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PSYCHOSOCIAL AND BEHAVIOURAL ASPECTS IN HIV INFECTED CHILDREN AND ADOLESCENTS

PSYCHOSOCIAL AND BEHAVIOURAL ASPECTS IN HIV INFECTED CHILDREN AND ADOLESCENTS

Resham Mishra,1 Alok Hemal2

Senior Resident1, Professor 2Department of Pediatrics. Post Graduate Institute of Medical Education and Research,

Dr Ram Manohar Lohia Hospital, New Delhi 110001.

 

Abstract

Literature reveals that children and adolescents with HIV infection experience more subjective distress than their uninfected peers (2). Dysphoria, hopelessness, preoccupation with their illness, low self esteem and poor body image are some of the important presenting complaints among them. According to a panel presentation at the Eighteenth International AIDS Conference in Vienna, the needs of adolescents living with HIV are much more sensitive and varied than those of adults, as they must simultaneously deal with 'adult' issues like disclosure, practicing safe sex, and adhering to treatment, while also addressing issues traditionally associated with adolescence, such as first sexual experience, peer pressure and forming personal identity. Some adolescents with HIV, report more sexual risk-taking behaviour and conduct or hyperactivity disorders. Little is known about the specific factors that predict psychological adjustment in these children, and how these children and families fare when compared to families of similar backgrounds (12,3,).

Key Words: Psychosocial, Behavioural, Hiv,Children And Adolescents

 

Introduction


As the number of young people living with HIV is rising internationally, new and innovative ways to talk about sex education, disclosure of status and health need to be developed for HIV-positive adolescents. Various studies and clinical reports have suggested that HIV-positive children and adolescents are at risk for behavioural problems. The transition of HIV from an acute, lethal disease to a sub acute, chronic disease has enormous implications for the neurocognitive and psychosocial development of children and families. In a study conducted at a tertiary health care centre of North India, 80.7% HIV-infected children were reported to have behavioural problems as compared to 18.3% of healthy control group. Also, psychiatric behaviour in HIV-infected children as a risk factor for further transmission of HIV infection was also identified in significant proportion in the study population (4).

Etiology

The etiology of behavioural abnormalities in HIV-infected children and adolescents is likely to be multifactorial, including factors such as prenatal drug exposure, severity of infection, difficult family environment, age of parents, level of parental education, absence of parent, changes in caregivers, illiteracy, nutrition and poverty (4). In India, a variety of stressors are experienced by majority of HIV-infected and affected children including trauma, number of hours spent by the parent with the child, HIV illness of the parent and familial mental illness that may contribute towards poor behavioural outcomes (1). A study conducted in Uganda and Kenya revealed that HIV-positive young people concurrently felt empowered and excited about growing older, while also being weary of the potential restrictions and increased responsibility resulting from their HIV status (5). Due to notions of AIDS as a deadly virus, it was found that many adolescents “lived in the moment” and wanted to get “the most out of a life with HIV”. In reality, this often resulted in early first sexual experience, as young people “did not want to die without having sex” (6).

While several studies have focused on neurocognitive and behavioural effects from viral infection, questions have arisen as to whether these effects stem from HIV and opportunistic infections specifically or, rather, are a result of social factors (2). Affected neurocognitive functions include fine motor strength, language, executive skills and memory, academic achievement, and general cognitive ability. The Harlem study found that “environmental influences on neurocognitive functioning may be negligible given the impact of advanced HIV infection and psychiatric illness.” As such, high rates of psychiatric illness among HIV-positive adolescents require increased prevention and intervention strategies (7,8,9).

Interestingly, as per few researchers, difference experiences for adolescents generally depend on whether an individual was infected through neonatal or postnatal exposure. However, this is currently an anecdotal observation, and requires further exploration before conclusions can be made (9).

Intervention

Studies reaffirm the need to acknowledge the crucial role of psychosocial support for HIV infected and affected adolescents. Adolescent-specific factors, such as cognitive immaturity and exploratory learning behaviour as well as a variety of other factors that moderate sexual behaviour, such as impulsivity, distress and adverse life experiences need to be targeted by intervention programs (7,10). Special information sessions must be conducted that deal with the problem of ‘status disclosure’ and its implications. A positive attitude refill is a must for these individuals as they face the world post status disclosure. Disclosure at school is of particular concern, it could be detrimental (7). Many children do not yet know or fully understand the meaning of their HIV infection, and disclosure to the school could result unintended disclosure to the child, as well as stigma and discrimination from the school staff and students. The work of medical personnel and policy makers should be focused not only to prolong the HIV-infected adolescent’s life span but also to strive for a good quality of life of these individuals (11,12).

Role of Caregivers

As clinicians it is our foremost duty to lay emphasis on prevention of the disease. Schools in association with clinicians must impart sex education as a part of prevention education programs. They are designed specifically to reduce sexual risk behaviours and support youth asset-development programs, which provide adolescents with more general skills that help them engage in health promotion. In addition to determining programs that are most effective in reducing sexual health risk behaviours among youth, scientists also have identified key common attributes among these programs. Effective HIV/STD prevention programs tend to be those that are delivered by trained instructors, are age-appropriate and include components on skill-building, support of healthy behaviours in school environments and involvement of parents, youth-serving organizations and health organizations. Youth asset-development programs, teach youth how to solve problems, communicate with others, and plan for the future. They also help youth develop positive connections with their parents, schools, and communities (12,13,14).

Future perspective

Future studies should seek to evaluate the efficacy of various interventions in this context (e.g., support groups, individual and family therapy, case management, etc.) for children and families as they struggle to cope with this devastating disease (7). In addition, there is need for case management, social work, and mental health services to be available for at-risk families, as many healthy children and adolescents exhibited significant levels of psychological distress and poor adjustment (15,16). It is our utmost responsibility to lay a platform for a better tomorrow for the future citizens of our country.

References


 

 


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