hiv/aids and orphaned and vulnerable children jane subak kennedy, msw outpatient pediatric clinic...
TRANSCRIPT
HIV/AIDS and Orphaned and Vulnerable Children
Jane Subak Kennedy, MSW
Outpatient Pediatric Clinic
Social Worker
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Johannesburg, South Africa
Wednesday, October 15, 2008
©2008 National Association of Social Workers. All Rights Reserved. 1
Prevalence of HIV/AIDS in 2006
18.8
0.4 0.5
0.0
5.0
10.0
15.0
20.0
South Africa USA Phila
%
5,500,000
1,200,000 21,000
Phila: Adult AIDS Diagnoses
77.5
68.4
22.5
31.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1980-2006 2006
%
male
female
Phila: Age at diagnosis
0.8 1.7
15.8
11.2
39.8
24.9
29.4
36.6
14.3
25.5
0
5
10
15
20
25
30
35
40
45
1980-2006 2006
%
13-19
20-29
30-39
40-49
50+
Phila: Transmission category
36.7
26.4
34.8
22.6
5.01.9
22.0
49.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1980-2006 2006
%
Male/male
IVDU
male/male+IVDU
Heterosexual
Angela
• A 16 year old AA female• Presents to the clinic because she has missed her menstrual period
• Evaluation includes testing for STIs, including HIV
• She consented to HIV testing
• Pretest counseling
Angela
• Rapid HIV test is positive– Angela waits for the results
• Angela gets results from practitioner and SW
• Confirmatory blood test is performed
• Referral made to Adolescent HIV Program at CHOP for specialty care
• Angela still comes to clinic for primary care
CHOP Adolescent HIV Program
• Case management• Evaluate developmental level
• Recognize supports• Identify barriers to care• Home visits by care team• Individual and family therapy
• Support groups• Transition to adult care program
How Adolescents Get HIV Info
• Medical clinics • School-based programs• Health fairs• Peer education• Media
Strategies to prevent perinatal HIV transmission
1. Primary prevention of HIV infection in women
2. Universal voluntary HIV counseling and testing during pregnancy
3. Prophylactic antiviral therapy for mother and newborn
4. Elective C/S delivery
5. Avoidance of breastfeeding
AZT regimen
• During pregnancy– Begin treatment at 14-34 weeks gestation
– five times a day orally
• During labor– Administer IV throughout labor and delivery
• Newborn– Begin 6 hrs after birth– Every 6 hrs by mouth– Continue until 6 wks of life