Bioethics Blogs

Is it ethical to pay adolescents to take HIV treatment?

Guest Post: Rebecca Hope, Nir Eyal, Justin Healy & Jacqueline Bhabha

Article: Paying for antiretroviral adherence: is it unethical when the patient is an adolescent?

With treatment, a child with HIV in sub-Saharan Africa can expect to live a healthy life. Better access to HIV treatment is contributing to a global decline in HIV deaths and new infections. Yet in adolescents, the mortality rate is rising – it increased by 30% between 2005-2012 – and HIV is now the leading cause of death among African adolescents. Globally, one in three adolescents with HIV do not take adequate therapy to suppress the HIV virus.

When antiretroviral treatment is life-saving and free, why is adherence so hard for infected adolescents? YLabs, a non-profit that designs and tests solutions to improve the health of disadvantaged youth, began working with adolescents living with HIV in Rwanda and South Africa to understand what prevents them from taking their treatment. Some of our team were involved in that work. Adolescents with HIV are navigating important transitions in their relationships, sexuality, and socio-economic roles, whilst living with a highly stigmatised condition. Lack of social support, isolation, and low mood made it hard for teens to motivate themselves to take medicines regularly. Poverty also stood in the way of regular clinic attendance. Many interviewees were more concerned about their finances than their health: one sixteen year old Rwandan girl living with HIV said: “When I’m in class thinking about how to pay school fees, I think about stopping taking my medicine and starting to try to find money.”

In addition, adolescence is often a time of risk-taking and short-term thinking, contributing to unhealthy habits.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.