Contributor – Celumusa C. Ndlangamandla

Adolescent girls and young women (AGYW) aged 13–29 have unique health needs that change as they grow. If our health services do not adapt alongside them, we risk losing them, not just from the clinic, but from care altogether. In 2021, I witnessed this firsthand while working as a mental health nurse in my home country of Eswatini (formerly Swaziland). I cared for AGYW living with or at risk of HIV. I still remember the girls who walked into our clinic carrying more than a diagnosis: school they had left behind, families depending on them, and relationships in which saying “no” was not always safe. At our clinic, we tried to meet them where they were. We helped girls return to school, strengthened their leadership skills, taught them about their rights, and helped them recognize and report gender-based violence. These efforts mattered because AGYW in Eswatini are three times more likely to acquire HIV than their male peers.

Many of these young women depended on others financially. Some had left school because of pregnancy or caregiving responsibilities. Gender inequality, harmful social norms, and gender-based violence deepened their vulnerability, while many struggled to negotiate condom use. Eswatini has made important progress in HIV treatment, but progress on paper does not always reach the girl who cannot afford transportation to her next appointment.

As a nurse, I provided post-violence care, treated opportunistic infections, conducted HIV testing, initiated antiretroviral therapy, and supported school-based HIV and violence-prevention programs. Every encounter reinforced the same lesson: youth-friendly care is not a nice extra; it can determine whether a young person comes back.

For me, youth-friendly care starts with creating a space that feels welcoming, respectful, confidential, and free from judgment. It means listening to young people and involving them in decisions about their care. It also means recognizing barriers that may be invisible from the examination room: privacy concerns, stigma, transportation costs, financial hardship, or family responsibilities. If we do not ask about these realities, we may treat the diagnosis while missing the person carrying it.

This approach to youth-friendly care reflects the principles of person-centered nursing. As Cassidy J. Ohnstad reflects in Nursology.net, person-centered care views individuals as complete human beings with their own histories, values, and aspirations rather than reducing them to the condition being treated. This perspective aligns with Boykin and Schoenhofer’s Theory of Nursing as Caring, which views nursing as a relational practice in which the nurse and person participate in a shared experience of caring. For instance, for nurses providing HIV services, this means looking beyond viral suppression and other clinical outcomes to understand how young people experience care, what matters to them, and what may prevent them from accessing or remaining engaged in services. Youth-friendly HIV care, therefore, is not simply about making services more convenient; it is about creating nursing relationships and care environments in which young people are respected as whole persons and active participants in their health.

So, what can nurses do?

• Listen to young people. Involve them in scheduling, service design, and developing age-appropriate educational materials.
• Create feedback loops. Give young people meaningful opportunities to tell us what works, what does not, and then show them how their feedback has influenced services.
• Invest in staff training. Make youth-friendly care part of ongoing professional development.
• Increase flexibility. Consider after-school clinic hours while protecting confidentiality.
• Use technology thoughtfully. SMS reminders can support appointments and medication adherence, particularly for newly diagnosed individuals.
• Build peer support. Youth mentors, peer supporters, and patient navigators can make care more relatable and accessible.

I think often of those girls in Eswatini not as case numbers, but as young women trying to finish school, stay safe, and imagine a future for themselves. Nurses have always advocated for the people we serve. We can help make HIV care more welcoming, responsive, and human for the next generation.
Let’s make sure the young people who walk through our doors leave feeling heard, respected, and supported!

Bibliography

Bennin, F., Fynn, L; Fuzile, P. ;Yola, N.; Julies, R.; Sindelo, S.; Madubela, N.; Vundhla, P.; Mpanda, Y.; Jonas, M.; Bekker, L. G.,; & Rousseau, E. (2024). “Youth are experts in what they need”: experiences and best practice in co-designing and implementing Fast-PrEP, a novel PrEP service for adolescents and youth in Cape Town, South Africa. Frontiers in Public Health, 12, 1459418. https://doi.org/10.3389/fpubh.2024.1459418

Hayfron-Benjamin, A., Obiri-Yeboah, D., Bockarie, Y. M., Asiedua, E., Baidoo, I., Akorsu, A. D., & Ayisi-Addo, S. (2020). Experiences and training needs of healthcare providers involved in the care of Ghanaian adolescents living with HIV: An interventional study. BMC Pediatrics, 20(1), 278. https://doi.org/10.1186/s12887-020-02086-w

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Ohnstad, C. J. (2026, February 13). Reflections on person versus patient centered care. Nursology. https://nursology.net/2026/02/13/reflections-on-person-versus-patient- centered-care/

Saul, J., Bachman, G., Allen, S., Toiv, N. F., Cooney, C., & Beamon, T. (2018). The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PloS one, 13(12), e0208167. https://doi.org/10.1371/journal.pone.0208167

Society for Adolescent Health and Medicine. (2023). Improving Outcomes for Adolescents and Young Adults Living with HIV. Journal of Adolescent Health, 73(3), 605-609. https://doi.org/10.1016/j.jadohealth.2023.05.006

World Health Organization. (2019). Adolescent-friendly health services for adolescents living with HIV: From theory to practice. World Health Organization. Retrieved from https://iris.who.int/server/api/core/bitstreams/287aff11-77bd-497d-aec8-b24627ee7f6b/content

Acknowledgement: I am sincerely grateful to Dr. Kamila Alexander for her thoughtful mentorship, continued encouragement, and insightful comments throughout the development of this blog.

About Celumusa C. Ndlangamandla

Celumusa C. Ndlangamandla is a PhD nursing student at Johns Hopkins University School of Nursing, where he hopes to examine the prevalence and risk and protective factors associated with suicidality among adolescents living with HIV. He holds a Bachelor of Science in Mental Health Nursing from the University of Eswatini (formerly the University of Swaziland) and a Master of Science in Community and Public Health Nursing from the American University of Beirut, Lebanon. His research focuses on adolescent/youth mental health and HIV/AIDS, with an emphasis on improving access to mental health care and HIV prevention among hard-to-reach adolescents and young people. He seeks to develop equitable, youth-centered interventions that address the intersecting challenges of mental health and HIV.