Key Cultural & Psychosocial Challenges of HIV-Infected Youth

Importance of Disclosure

Regardless of family circumstances or mode of HIV infection, adolescents are very concerned about sharing information regarding their HIV diagnosis with others. Disclosure of one's HIV status is complex and delicate, and each disclosure is encumbered with consequences. For some youth, the impact of a new diagnosis is immediate. For others, it can take weeks to years for the emotional reality of the diagnosis to be absorbed. The particular developmental traits of adolescence make it particularly challenging for young people to cope with the diagnosis of HIV. These include a strong sense of invulnerability and immortality, being prone to peer pressure, limited ability to conceive of long-term consequences of behavior, and a struggle between a sense of omnipotence and impotence. For adolescents who have already experienced poverty, loss, and living arrangements that brought constant threats and dangers, living with HIV is another burden in their lives, and it is often perceived as confirmation that the world they inhabit is untrustworthy. 18 Despite these challenges, providers should facilitate the support needed for a patient to learn the importance of disclosure. A multisystems approach may help the provider locate important community supports for the process of disclosure. For example, peer support groups, networks, or interactions may be helpful during contemplation and after disclosure.

Adolescents who disclose their HIV status to peers and family have been shown to have:

• Better psychosocial outcomes
• Fewer symptoms of posttraumatic stress disorder
• Greater likelihood of disclosing to romantic partners
• Higher peer self-competence 19
• Greater resources and psychological support from family and friends

On the other hand, sharing one's health status with others can result in being shunned and even discriminated against. Referral to a mental health professional or a spiritual adviser who is informed about HIV/AIDS can help adolescents decide to whom, how, and when to disclose their status to others. Role playing, in particular, can be a very effective way for teens to practice informing potential sexual partners about their HIV status.

References

18. Lyon ME, Brasseux C, D'Angelo LJ. Who should I tell? Disclosure of HIV status by infected adolescents. In: Annual Meeting of the Society for Adolescent Medicine; Los Angeles; March 17-21, 1999. Poster presentation.
19. Wiener LS, Battles HB. Untangling the web: a close look at diagnosis disclosure among HIV-infected adolescents. J Adolesc Health. 2006 Mar;38(3):307-9.