"She needed affection after her parents died. When her [first] child died, she had to carry it on her back to get home because she didn't have anyone to help. It is really sad."

They need to understand that all is not lost, and that they have the right to have children; it just has to happen in consultation with doctors

Célestine's case is not unique. "The issue of telling people about your status is a difficult one, particularly with [couples] who are serodiscordant [when only one of them is HIV positive] because many girls and women find themselves on the streets when their [partner] finds out about their status," said Paré.

Perhaps what makes it even more difficult is that in a country with a prevalence rate of 2 percent, there are still low numbers of openly HIV positive people in Burkina Faso.

Sometimes the fear of being alone can be stronger than reason. "Célestine can't explain why she doesn't insist on her partner wearing a condom," said Paré. "Despite advice to infected young people about wearing condoms, girls are reluctant to do so because over time this might make their partner suspicious [he might think she is unfaithful]."

Sex advice

So how do organisations help teenagers find a balance between having a full sex life, without denying their HIV positive status?

"We tell them that they are not the only ones in this situation: thanks to ARVs, they will be able to have children one day by taking all the precautions," said Jacques Sanago, Secretary General of Association Espoir et Demain (AED), a non-governmental organisation that cares for children.

The same message is given at the Charles de Gaulle paediatric hospital in Ouagadougou, capital of Burkina Faso, which looks after 405 HIV positive children, 270 of whom are on ARVs.

"We concentrate on prevention when talking to infected children. They need to understand that all is not lost, and that they have the right to have children; it just has to happen in consultation with doctors," said Dr Alica Zoungrana, a paediatrician at the hospital.

The traumatic effects of late detection

The issue of sex can be even trickier when young people are still in the dark about their HIV-positive status. "We have a problem with HIV-positive children whose parents refuse permission for them to be informed," said Zoungrana.

Fortunately, not all parents are the same. "It is much easier for these children, who haven't started having sexual relations, to talk about wearing a condom," added Zoungrana. "For someone who starts their sexual life using these methods, it's much easier to manage than an adult who had a normal sex life and then has to change their methods."

Read more

The cost of keeping children from knowing their status

Love and sexuality among teens born with HIV

Sex education - the ugly stepchild in teacher training

Shielding children from their HIV status does more harm than good

Awareness is raised among parents to help them understand the importance of telling their child about their HIV positive status as early as possible.
Zoungrana recounted the story of how a child receiving treatment at the hospital was traumatised when he realised he was HIV positive after watching a television programme and recognised the ARV bottles, which were the same as his.

François Coulibaly*, who is now studying at a secondary school in Bobo-Dioulasso, was 10 when he found out he was HIV positive and has been on treatment ever since. He said he had accepted his situation, but "you have to keep it a secret - there are certain things you shouldn't say."

"If I liked a girl, I could tell her about my [HIV positive] status. She could do a test and if she's HIV negative, and if she wants to live with me, then she'll make the decision," he told IRIN/PlusNews. He doesn't have a girlfriend, and "doesn't yet have the courage" to find one.

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