Team PATA

Adolescent ART, new challenges and new opportunities: using the Auntie Stella kit to discuss difficult issues

As children are able to access and receive on anti-retroviral treatment, they are surviving longer and growing into adolescence. This success presents new set of challenges as children grow into adolescence.

PATA teams will remember that ‘care of the adolescent' was a topic at the 2008 PATA forum in Swaziland , the 2009 forum in Gauteng and the 2010 PATA forum in Uganda.

As a follow-up to the Swaziland meeting, an adolescent care planning workshop for the Western Cape Province of South Africa was organised and presented by PATA as a regional forum during May 2008.

A major outcome of this meeting was agreement by all participants on the need for staff training to deliver adolescent friendly life skills education to HIV-positive adolescents in the Western Cape Province.

The Auntie Stella kit, produced by the Training Research and Support Centre – TARSC – in Zimbabwe (www.tarsc.org) is designed to provide adolescent friendly and highly pertinent life-skills education to adolescents – with and without HIV infection. The toolkit was presented at the 2009 PATA Forum. A clinic in South Africa has provided PATA with some feedback on their experience with the toolkit:

Some feedback on Auntie Stella from Harriet Shezi Children's Clinic, South Africa

With PATA's help, Harriet Shezi Children's Clinic at Chris Hani Baragwanath Hospital, Soweto, has purchased 20 ‘Auntie Stella' kits which will be used by a number of facilities which the clinic supports. This includes the Ekurhuleni and Johannesburg Metro districts in Gauteng ; and Dr Kenneth Kaunda, Ngaka Modiri Molema and Dr Ruth Segomotsi Mompati districts in North West Province. The kits will also be made available for use by the teams in the Institute's Community Care Centre and by the Prevention Quality Improvement Managers that work across those districts. The kits will be used to help facilitate appropriate adolescents groups and to teach on how to conduct groups using this tool. The intended outcome is improved mental health for adolescents and a structure for facilitators in managing difficult issues.

Shanaaz Randeria, the Adolescent Project Manager Harriet Shezi Children's Clinic has been using the "Auntie Stella" tool kit with adolescents 16 years and older since receiving it last year at the PATA Forum. The toolkit has been used in support groups where the topics in the kit were an extension of discussions covered in the weekly adolescent support group, and at other times a topic was drawn from the "Auntie Stella" kit would initiate new and surprising discussions. Some of the issues discussed were teenage pregnancy, gender roles, culture and children's rights.

Randeria remarks that the kit makes "communication regarding sensitive topics or issues a lot freer and honest. These discussions also serve to challenge stereotypes, culturally-accepted, but unacceptable norms, values and beliefs , prejudice to mention a few".

However Randeria warns that the topics from the kit are sometimes "controversial and spark heated discussions and debates among the adolescents in the support group". She notes that facilitators need to be skilled in many areas of communication and counselling. Randeria suggests that facilitators must be aware of the following:

• The influence that dominant group members can have on the other members
• The ability that less extrovert group members have to express their views without fear of being ridiculed or judged
• The need to correct inaccurate information and myths even if they are sanctioned by culture
• The importance of sensitivity to intra-group cultural diversity and self-reflective practice so that the group and facilitator are not biased in favour of any particular culture or set of beliefs

Randeria also notes that facilitator needs to be comfortable to discuss issues and topics which other adults may not feel comfortable discussing with adolescents.

In addition, Randeria comments that the discussions in Auntie Stella can re-awaken trauma. The containment of these difficult and powerful feelings and emotions is essential. Otherwise, group members may leave the support group feeling less empowered and more traumatized than before the discussion. Randeria says "the implication of this is that adolescents may feel an overwhelming sense of losing control over their already difficult, and sometimes dire, living situation. This in turn may affect their health, adherence to medication, school performance, etc."

For more information, go to www.tarsc.org and click on the 'Auntie Stella' link.