Fellow Bio:
My name is Ngozi Ogbuehi and I am a current second year medical student from Atlanta, GA. I went to undergrad at the University of Georgia, majoring in Child and Family Development with a minor in Biology. I enjoy volunteering with children and dancing. My favorite quote is "Cowards die many times before their death, but the valiant taste of death but once" from Shakespeare's Julius Caesar.

Project Description:

The purpose of my study was to evaluate the effectiveness of an education and support program for HIV positive adolescents facilitated by HIV positive adolescents. Because studies have shown that teens are more likely to listen to their peers rather than doctors and/or educators, it is believed that HIV positive teens will gain more knowledge and support from the one-on-one peer counseling program than if they were being taught by adults or in a peer group setting. I hypothesized that at the end of the program, the participants would improve medical adherence, improve physical health, reduce sexual risk-taking and drug use, and enhance personal quality of life of peer counselors and program participants.

First, I proceeded to do an in-depth literature review of HIV in behaviorally-infected (contracted HIV via drug use or sexual contact) adolescents and education programs for secondary prevention (preventing the transmission of HIV from an infected person to an uninfected person). The studies I researched found that the risky acts of behaviorally-infected HIV-positive adolescents do not decrease after their diagnosis. The risky behavior that initially exposed the teens to HIV is hard to change and many of the risk factors in the teens’ lives remained after their diagnosis. Next, I interviewed some of the teens at the clinic as well as spoke to clinic social workers. Many of the teens that come to the clinic are homeless, high school drop-outs, or are in foster care. Most of them come from low-income homes and have experienced hardships, such as sexual abuse, that most adults can not fathom. Because of these backgrounds, many of the teens engage in risky behavior. Drug use, survival sex, and continued unprotected sex remain apart of the teens’ lives. It was my interaction with the teens that truly gave me insight into their lives.

My interviews were followed by a literature review of effective education programs for HIV positive adolescents. From my literature review I found that the most effective programs were programs that were individualized to each of the HIV positive teens and involved a peer component. The clinic staff also had a focus group. The focus group consisted of 4 women, 2 men and 1 transgender youth. Participants were selected by clinic staff so as to be representative of the behaviorally-infected clinic patients. The focus group feedback was consistent with the literature review findings.

Based upon the focus group and the literature review findings, the education program model developed was counseling sessions with peer counselors on a one-on-one basis. The counselors will be HIV positive adolescents between the ages of 18 and 25. The sessions will occur up to four times in the first month, then one or two times a month as dictated by the counselee’s needs. The intervention will last for at least a calendar year. My research mentor will be conducting the intervention at her clinic in Atlanta and I will be corresponding with her throughout the school year to monitor its effectiveness.

1. Time
2. Funding for educational materials
3. HIV transmission educational handouts (i.e pamphlets, copies)
4. STD prevention methods (i.e condoms)
5. Sex education models
6. Activities to teach peer educators and for them to teach their peers

Activities:

1. Recruit HIV+ teen volunteers that have been successfully living with HIV
2. Educate the peer volunteers about prevention of HIV transmission, the importance of maintaining their HIV medication regimen, side effects of HIV medications, and maintaining proper mental health and self-worth.
3. Once peer educators trained, enroll other HIV+ teens into program
4. Pair the counselors with three program participants for one on one meetings in which there will be education about sexual risk taking, drug use, medication adherence, and psychological functioning. There will also be peer support due to the confidentiality that the one-on-one format provides.
5. Honor counselors and program participants at the end of the program

Short Term Outcomes:

1. Peer educators will be trained to teach others
2. Teens that are recently diagnosed will gain knowledge of their disease as well as peer support
3. Program will be assessed for effectiveness by looking at program participant medication compliance, mental status, and knowledge of HIV transmission.

Final Outcomes:

1. If program deemed effective, it will be continued at the clinic in Atlanta
2. The program may also be expanded, enabling peer educators to talk to high school teens so that they will know that although they are young, they are still at risk of contracting HIV
3. Program may be modified to be a general STD/HIV program for community health programs

1. Reduce the sexual risk taking and possible drug use of HIV+ teens while increasing their medication adherance and feelings of self worth
2. If program effective, initiate the process of expanding program to other clinics or modify the program to be taught at community health centers and high schools.
3. Learn about HIV infection in children and adolescents: factors associated with transmission, behaviors that increase the risk of transmission, pathophysiology of HIV and the immune system, decisions about treatment, and medication adherence.
4. Learn about effective HIV education programs for adolescents and demographics of HIV positive adolescents via literature review.
5. Build skills in conducting behavioral assessments in a clinical intervention study

Challenges and Solutions:

1. Program participants may become ill by contracting an opportunistic infection during the program
2. Participants of lower incomes may not be able to afford regular trips to site on meeting days
3. Because immunocompromised, peer educators may not be able to go into high school settings for education programs because of the large amount of people.

Challenges - Past:

I have experienced two major problems. The first is that there is a limited number of articles addressing secondary prevention interventions for HIV positive teens. I have addressed it by making the lack of information concerning HIV positive teens a major point of my paper, showing how this population is often overlooked. The other challenge was that my research mentor was behind schedule with her research, so I was not able to be active in the implementation of the peer counseling program because it would happen after I left. I will just continue to correspond with my mentor throughout the year to monitor the effectiveness of the program.

Accomplishments:

Since my last report, I have completed a literature evaluating the HIV/AIDS disease in behaviorally-infected adolescents as well as reviewed literature concerning effective education programs for reducing risky behavior (drug use and unprotected sex) in HIV positive adolescents. I have used my findings to help design an education program. I have presented my preliminary findings to the Pediatric Infectious Disease Dept at Emory University and I am currently preparing a paper to be submitted for publishing. I have also served as a camp counselor at a camp for HIV positive teens and children.