What parents can expect when children with HIV join high school

Many adolescents living with HIV are expected to join Form One next year, raising concern over how boarding schools support students who must secretly take drugs every day.

An assessment of 17 boarding schools in Nairobi suggests that while some schools ensure high confidentiality, others force students to reveal their status to teachers without protecting their privacy.

The evaluation sheds light on the experiences of the students, their guardians, and school nurses, offering insights into the challenges they face and the innovative strategies employed to navigate adherence to medication.

The students also report the challenge of taking daily pills without disclosing their status to unnecessary parties.

The study, published by the Plos Global Public Health journal, was led by Nicholas Kipkurui from Impact Research Development Organization, a Kisumu-based NGO.

Other researchers are from the Kenya Medical Research Institute.

It is titled, “Navigating antiretroviral adherence in boarding secondary schools in Nairobi, Kenya: A qualitative study of adolescents living with HIV, their caregivers and school nurses.”

The majority of students said they disclosed their HIV status to school nurses or teachers upon admission. Most schools do not allow students to keep drugs, so they are kept by the school nurse and students must go to take a pill daily.

‘‘There was a day I was going to take my drugs and I found her (the school nurse) at the teacher’s office and the teacher had already placed the drugs on the table. So, she asked me if those really looked like sickle cell medication and I told her I didn’t know. She then told me to tell her the truth that she wouldn’t tell anyone, and I just told her,” said one student.

The study also uncovers various strategies employed by adolescents living with HIV to adhere to medication while navigating the challenges of a stigmatised school environment.

These strategies included waiting until other students were engaged in activities, waking up early, excusing themselves, and even falsely claiming that their medication was for different ailments.

"I take mine in the morning only and I lie that it is an allergy medication. I also changed the storage bottle; my mum changed it for me so even if they see the bottle, they will just think it is medication for my chest,” one 18-year-old student said.

Caregivers expressed anxiety regarding school-based adherence counselling, fearing inadvertent disclosure of the adolescents' HIV status and subsequent stigmatisation by fellow students.

Furthermore, the study highlighted a critical gap in the training of school nurses, with all respondents reporting a lack of appropriate training in HIV adherence counselling for adolescents.

Some students reported a lack of privacy and confidentiality from the people who should protect them.

‘‘For example, with these guidance and counselling teachers, as soon as you leave that room, you become the topic of discussion. What you disclose to that teacher, she will disclose to other teachers and so in class, there is a way the teacher looks at you. These teachers like backbiting people,” said one student.

The study concludes that, despite the challenges, adolescents with HIV in Kenyan boarding schools have developed resourceful strategies to navigate medication adherence.

It notes the need for targeted training for school nurses and a concerted effort to build a trusting relationship between healthcare providers and adolescents.

The Kenya Aids Strategic Framework identifies adolescents and young people as a priority population for the HIV response.

The Kenya HIV estimates 2018 by the National AIDS  and STIs Control Programme indicates that 105,230 adolescents were living with HIV. Most of these were in high school.

The school-age also features strongly in new infections. In 2022, new HIV infections among children, adolescents, and young people,  reached an estimated 62 infections per week among those aged 10-19, according to Nascop.