Preventing HIV and Adolescent Pregnancies

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In honor our our dear friend and former Living Legacy Award honoree Dame Elizabeth Taylor whose passing yesterday has left our world stunned, we share this program as an example of HIV reform at work, in honor of the great humanitarian strides she made via amFAR and the Elizabeth Taylor AIDS Foundation.

Preventing HIV and Adolescent Pregnancies

Many years ago, The Women’s International Center recognized Rotary International as an Outstanding Organization and at this year’s Living Legacy Awards, the Rancho Santa Fe Rotary Club # 5390 presented a scholarship to the General Raymond L. Murray High School Scholarship Fund. WIC CEO Dr. Bridget McDonald is simultaneously a proud Rotarian and learned of an important project led by Dr. Amparo Buendida of the Bogotá-Centennial Rotary Club, presented here in an article by past Rotary International Director, Dr. Bill Cadwallader. This article has also been published in the PDG magazine for the Past District Governors of Uruguay and by the District Governor of D4855 in Argentina, as well as the Mexican and the Brazilian Rotary magazines.

Two Destabilizing Factors of Society:

Adolescent Pregnancies and the Transmission of HIV

By Dr. Bill Cadwallader, PRID

The increase in the numbers of adolescent pregnancies and the transmission of HIV (Human Immunodeficiency Virus), the cause of AIDES (Acquired Immunodeficiency Syndrome), are two important reasons for social destabilization and two problems which should worry many of the leaders of our world communities.

In addition to being the cause of infant death, adolescent pregnancies also are the cause of maternal deaths. Among the various other factors, the pelvises of young girls are not anatomically developed adequately to allow for the easy passage of a baby, thus producing prolonged and difficult births; dangerous to both mother and infant.  Also, the number of pregnancies and births to an adolescent mother frequently number more than one, leaving the young girls weak and with anemia, especially if they do not have access to good nutrition.  Many of the young girls have babies, each by a different father. Usually the father of the baby abandons the mother as soon as he knows that she is pregnant, leaving the single parent mother to look for another man to take care of her and the new child.

The result of the adolescent pregnancy is that the mothers abandon their school studies because she must look for work to provide food for her family. Furthermore, quite often many of the children, children of the adolescent mothers, also defer from attending school, looking for work to provide food for the family. As this work is not easy to come by, the young men often spend their time with street gangs and become juvenile delinquents. Without education and without work these youngsters often begin the use of drugs and the distribution of illicit drugs, or join the armies to fight guerilla warfare, becoming, therefore, a destabilizing force for democratic countries.

For its part, the transmission of HIV is mainly related to the initiation of early sexual relations with multiple partners. Less than 10% of the transmission of HIV is through the use of needles and syringes contaminated with the virus. While those infected by the diseases of gonorrhea, Chlamydia, and Syphilis can be treated and cured with antibiotics, the infection with HIV, if not diagnosed and treated early, without a doubt will cause the early death of the infected person. It is for this reason that it is important that adolescents beware of the transmission of HIV and take steps to prevent it.

Another sexual disease that is dangerous, especially for the women, is the infection with the Human Papilloma Virus (HPV). HPV is the cause of cancer of the uterine cervix.  This disease is prevented in the same manner as with HIV/AIDS: 100% prevented by not engaging in early sexual activity, or in a significant number of cases by protected sex or having sexual relations with one single sexual partner. While there is a vaccine against HPV, it is very costly and it does not protect more than 70- 80% of the women vaccinated. Nevertheless, because of the risk of developing cervical cancer, which is the second most common reason for maternal mortality in the world, the government of Panama has decided to assume the cost of the vaccine (three doses) and to give it to all girls less than 10 years of age, which is before they start their own sexual activity, in order that they have a protective immunity against the most common serotypes causing cancer.

What can Rotarians do to prevent these two grave social problems?

Education of the students in the secondary school:

In the first place, we must begin to work with the boys and girls when they are only 12 years of age as this is the age when many of them begin to have sexual relations.  Nevertheless, in many places of poverty and misery, sexual relations will begin as early as nine (9) years of age.

It is known that while Rotarians will have more knowledge than the adolescents about the dangers that result in sexually transmitted diseases (STDs), it is the student leaders who will have the best ability to communicate the risks and the dangers to their fellow classmates, doing so in a more convincing manner than the adults can do.

The Rotarians of the Rotary Club of Barquisimeto Nuevo Segovia, Venezuela, have developed by their medical committee a program with a curriculum and detailed addenda (www.RIFD.org) for the clear and effective training of their student leaders. The student leaders discuss the need for high goals for one’s lives with the desire to achieve those goals.  They speak of the need to have a stable and successful family. They also speak of the importance of the need to have pride in oneself. The students consider the desirability for abstention, to not to have sexual relations outside of wedlock, which is the best tool to prevent pregnancy and sexually transmitted diseases. They speak of in the event that one’s boy friend wants to have sexual relations it is proper for the girl to say, “If you truly love me you will let me finish my studies before we have sexual relations. Now I do not want not become pregnant.”

The correct use of the condom:

Nevertheless, if the students think that it is not possible to postpone the initiation of sexual relations, then one should know how to protect oneself. They need to know how to use a condom. The student leaders then show their classmates the proper use of the condom. We have noted that the most frequent reason that condoms are not used is because the students do not have the confidence on how to use them correctly. We do not distribute condoms to the students, but we do want the students to know of their proper use.

We also want the students to know the difference between HIV and AIDS. We want them to know that a person can be infected with HIV and there does not need to be any transmission to another person as long as there are no sexual relations between the two individuals (or the sharing of drug needles contaminated with the virus). AIDS is the demonstration of clinical signs of the disease which lead to the death of the individual.

Stigma Against HIV and How to Prevent It

We want to prevent the stigma, or the mark against people infected with HIV. We use the example, “If we were seated around a table with friends at a meal and one friend were infected with HIV and another were infected with the flu,  our risk of being infected with the flu would be much higher than being infected with HIV. It would be essentially impossible to become infected with HIV, but there would be a high probability of being infected with the flu. Since there would not be any stigma against the person with the flu, there should be an even less reason for a stigma against the person with HIV.

The Students Should be Aware of the Dangers of HIV:

We use an oral test, OraQuick HIV 1 & 2 (OraSure Technologies, 220 East First Street, Bethlehem, Pennsylvania 18015, USA. http://www.OraSure.com), which has a specificity, using oral fluids, of 99.8 %( 99.6-99.9%) and a sensitivity of 99.3% (98.4-99.7).

We have noted that many young students do not pay attention to the risks and dangers that they can suffer from HIV if we simple talk on this subject. Just talking about HIV does not necessarily change the student’s behavior regarding precocious sex relations.  We have noticed that only when the students are having the samples taken from their mouths are they truly considering the dangers from their sexual behaviors. At this time they are thinking of every sexual experience that they have had in the past year, or are planning to have in the coming months.

We feel that it this important link of” testing to the talking” that we make in our program that links the prevention of precocious sexual behavior and the risks and dangers of infection with HIV.

We have also noted that 60% more students will volunteer to be tested using the oral test than if blood were to be used for the procedure. Furthermore, there is no danger for those technicians and doctors taking the samples. The environment of the testing procedures is not contaminated with the possible HIV from blood nor are there contaminated disposables for medical wastes.

If you think that you could be infected, why should you want to be tested for HIV?

There are three very important reasons that someone who thinks that they could be positive for HIV should want to participate in this testing procedure.

• If a person is positive, the person can receive anti-retroviral drugs. With these treatments the person can live a productive life for approximately 20- to 30 years instead of dying within 10 years of the sad and painful complications of AIDS.
• If a positive person receives the anti-retroviral drugs they can know that the drugs will lower their viral load in the blood stream to a point so low that it will be impossible to infect another person. Also, if they take the anti-retroviral drug they can know that their CD4 white blood cells will not drop so low and they will be protected against usual diseases.
• If a girl is positive for HIV, and is pregnant, she can be given anti-retroviral drugs to prevent the vertical transmission of the virus to her baby. The baby will not be infected with HIV. Likewise, the mother can live long enough to see her child become an adult and we can thereby prevent AIDS orphans.

Counseling  must be practiced before, during and upon receiving the test results for HIV:

It is important that the students have available counseling before the tests, during the tests and after the tests when the test results for HIV are given to the students. Each student is counseled privately by the nurse or physician in the privacy of an examination room.

If the student’s results are negative they will receive advice explaining clearly that if they have had sexual relations within the previous three months that they should have another test within 3-6 months. This is because the person with whom they had sex could have been positive and the level of antibodies (that which we measure in the mouth sample) could be too low to measure at this time. A similar test taken in 3-6 months should be high enough to measure the antibody level from the previous sexual encounter. It is important to keep in mind that the OraQuick HIV 1 & 2 test measures antibody levels in the mouth and not virus.

If a student is positive they are informed that they should have a confirmatory blood test performed at a government laboratory using the test process of Western Blot. This test is performed in accordance with laws of the country where the testing is being done and in accordance with the guidelines of the United Nations HIV/AIDS programs and is done so without cost to the student’s family. If the confirmatory test is positive the government of that country will be responsible for their treatment with anti-retroviral drugs for the rest of their lives.

Why national governments should want to follow the example of Rotary:

There are three reasons that the authorities of any nation should want to utilize this Rotary program;

• If students diagnosed positive for HIV are treated immediately with anti-retroviral drugs it will reduce the viral load of that person to a point that they cannot transmit the virus to another person. Any government can intervene in an effective manner to stop the epidemic of HIV/AIDS.
• If one can diagnose HIV early in a girl that is positive and pregnant, the mother can be treated with anti-retroviral drugs to prevent the infection of the baby with HIV, and the mother can live long enough to see her child become and adult. A government can reduce, or prevent, AIDS orphans and the costs associated with this huge challenge.
• Actually, we want to increase awareness of HIV/AIDS in secondary school students in order to reduce the risks of HIV/AIDS in university students where the risk of AIDS is even greater than in secondary schools. Any government should want to protect the future professional and business leaders of their nation by preventing the transmission of HIV.

The Importance of Our Work:

The author of this article had the opportunity to visit Umahia, Nigeria with a physician friend who was born in Umahia and had studied in the USA with those medical leaders who developed HIV tests.  The Nigerian born doctor wanted to learn of the level of the infection of his native home. He trained 18 nurses to test and counsel others so that the citizens of Umahia could be tested. As the citizens gathered, the organizers of the procedure asked the nurses to test themselves to show the villagers how simple and easy the test would be. Of the 18 recently university graduated nurses 15 were diagnosed positive for HIV.

Our Rotary Theme: Build Communities/Unites Continents:

• If we work in our communities to reduce adolescent pregnancies and single parent families we will make a significant contribution to improving infant and maternal health.
• If we prevent pregnancies in adolescents we will be preventing the complications of pregnancy and births that occur at such early ages and also the diseases and perinatal deaths of baby children of adolescent mothers. These children not only imply a high social cost for the families, but also a high economic cost to the short resources of health systems of countries of low levels of development.
• If we can increase the numbers of girls that will continue their academic studies, instead of abandoning their secondary educations at an early age, we will be contributing to the improvement of literacy and the basic education of future mothers and the quality of their families.
• If with our program we can prevent adolescent pregnancies the girls will have the opportunity, with a better education, to be more socially and economically productive.
• If the boys and the girls could wait until they had more than 20 years of age to plan and care for their children in a responsible manner, when they can better provide sufficient care for their babies, they would have the opportunity to have only those children that they want and for whom they could care for and to educate.
• If we had only the population desired and cared for by their parents, we could be more rational in the use of the natural resources that are essential to the human race such as water.
• We believe that the most important of all is that we will be building healthy families with children that are healthy and educated, that could become technical and professional workers or leaders of business, that will be free of HIV/AIDS and of uterine and cervical cancer; families that could have lives with high goals, hopes for the future and dreams to be realized.

In this manner, Rotary will be able to realize their goal for world peace and the resolution of conflicts in their communities as much as they are needed.

I ask you all to Believe in the Power of Rotary to Create a World at Peace.