Laborde-Balen Gabrièle, Diop Maimouna, Sow Khoudia, Ndiaye Ndeye Bineta, Diop Karim, Taverne Bernard
TransVIHMI (Université de Montpellier, INSERM, IRD), 911, Avenue Agropolis- BP 64501 - 34394 Montpellier Cedex 5, France.
Centre régional de Recherche et de Formation à la Prise en Charge Clinique de Fann (CRCF), Dakar, Senegal.
Ther Adv Infect Dis. 2023 Mar 14;10:20499361231159295. doi: 10.1177/20499361231159295. eCollection 2023 Jan-Dec.
In Senegal, the dominant social norm upholds virginity before marriage and edifies abstinence for adolescents as a cardinal moral value. Currently, sex outside of marriage remains socially condemned. The onset of sex for adolescent girls born with HIV in Senegal brings up several challenges. In Dakar, initiatives, especially through digital applications, are being developed to support these young people. These programs are much rarer in rural settings. A study conducted in 2021 explored how adolescent girls born with HIV who live outside of Dakar experience sexuality, what socio-health constraints they face, and what support they receive from the healthcare system.
An anthropological study titled 'Treatment Failure among Children and Adolescents Living with HIV in Senegal, Outside Dakar' (ETEA-VIH, ANRS 12421) was conducted in 2021 in 14 regional hospitals and health centers. Semi-structured interviews were conducted with 87 HIV-positive children and adolescents, 95 parents/guardians, and 47 health care workers. Adolescent girls' onset of sexuality was specifically analyzed for 40 adolescent girls age 12-19 years old.
Generally, parents feign oblivion about their children's sexual lives. Mothers dread a pregnancy out of marriage because they are responsible for overseeing sex education and would be 'blamed' for the transgression. The occurrence of an unintended pregnancy can lead to exclusion from the family and a risk of transmitting HIV to the child due to the lack of medical and social support. HIV remains a stigmatizing disease that families keep secret. The risk of disclosure is a major concern. Despite sexual and reproductive health (SRH) programs, most healthcare workers are reluctant to discuss sexuality or to offer contraception to adolescent girls. Information spaces have been set up in some regional hospitals by associations trained in SRH. They are rarer in health centers. Accessibility to digital applications and discussion forums is limited due to the lack of smartphones and Internet access.
In rural settings, HIV-positive adolescent girls are confronted with the silence that surrounds sexuality and HIV. An individualized approach and confidential access to contraception should be prioritized to support them with assistance from PLHIV associations.
在塞内加尔，占主导地位的社会规范崇尚婚前贞操，并将青少年禁欲奉为一项基本道德价值观。目前，婚外性行为在社会上仍遭谴责。塞内加尔感染艾滋病毒的青春期女孩开始性行为带来了诸多挑战。在达喀尔，正在开展一些举措，尤其是通过数字应用程序来支持这些年轻人。而这些项目在农村地区则更为罕见。2021年进行的一项研究探讨了生活在达喀尔以外地区的感染艾滋病毒的青春期女孩如何体验性、她们面临哪些社会健康方面的限制以及她们从医疗系统获得了哪些支持。
2021年，在14家地区医院和健康中心开展了一项名为“塞内加尔达喀尔以外地区感染艾滋病毒的儿童和青少年的治疗失败情况”（ETEA-VIH，ANRS 12421）的人类学研究。对87名艾滋病毒呈阳性的儿童和青少年、95名家长/监护人以及47名医护人员进行了半结构化访谈。专门对40名年龄在12至19岁的青春期女孩的性发育情况进行了分析。
总体而言，家长对孩子的性生活佯装不知。母亲们担心未婚先孕，因为她们负责监督性教育，会因这种违规行为而“受到指责”。意外怀孕的发生可能导致被家庭排斥，并且由于缺乏医疗和社会支持，存在将艾滋病毒传染给孩子的风险。艾滋病毒仍然是一种会带来污名的疾病，家庭对此保密。暴露风险是一个主要担忧。尽管有性与生殖健康（SRH）项目，但大多数医护人员不愿与青春期女孩讨论性问题或提供避孕措施。一些接受过性与生殖健康培训的协会在一些地区医院设立了信息空间。在健康中心则较为少见。由于缺乏智能手机和互联网接入，使用数字应用程序和讨论论坛的机会有限。
在农村地区，感染艾滋病毒的青春期女孩面临着围绕性和艾滋病毒的沉默。应优先采用个性化方法并提供保密的避孕措施，在感染艾滋病毒者协会（PLHIV）的协助下为她们提供支持。
