[Experiences of adolescents seropositive for HIV/AIDS: a qualitative study]

["Revealing in the gerund": secrecy and stigma in practices of care for children and adolescents living with HIV/Aids]

This article analyzes practices of care and the HIV diagnosis disclosure process to children and adolescents living with HIV/AIDS. A case study was conducted in an outpatient clinic located in a public hospital in Rio de Janeiro through participant observation, semi-structured interviews with health professionals, and the consultation of documents produced by the professionals. The analysis, based on the sociology of Simmel and Goffman, points to the revelation of the diagnosis as a hallmark that accompanies all the care established with users and sheds light on issues such as secrecy, stigma and the possible understandings about the health condition established. As a result, institutionalized relationships contribute to a progressive contact with the condition of bearing a stigma and enable phases of a patient's life protected by information to exist.

New Insight into HIV-Related Psychological Distress: A Concept Analysis

Psychological distress is a frequently reported outcome measure in HIV research. However, because of its poor conceptualization, many studies only partially capture it because they focus solely on depression or anxiety based on symptoms. This study undertook a concept analysis of HIV-related psychological distress (HRPD) using Walker and Avant's method. The findings include HRPD's (a) attributes, including changes to emotional status, symptom burden, HIV disclosure distress and HIV-related stigma; (b) antecedents, including HIV-related stressors, cognitive appraisal of stressors and difficulty coping with the disease or treatment; and (c) consequences, including poor health outcomes and posttraumatic growth. Lazarus and Folkman's theory and the conservation of resources theory were adapted to further understand HRPD. This article provides insight into HRPD and increases the awareness of how to screen and assess HRPD at an early stage. The findings indicate the need to develop specific and rigorous measures and to provide appropriate interventions.

Storyboarding HIV Infected Young People's Adherence to Antiretroviral Therapy in Lower- to Upper Middle-Income Countries: A New-Materialist Qualitative Evidence Synthesis

Young people living with perinatal infections of Human Immunodeficiency Virus (YLPHIV) face a chronic disease, with treatment including adherence to lifelong antiretroviral treatment (ART). The aim of this QES was to explore adherence to ART for YLPHIV as an assemblage within the framework of the biopsychosocial model with a new materialist perspective. We searched up to November 2021 and followed the ENTREQ and Cochrane guidelines for QES. All screening, data extraction, and critical appraisal were done in duplicate. We analysed and interpreted the findings innovatively by creating images of meaning, a storyboard, and storylines. We then reported the findings in a first-person narrative story. We included 47 studies and identified 9 storylines. We found that treatment adherence has less to do with humans' preferences, motivations, needs, and dispositions and more to do with how bodies, viruses, things, ideas, institutions, environments, social processes, and social structures assemble. This QES highlights that adherence to ART for YLPHIV is a multisensorial experience in a multi-agentic world. Future research into rethinking the linear and casual inferences we are accustomed to in evidence-based health care is needed if we are to adopt multidisciplinary approaches to address pressing issues such as adherence to ART.

Social representations of the quality of life of the young people living with HIV

OBJECTIVES

to analyze the social representations of the quality of life of the young people living with HIV.

METHODS

qualitative survey, based on the Social Representations Theory, with 24 young people living with HIV, monitored in specialized services in Rio de Janeiro, through semi-structured interviews, and the analysis supported by the software IRAMUTEQ.

RESULTS

multidimensionality of the quality of life was observed unfolding the implications of living with HIV/aids concerning the familiar and social support network, time of diagnosis, healthcare services, antiretroviral therapy, and prejudice expressions.

FINAL CONSIDERATIONS

a conceptual synthesis of quality of life is observed when it is associated with healthy lifestyle habits, interpersonal relationships, and health services and professional practices.

Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study

BACKGROUND

Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers' perspectives about DR-TB treatment journey of patients and caregivers.

METHODS

This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis.

RESULT

The age of adolescent patients ranged from 15-19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care.

DISCUSSION

The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.

Prolonged Antiretroviral Therapy in Adolescents With Vertical HIV Infection Leads to Different Cytokine Profiles Depending on Viremia Persistence

BACKGROUND

We investigated immune activation, exhaustion markers and cytokine expression upon stimulation in adolescents with vertical HIV infection.

METHODS

Thirty adolescents receiving antiretroviral therapy (ART) for vertical HIV infection, including 12 with detectable viral load (HIV/DET), 18 with undetectable viral load (HIV/UND) and 30 control adolescents without HIV infection (CONTROL), were evaluated for immune activation and programmed cell death protein-1 expression by flow cytometry, and 21 cytokines by Luminex Multiple Analyte Profiling technology after in vitro peripheral blood phytohemagglutinin stimulation.

RESULTS

Lower CD4 T cells and higher T cell activation and exhaustion markers were noted on CD4 T and on CD8 T cells and memory subsets from HIV/DET group, who also produced lower in vitro IFN-gamma, IL-10, IL-13, IL-17A, IL-5 and IL-6 than HIV/UND group. HIV/UND were comparable with CONTROL group in respect to CD4 T cell counts and T cell activation and exhaustion markers, but with higher in vitro production of ITAC (a chemokine with leukocyte recruitment function), IL-4 and IL-23. An inverse correlation between cytokine production and programmed cell death protein-1 expression on CD4 T and CD8 T subsets was detected.

CONCLUSIONS

Persistent viremia despite ART leads to T cell activation and immune exhaustion with low cytokine production, whereas viral suppression by ART leads to parameters similar to CONTROL, although a different cytokine profile is observed, indicating residual HIV impact despite absence of detectable viremia.

ADHERENCE TO TREATMENT OF YOUNG ADULTS LIVING WITH HIV/AIDS FROM THE PERSPECTIVE OF COMPLEX THINKING

ABSTRACT Objetive: to understand the adherence to treatment of young adults with HIV/AIDS treated in a specialized care service from the perspective of complex thinking. Method: a qualitative study, with the data grounded theory approach. Twelve young adults aged from 15 to 24 years old living with HIV/AIDS, nine health professionals and four mothers participated in the study. Data was obtained from interviews conducted between April and September 2016 and analyzed using the constant comparative method. Results: the adherence to treatment of young adults with HIV/AIDS has been understood as a dynamic, multifactorial and constantly changing phenomenon. This process involves multiple aspects, including fear of becoming ill, physical and social death, discrimination and stigma. It was found that even in the face of these difficulties, young adults decide to continue their treatment in search of normalization of health, a long and common life like other young people who do not live with HIV/AIDS. Conclusion: it was considered that in view of the complex and changing phenomenon, adherence to treatment of young adults with HIV/AIDS should be understood and managed by health professionals.

Adolescentes que vivem com HIV/aids: experiências de sexualidade

Resumo OBJETIVO Analisar as experiências de adolescentes que vivem com HIV/aids acerca da sexualidade. MÉTODO Pesquisa qualitativa realizada em um Serviço de Atendimento Especializado, de um município do Rio Grande do Sul, com 15 adolescentes que vivem com HIV/aids, no ano de 2014. Utilizou-se entrevista semiestruturada. Os dados foram analisados por meio da proposta operativa de Minayo. RESULTADOS As primeiras interações afetivas dos adolescentes foram experienciadas por meio do ficar e namorar, fortemente, influenciadas pela valência diferencial de gênero nas construções familiares. As experiências de relações sexuais foram decorrentes da dimensão afetiva do relacionamento e não se davam sem preocupação para os adolescentes. Administrar a condição de soropositividade em seus relacionamentos afetivos mobilizava o seu cotidiano. CONCLUSÃO O aprendizado da sexualidade extrapola o acesso às informações, decorrendo das experiências vivenciadas, do momento e dos distintos cenários em que elas se inserem.

“Essa doença para mim é a mesma coisa que nada”: reflexões socioantropológicas sobre o descobrir-se soropositivo

Resumo Nas quase quatro décadas da epidemia de HIV/aids, sua administração clínica sofreu mudanças consideráveis. O atual alargamento temporal impõe aos sujeitos HIV+ (re)posicionamentos no agenciamento da vida e da enfermidade a partir da perspectiva de uma doença de longa duração que sugere adequação dos hábitos e comportamentos, frequente interação com serviços e profissionais da saúde e uso contínuo de medicamentos - além da convivência com os impactos sociais, subjetivos e físicos da enfermidade. A pesquisa discute, a partir de dados de uma pesquisa com jovens soropositivos, os processos de revelação do diagnóstico. Foram seis entrevistas abertas, a partir de uma questão norteadora, com jovens entre 18 e 22 anos, de camadas populares, de ambos os sexos e transmissão materno-infantil. A perspectiva teórica que ancorou nossas digressões foi a socioantropológica. Entre esses jovens a normalidade figura como eixo estruturante do diagnóstico, o que contrastou, entre outras coisas, com o fato de que a maioria dos entrevistados preferia manter segredo sobre sua sorologia. Família e serviço alternaram-se como responsáveis pela revelação. Além disso, o ativismo aparece como forma de encontrar lugar para a sorologia no curso da vida e como estratégia acionada para lidar com o cotidiano após o diagnóstico.