PSYCHOSOCIAL AND BEHAVIOURAL ASPECTS IN HIV INFECTED CHILDREN AND
PSYCHOSOCIAL AND BEHAVIOURAL ASPECTS IN HIV INFECTED CHILDREN AND
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.
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
Key Words: Psychosocial, Behavioural, Hiv,Children
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).
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).
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 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.
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