http://www.hivcareforyouth.com/adol?page=md-module&mod=01-03-02

Key Cultural & Psychosocial Challenges of HIV-Infected Youth

Adolescence and HIV

A key task in working with HIV-infected adolescents is helping them adjust to their HIV status. Whereas psychosocial care is an intrinsic part of primary care for all people with HIV, meeting psychosocial needs is paramount in caring for adolescents. Without proper support, adolescents have enormous difficulty accessing care and adhering to treatment. Goals of psychosocial care for youth include:

  • Identifying and addressing crises (eg, suicidal behavior, homelessness)
  • Providing access to benefits, entitlements, and services
  • Promoting adherence to medical regimens
  • Assessing and expanding social support (if needed)
  • Supporting development of self-care and life-enhancing practices
  • Identifying and treating chronic problems (eg, depression, substance abuse)
  • Promoting skills to live independently and to make the transition to adulthood
  • Reinforcing and sustaining safer sex behaviors
  • Encouraging drug treatment and supporting recovery to prevent relapse (if needed)

Normal adolescent behavior that would be healthy in other youth can be detrimental to the health of an HIV-infected young person. Developmental tasks of adolescence such as risk taking, struggles for independence, experimenting with adult behaviors, impulsivity, and a sense of invulnerability, coupled with awakening sexuality, put adolescents at particular risk of acquiring HIV and nonadherence to complex medical therapies.17 As HIV-infected adolescents strive for independence, many are dependent on doctors, a medical system, case workers, and medicines. Resentment and ambivalence for such forced dependency is not uncommon and often manifests itself in poor adherence and substance abuse-related behaviors. For many perinatally infected adolescents, there are added challenges arising from the fact that they were not expected to survive childhood and, therefore, were not prepared for adulthood and independent living. Providers should understand the key psychosocial challenges unique to youth who acquire HIV perinatally or behaviorally:

Perinatally Infected Youth

  • Have spent their lifetimes coping with their illness
  • Parents are aware of infection and engaged in care
  • Many struggle against parents and providers to establish their independence

Behaviorally Infected Youth

  • Just beginning to cope with their illness
  • Parents often unaware of infection, so patients navigate care alone
  • Less in need of asserting independence from providers

References

  1. Samples CL, Goodman E, Woods E. Epidemiology and Medical Management of Adolescents. In: Pizzo PA, Wilfert C, eds. Pediatric AIDS, 3rd ed. Baltimore: Lippincott Williams & Wilkins; 1998:615.