Human Immunodeficiency Virus Positive Adolescents Research Articles

Mental Health Problems Experienced by HIV Positive Adolescents; A Case of Choma District, Zambia

Several scholars have reported high mental health problems among adolescents with Human Immunodeficiency Virus (HIV) globally. However, little is known about the mental health of this peculiar group of young people in Choma district. This study aimed to determine the mental health problems experienced by HIV positive adolescents in Choma District. Using the Strengths and Difficulties Questionnaire (SDQ), data were obtained from 103 HIV positive adolescents receiving treatment at Choma General Hospital plus a corresponding number of parents/care givers. Information about mental health services was obtained qualitatively from 10 nurses working in the mental health unit and the Antiretroviral (ART) clinic. The results showed that more than three quarters of the adolescents had mental health problems. Of this number, 57.3 percent had multiple mental health problems: predominantly emotional and peer problems. The study also found a statistically significant relationship between level of stigma and presence of mental health problems (X2 = 1.123, P = 0.003). In conclusion, the study demonstrated that multiple mental health problems particularly emotional and peer problems are prevalent among adolescents with HIV/AIDS yet are most often undiagnosed. In addition, adolescents with high levels of internalized stigma are more likely to have multiple mental health problems. The findings suggest the need to integrate psychiatric services into routine care of HIV infected adolescents, routine screening for mental health problems and provision of continued professional development among nurses managing these patients.

Refusal of care by a HIV-positive adolescent: role of the cross-cultural approach

The refusal of treatment is frequent in human immunodeficiency virus-positive adolescents. The clinical history of a teenage girl presenting severe immunodepression secondary to the virus, a depressive disorder and a refusal of treatment, illustrates the benefit of combined paediatric, child psychiatric and cross-cultural care as proposed by the Cochin-Paris Adolescent Centre. Working on the meaning of the refusal was a prerequisite for the construction of a care project forming part of a life project, as the psychopathological work could only begin once somatic care ensuring the patient's protection was in place.

Antiretroviral therapy for HIV-1 infected adolescents in Uganda: Assessing the impact on growth and sexual maturation

There is a paucity of knowledge about perinatally infected human immunodeficiency virus (HIV) positive children surviving into their adolescent years, especially from sub-Saharan Africa. Although studies have described the effects of the disease on the physical and sexual maturation of this population, their response to highly active antiretroviral therapy has not been systematically studied. At the pediatric infectious diseases clinic in Mulago hospital, Kampala, Uganda, we evaluated the effect of antiretroviral therapy (ART) on 118 treatment-naive, perinatally-infected HIV positive adolescents between the ages of 10–19 for 12 months. We monitored physical growth using The Centers for Disease Control and Prevention and recently published World Health Organization (WHO) reference growth standards for height and weight measurements as well as sexual maturation using Tanner staging. Laboratory tests including: complete blood count, absolute CD4 cell count and percentage, and HIV-1 RNA viral load, were performed at baseline and at 3-month intervals. Of 118 children, 64% were female; the median age was 13.6 years old. At baseline, 75% were classified as WHO clinical stages III and IV, with a median CD4 count of 124 cells/ul. Apart from four adolescents, all were on first-line antiretroviral therapy with 2 nucleoside reverse transcriptase inhibitors and 1 non-nucleoside reverse transcriptase inhibitors. After 6 months, the median CD4 count was 304 cells/μL, increasing to 370 cells/μL, by 12 months. Antiretroviral therapy was virologically suppressive (HIV-1 RNA viral load

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This study evaluates the effectiveness of a peer support intervention on human immunodeficiency virus (HIV) related information and self-management in HIV positive adolescents. Adolescents in this study referred to children in the age group 11 to 16 years. An intervention study, with outcomes assessed the intervention and immediately post-intervention.  Participants aged 11 to 16 years (N = 114) were recruited from three antiretroviral treatment (ART) clinics in Lusaka, and interviewed using semi-structured questionnaires. Information on HIV and acquired immune deficiency syndrome (AIDS) was given using an information leaflet entitled 'Let’s Talk about HIV and Living positively; How can young people with HIV live normally?’ After the intervention, the findings showed that 96% of the participants were knowledgeable that unprotected sex was the most common route of transmission of HIV. The belief that people with HIV should stop ART when they feel better; and that ART can have unwanted side effects decreased amongst the participants. Overall after the intervention, knowledge and belief about HIV and ART; and self-management improved. Peer support intervention using information leaflets seems to be useful strategy in improving knowledge and self management in HIV positive young people.   Keywords: HIV, young people, self-management, information.

Randomized control trial to evaluate yoga-based peer support group for human immunodeficiency virus (HIV) positive Zambian adolescents

It has been shown that Human immunodeficiency virus (HIV) positive adolescents are more vulnerable to behavioural problems than non-infected adolescents and stress compromises immune function. There is some evidence that yoga and peer support benefits mental health. This study aimed to evaluate the impact of a 10-week programme of peer support and yoga on the psychological well being of HIV positive Zambian adolescents. An exploratory randomized controlled trial design was used. Adolescents aged 11 to 16 (n = 34) were randomized to peer group with yoga, peer support only group/social support group or waitlist control. Outcomes were immune function (CD4 count), self-rated physical health (SF12), psychological well being (Strengths and Difficulties Questionnaire). Outcomes were measured pre intervention, post intervention and at 10 weeks follow-up. There were no differences between the yoga and peer support group and the peer support only group, and both were evaluated well by participants. The peer only group had fewer emotional symptoms after the intervention (p < 0.05), while a combination of yoga and peer support group had a beneficial effect on CD4 count (p < 0.05). There were no differences between the groups at 10-week follow-up. Peer support/social support interventions were associated with short term benefits for the psychological and physical well-being in HIV positive adolescents, suggesting the need for sustained support. Key words: Human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), adolescents, yoga, peer support.

To Say or Not to Say: A Qualitative Study on the Disclosure of Their Condition by Human Immunodeficiency Virus–Positive Adolescents

Purpose Human immunodeficiency virus (HIV)–positive adolescents face a number of challenges in dealing with their disease, treatment, and developmental tasks. This qualitative study describes some of the reasons why, and the extent to which, adolescents may or may not disclose their condition to others. Methods A semistructured interview lasting 40–110 minutes was conducted with each of 29 adolescents 12–20 years old, 22 female and seven male) living in Switzerland. Interviews were tape recorded and transcribed verbatim. The analysis of the content of interviews allowed us to identify salient topics (e.g., disclosure), which were then explored in detail. Results Of 29 participants, eight had not disclosed their condition to anyone outside the family, 19 had disclosed it to good friends, and 16 had disclosed it to some teachers. Four participants had engaged in public disclosure, and six of 10 sexually active teenagers disclosed their status to their partners. The attitudes toward disclosure among younger adolescents were mostly related to those of the parents, particularly the mother. Older adolescents, engaged in their search for autonomy, tended to decide independently what to say and to whom. Although foster/adoptive parents would often encourage disclosure, biological parents, especially HIV-positive mothers, insisted on not disclosing the adolescent's status for fear of stigma. Conclusion The health care team should systematically address the issue of disclosure with the adolescent and his family (or foster parents), the aim being to balance the right of the adolescent and that adolescent's family to maintain privacy against the concerns of sexual partners, as well as the adolescent's interest in divulging HIV status to relatives, school staff, and friends.

Sexual behavior change among human immunodeficiency virus-infected adolescents with hemophilia. Adolescent Hemophilia Behavioral Intervention Evaluation Project Study Group.

To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia. One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat. Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4-20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2-20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04-20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior. These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being.

Inaccurate documentation of HIV-positive status in adolescents visiting an urban emergency department

Purpose: To identify the frequency of documentation of human immunodeficiency virus (HIV)-positive adolescents’ serostatus during urban pediatric emergency room visits, and to examine possible differences between those whose HIV positive serostatus was and was not documented. Methods: Between 1986 and 1996, 115 HIV-positive adolescents (41 male, 74 female) were followed for primary medical care at the Children’s National Medical Center’s adolescent HIV clinic (Burgess Clinic) in Washington, DC. A retrospective chart analysis of visits to the emergency room by these adolescent patients known to be HIV positive was conducted. Results: Forty-nine of the HIV patients (ages 10–23 years) visited the hospital’s emergency room a total of 124 times in the time following notification (range, 2 days to 15 years; mean, 2.6 years) of their seropositivity and joining the program. Twenty-nine of the patients had no HIV seropositivity recorded during one or more of their visits; this prevalence represents 38% of the 124 emergency room visits. Twenty of the HIV-positive emergency room patients had no seropositivity documented during any emergency department visit. Of all 124 visits, 45 involved potential health care worker exposure to the HIV virus. Diagnosis of acquired immunodeficiency syndrome, CD4 count, age, gender, and year of visit did not differ among those with and without HIV documentation. Conclusion: Human immunodeficiency virus–positive adolescents are seen in this emergency room and their records do not reflect their infection status. These data reinforce the need for universal precautions for every patient.