In-depth: South Africa - The world’s biggest ARV Programme?

SOUTH AFRICA: Teenage determination

JOHANNESBURG, 14 September 2006 (IRIN In-Depth) - There was nothing sweet about Jacqueline Dlamini's* sixteenth year - she found out she was HIV positive and had to start taking antiretroviral (ARV) drugs.

Raped by her uncle at 14, who threatened to kill her if she told anyone, Jacqueline managed to keep it a secret until she became sick and nurses at the local clinic advised her to be tested for HIV. Having a supportive mother who was with her when she got the result made it easier for Jacqueline to finally tell her about the rape.

The lively 17-year-old has been taking ARVs for almost two years, and says her life has "changed a lot". Taking the drugs is no picnic at any age, but when you're a teenager, sticking to a treatment regimen for the rest of your life is more "annoying" than anything else, she told PlusNews.

Treating children is not that easy. Pharmaceutical companies have not yet developed appropriate fixed-dose combination treatments, and Jacqueline's doctors have to keep adjusting the dosage as she gains or loses weight.

The leader of her support group commented, "Sometimes its 30 grams [of medication] or it can go up to 40 grams ... its very complicated. A lot of the children in my support group just think it's so boring."

Dr Tammy Meyers, director of the Harriet Shezi Children's Clinic at the Chris Hani Baragwanath hospital in Johannesburg, South Africa's commercial hub, noted that adherence required "an enormous amount of effort" by young children. Jacqueline is more fortunate because her mother bought her a cell phone, which reminds her to take treatment.

"I take them [ARVs] every day - I don't want to do anything to disturb the treatment," she said determinedly as she held out a brightly coloured box containing her tablets.

Jacqueline's diet is not that of a typical teenager: she avoids junk food and has never experimented with alcohol or smoking, which inevitably causes teasing and complaints about her "boring" lifestyle by her friends.

Apart from her parents and aunt, no-one knows the reason for Jacqueline's lifestyle, and she would rather be labelled 'stingy' by her friends than do something as natural as sharing a lollipop - popularised by music videos as a 'must have' accessory for teenage girls. Even her 10-year-old brother, dashing through the small four-roomed house, is unaware of his sister's HIV status.

When she has to collect her ARVs from the hospital, Jacqueline leaves school early, telling her teachers she has to fetch her asthma medicine.

Jacqueline's mother is adamant that her daughter is still "too young to even think about disclosing" her status. "I don't want people talking in the streets ... kids are very cruel these days."

Her daughter agreed: "I don't want to get to school and the toilet walls are full of writing [as graffiti] that Jacqueline has HIV. If my dreams come true, when I have my own, car, my own house and a job ... I will be ready."

The self-confessed "go-getter" proudly reels off her achievements at school, and talks about her ambition of becoming a pilot. Like most parents of teenagers, Jacqueline's mother believes her talkative daughter should be studying more, and not "day dreaming, writing poetry and reading romance novels", especially during her penultimate year at school.

Jacqueline has just started seeing someone, and enjoys going on double dates to a local shopping centre. Her boyfriend, 20, does not know about her status yet. "If it becomes serious and we go to the next level, then I will need to tell him, but you can't just rush into these things," she said.

Apart from the pills she takes twice a day, she cooks, cleans, reads romance novels when she's supposed to be studying, and goes partying - all the things normal teenage girls do.

"HIV does not mean 'Here I Vanish', and AIDS is not 'And I Die Soon' ... I'm here to stay."

*Not her real name

South Africa The world’s biggest ARV Programme? September 2006 C O N T E N T S Lead Feature Overview Features Some are less equal than others Gaps remain in government's PMTCT programme HIV-positive kids falling through the cracks Teenage determination A battle of the sexes over national ARV programme Disability grant cutoff threatens livelihoods of people on treatment Links & References Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa Overview of HIV/AIDS in South Africa Joint Civil Society Monitoring Forum The Treatment Monitor In-Depth Feedback PlusNews welcomes feedback. Send your messages to feedback.

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