Key Cultural & Psychosocial Challenges of HIV-Infected Youth

This section addresses the major psychosocial health issues that providers should be aware of when treating HIV-infected youth. It should be noted that many of these issues are common among both perinatally and behaviorally infected youth; however, there are psychosocial issues unique to perinatally infected youth, and those are highlighted here.

All HIV-infected youth--whether they acquired HIV perinatally, through an early-life transfusion, by sexual abuse, or by way of behavioral risk factors--confront the same challenges as their healthy peers, including experimental behavior and the development of skills needed for adulthood. However, unlike other youth, HIV-infected youth must negotiate these challenges while living with a highly stigmatized disease. Their choices regarding intimate relationships, sexual activity, and experimentation with drugs and alcohol are complicated by:

• Fears of rejection
• The side effects of HIV medications
• An uncertain life span
• Concerns about disclosure and transmission
• The impact of loss
• Stigma

Cognitively, late adolescents and young adults who have achieved or who are in the process of completing the developmental tasks of adolescence may be more capable of dealing with their HIV status proactively. But, even these patients require significant psychological and emotional support. Further, all HIV-infected young people experience two other transitions to adult life that are affected by their illness: academic/vocational planning and negotiating the adult medical care system. It is critical to help them understand and internalize that HIV is a chronic illness that, when successfully managed, can still allow for a long and healthy life that includes marriage or long-term relationships, children, academic/vocational success, and longevity. Black/African American and AI/AN youth may have access to rites of passage programs or activities that can help to foster their growth and development. Among many in these cultural groups, the transition to adolescence is seen as a time for preparation to assume community responsibilities and live productive adult lives. There may be community-based programs available to youth and families.