Age-of-access barriers and adolescent engagement with human immunodeficiency virus prevention and care
1
SDG Alliance, Yola, Nigeria
2
Society for Family Health, Kano, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
In Nigeria, adolescents need parental consent before accessing HIV services. However, cultural norms make many avoid discussing sexual activity or health concerns with parents. Sexual debut often occurs around the age of 15, yet adolescents face barriers to confidential care at this stage making them delay testing, hide symptoms, or avoid services. This study examined how age-of-access policy influence HIV risk, prevention practices and care-seeking behaviours among adolescents in Adamawa.
METHODS:
A mixed-methods study was conducted between May-September 2025 in Adamawa. Questionnaires were administered to 184 adolescents and young adults aged 15-24 years to assess sexual activity, condom use, HIV testing history and disclosure concerns. Qualitative data were collected through in-depth interviews with 22 adults living with HIV who reported acquiring HIV during adolescence, and 12 interviews with adolescents aged 16-19 years. Data were disaggregated by age and gender. Quantitative data were analysed descriptively, while qualitative data were analysed thematically to explore how consent requirements, stigma and service design influenced care-seeking decisions.
RESULTS:
Among sexually active adolescents aged 15–19 years (n=96), 65 reported avoiding HIV testing due to fear of parental discovery, despite perceiving themselves at risk. 39 reported using a condom at last sex, while only nine had ever accessed youth-friendly sexual health services. Older participants living with HIV described delayed testing and late entry into care during adolescence, often occurring only after severe illness or pregnancy. Across groups, participants described secrecy, avoidance of formal health services, and reliance on informal alternatives as common responses to parental consent requirements.
CONCLUSIONS:
Age-of-access and parental consent requirements, when combined with stigma, contribute to delayed HIV testing, limited prevention uptake and late engagement with care. Public health responses should prioritise confidential adolescent-friendly services, review consent policies and strengthen rights-based approaches to adolescent health to reduce long-term HIV vulnerability.
In Nigeria, adolescents need parental consent before accessing HIV services. However, cultural norms make many avoid discussing sexual activity or health concerns with parents. Sexual debut often occurs around the age of 15, yet adolescents face barriers to confidential care at this stage making them delay testing, hide symptoms, or avoid services. This study examined how age-of-access policy influence HIV risk, prevention practices and care-seeking behaviours among adolescents in Adamawa.
METHODS:
A mixed-methods study was conducted between May-September 2025 in Adamawa. Questionnaires were administered to 184 adolescents and young adults aged 15-24 years to assess sexual activity, condom use, HIV testing history and disclosure concerns. Qualitative data were collected through in-depth interviews with 22 adults living with HIV who reported acquiring HIV during adolescence, and 12 interviews with adolescents aged 16-19 years. Data were disaggregated by age and gender. Quantitative data were analysed descriptively, while qualitative data were analysed thematically to explore how consent requirements, stigma and service design influenced care-seeking decisions.
RESULTS:
Among sexually active adolescents aged 15–19 years (n=96), 65 reported avoiding HIV testing due to fear of parental discovery, despite perceiving themselves at risk. 39 reported using a condom at last sex, while only nine had ever accessed youth-friendly sexual health services. Older participants living with HIV described delayed testing and late entry into care during adolescence, often occurring only after severe illness or pregnancy. Across groups, participants described secrecy, avoidance of formal health services, and reliance on informal alternatives as common responses to parental consent requirements.
CONCLUSIONS:
Age-of-access and parental consent requirements, when combined with stigma, contribute to delayed HIV testing, limited prevention uptake and late engagement with care. Public health responses should prioritise confidential adolescent-friendly services, review consent policies and strengthen rights-based approaches to adolescent health to reduce long-term HIV vulnerability.
| eISSN: | 2654-1459 |
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