Addressing Psychosocial Comorbidities among HIV-Infected Youth
Mental Health & Stigma
Individuals diagnosed with a mental disorder feel stigmatized by their illness and often experience shame, grief, and anger over their diagnosis. Once they have "recovered" from learning of the diagnosis, they feel they can pass for "normal" as long as no one finds out about their condition. In addition to their HIV diagnosis, adolescents can perceive their association with psychiatric services as stigmatizing. Many youth already see themselves as stigmatized by segments of society because of their appearance, behaviors, and attitudes, and thus may be resistant to accepting mental health services. 45
In recent years, mental health practitioners have recognized the importance of "bringing the service to the patient" in an effort to minimize barriers to care:
- At-home therapy provides mental health services to children, adolescents, and their families where they live. Although not ideal for all individuals (some patients tightly guard their privacy and prefer that staff not visit their homes), this approach addresses barriers to services. This approach also avoids referring adolescents to mental health services in the community, where they are known to their peers and neighbors.
- Availability of a mental health practitioner in the primary or specialty clinic site facilitates access to services. A culturally sensitive psychiatrist, psychologist, or social worker should be identified as a member of the multidisciplinary team, and the treatment should be normalized as a routine service intervention of the care plan.
- Alternative approaches can be tried in the event a mental health practitioner is not available for the youth in a particular community. Information on how to access support via the Internet should be made available in these cases, especially to those living in rural areas. Some websites offer valuable resources that address many of the concerns associated with a new diagnosis and provide updated information on current treatments and interventions. Several of the youth-specific sites have chat rooms with "instant messaging" capabilities. If a young person is reluctant to seek services within the community for fear of recognition, this cyber approach may be a suitable alternative.
Once a therapeutic alliance is formed between the patient and the mental health practitioner, retention in care is optimized. Having an array of choices appeals to youth who are seeking to be more involved in the decision-making process regarding their health.
- Chandra A, Minkovitz CS. Stigma starts early: gender differences in teen willingness to use mental health services. J Adolesc Health. 2006 Jun;38(6):754.e1-8.