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Ibrahim N, Viard JP, Ludot-Grégoire M, Lachal J, Dumas A, Brazille P, Lechat D, Bridou S, Molinari D, Hassler C, Rouquette A. Sexual Health of Young Adults Living with Perinatally Acquired HIV in Paris, France: A Qualitative Study. AIDS Patient Care STDS 2024; 38:477-486. [PMID: 39166291 DOI: 10.1089/apc.2024.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
We aimed to explore the sexual health of young adults with perinatally acquired human immunodeficiency virus (PHIV). Eighteen to 25 years old PHIV participants were recruited in two tertiary care units in Paris. Sexually transmitted HIV was an exclusion criterion. Individual interviews were conducted. Transcripts were analyzed using a semio-pragmatic phenomenological method. Twenty-five participants were interviewed from March 2022 to September 2022. Some of them renounced being in any romantic relationship. Those who disclosed their HIV status to their romantic partner reported that dating was more complex and those who did not disclose reported that keeping HIV a secret was a significant mental burden. Young men tended to disclose their HIV status to their romantic partner whereas young women did not consider doing so before marriage. Many participants had to educate themselves about sexuality, through school or websites. Identified interlocutors for sexuality varied across participants. All participants were aware of U = U (Undetectable = Untransmittable) slogan. Despite that, participants remained worried about transmitting HIV to their sexual partners. That hindered their sexual satisfaction. In addition, they neglected the risk of unwanted pregnancies or sexually transmitted diseases (STDs). In our study, knowing the U = U slogan did not provide reassurance to PHIV participants regarding the risk of onward HIV transmission. Further, they showed very little concern for protecting themselves from their partner's STD.
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Affiliation(s)
- Nour Ibrahim
- Paris-Saclay University, UVSQ, CESP, Paris, France
- Groupe Français de Recherche en Médecine et Santé de l'Adolescent (GRMSA), Maison de Solenn, Paris, France
- Hôpital Robert Debré, Service de Médecine de l'Adolescent, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Paul Viard
- Unité d'Immuno-infectiologie, Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Cité, Paris, France
- Faculté de Médecine Paris Descartes, Unité de Recherche EA 7327, Paris, France
| | - Maude Ludot-Grégoire
- Paris-Saclay University, UVSQ, CESP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Jonathan Lachal
- Paris-Saclay University, UVSQ, CESP, Paris, France
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
| | - Agnès Dumas
- Université Aix Marseille, INSERM, IRD, ISSPAM, SESSTIM (Economic and Social Sciences of Health and Medical Information Processing), Marseille, France
| | - Patricia Brazille
- Hôpital Hôtel Dieu, Espace Santé Jeunes-Unité Guy Môquet, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Lechat
- Hôpital Hôtel Dieu, Espace Santé Jeunes-Unité Guy Môquet, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sophie Bridou
- Hôpital Hôtel Dieu, Espace Santé Jeunes-Unité Guy Môquet, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Domitille Molinari
- Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Paris, France
| | | | - Alexandra Rouquette
- Paris-Saclay University, UVSQ, CESP, Paris, France
- Public Health and Epidemiology Department, AP-HP, Hôpital du Kremlin Bicêtre, Le Kremlin Bicêtre, France
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Evangeli M, Gnan G, Musiime V, Fidler S, Seeley J, Frize G, Uwizera A, Lisi M, Foster C. The HIV Empowering Adults' Decisions to Share: UK/Uganda (HEADS-UP) Study-A Randomised Feasibility Trial of an HIV Disclosure Intervention for Young Adults with Perinatally Acquired HIV. AIDS Behav 2024; 28:1947-1964. [PMID: 38491226 PMCID: PMC11161430 DOI: 10.1007/s10461-024-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/18/2024]
Abstract
Young adults with perinatally acquired HIV (PAH) face numerous challenges, including antiretroviral therapy (ART) adherence, managing onward HIV transmission risks and maintaining wellbeing. Sharing one's HIV status with others (onward HIV disclosure) may assist with these challenges but this is difficult. We developed and tested the feasibility of an intervention to help HIV status sharing decision-making for young adults with PAH. The study used a randomised parallel group feasibility design with 18-25-year-olds in Uganda and 18-29 year-olds in the UK. Participants were randomly assigned to intervention or standard of care (SOC) condition. The intervention consisted of four sessions (3 group, 1 individual) with follow-up support, delivered in person in Uganda and remotely in the UK. Assessments were carried out at: Pre-intervention /baseline; Post-intervention (intervention group only); Six-month follow-up. 142 participants were recruited (94 Uganda, 48 UK; 89 female, 53 male). At six-month follow-up, 92/94 (98%) participants were retained in Uganda, 25/48 (52%) in the UK. Multivariate analysis of combined data from both countries, showed a non-significant effect of intervention condition on HIV disclosure cognitions and affect (p = 0.08) and HIV disclosure intention (p = 0.09). There was a significant intervention effect on well-being (p = 0.005). This study addressed important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH across two very different settings. The intervention was acceptable in both countries and feasible in Uganda. In the UK, retention may have been affected by its remote delivery.Trial registration: ISRCTN Registry, ISRCTN31852047, Registered on 21 January 2019.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Georgina Gnan
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Victor Musiime
- Makerere University, Kampala, Uganda
- Joint Clinical Research Centre, Kampala, Uganda
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, Imperial College NIHR BRC, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Graham Frize
- Central and North West London NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Matteo Lisi
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
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Fair C, Fraser L, Zendt M, Santana-Garces M, Homans J, Stek A, Operskalski E. "We Are Not Different than Others": A Qualitative Study of the Lived Experience of Hispanic Adolescents and Young Adults Living with Perinatally Acquired HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2996. [PMID: 36833690 PMCID: PMC9957359 DOI: 10.3390/ijerph20042996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Though Hispanic youth with perinatally acquired HIV (PHIV) comprise 14% of those living with PHIV, little research has documented their lived experiences. Eighteen Hispanic adolescents and young adults (AYA) with PHIV were recruited from two pediatric infectious disease clinics in California (mean age = 20.8 years, 12 females and 6 males). Interview transcripts were analyzed for emergent themes regarding relationships, childbearing intentions, and future career aspirations. Participants acknowledged HIV as cause for rejection and fear of transmission from partners. Most desired children in the future. Those with children (n = 7) expressed a strong desire to continue their education for the benefit of their children. Many did not view HIV as a barrier to their career aspirations. HIV influenced their daily lives. However, the challenges of poverty, loss, and trauma also significantly shaped their well-being. Health care providers offered emotional and instrumental support which helped AYA make progress towards their goals.
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Affiliation(s)
- Cynthia Fair
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA
| | - Leandra Fraser
- Department of Infectious Disease, University of Southern California Medical Center, Los Angeles, CA 90033, USA
| | - Mackenzie Zendt
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA
| | | | - James Homans
- Department of Infectious Disease, University of Southern California Medical Center, Los Angeles, CA 90033, USA
| | - Alice Stek
- Department of Infectious Disease, University of Southern California Medical Center, Los Angeles, CA 90033, USA
| | - Eva Operskalski
- Department of Infectious Disease, University of Southern California Medical Center, Los Angeles, CA 90033, USA
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Laborde-Balen G, Diop M, Sow K, Ndiaye NB, Diop K, Taverne B. Sexuality of adolescent girls born with HIV in Senegal: an anthropological analysis. Ther Adv Infect Dis 2023; 10:20499361231159295. [PMID: 36938146 PMCID: PMC10017953 DOI: 10.1177/20499361231159295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
Objectives In Senegal, the dominant social norm upholds virginity before marriage and edifies abstinence for adolescents as a cardinal moral value. Currently, sex outside of marriage remains socially condemned. The onset of sex for adolescent girls born with HIV in Senegal brings up several challenges. In Dakar, initiatives, especially through digital applications, are being developed to support these young people. These programs are much rarer in rural settings. A study conducted in 2021 explored how adolescent girls born with HIV who live outside of Dakar experience sexuality, what socio-health constraints they face, and what support they receive from the healthcare system. Method An anthropological study titled 'Treatment Failure among Children and Adolescents Living with HIV in Senegal, Outside Dakar' (ETEA-VIH, ANRS 12421) was conducted in 2021 in 14 regional hospitals and health centers. Semi-structured interviews were conducted with 87 HIV-positive children and adolescents, 95 parents/guardians, and 47 health care workers. Adolescent girls' onset of sexuality was specifically analyzed for 40 adolescent girls age 12-19 years old. Results Generally, parents feign oblivion about their children's sexual lives. Mothers dread a pregnancy out of marriage because they are responsible for overseeing sex education and would be 'blamed' for the transgression. The occurrence of an unintended pregnancy can lead to exclusion from the family and a risk of transmitting HIV to the child due to the lack of medical and social support. HIV remains a stigmatizing disease that families keep secret. The risk of disclosure is a major concern. Despite sexual and reproductive health (SRH) programs, most healthcare workers are reluctant to discuss sexuality or to offer contraception to adolescent girls. Information spaces have been set up in some regional hospitals by associations trained in SRH. They are rarer in health centers. Accessibility to digital applications and discussion forums is limited due to the lack of smartphones and Internet access. Conclusion In rural settings, HIV-positive adolescent girls are confronted with the silence that surrounds sexuality and HIV. An individualized approach and confidential access to contraception should be prioritized to support them with assistance from PLHIV associations.
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Affiliation(s)
- Gabrièle Laborde-Balen
- TransVIHMI (Université de Montpellier, INSERM, IRD), 911, Avenue Agropolis- BP 64501 – 34394 Montpellier Cedex 5, France
| | - Maimouna Diop
- Centre régional de Recherche et de Formation à la Prise en Charge Clinique de Fann (CRCF), Dakar, Senegal
| | - Khoudia Sow
- Centre régional de Recherche et de Formation à la Prise en Charge Clinique de Fann (CRCF), Dakar, Senegal
| | - Ndeye Bineta Ndiaye
- Division de Lutte Contre le Sida et les IST, Ministère de la Santé et de l’action Sociale, Dakar, Senegal
| | - Karim Diop
- Centre régional de Recherche et de Formation à la Prise en Charge Clinique de Fann (CRCF), Dakar, Senegal
- Division de Lutte Contre le Sida et les IST, Ministère de la Santé et de l’action Sociale, Dakar, Senegal
| | - Bernard Taverne
- TransVIHMI (Université de Montpellier, INSERM, IRD), Montpellier, France
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Hightow-Weidman LB, Muessig K, Soberano Z, Rosso MT, Currie A, Adams Larsen M, Knudtson K, Vecchio A. Tough Talks Virtual Simulation HIV Disclosure Intervention for Young Men Who Have Sex With Men: Development and Usability Testing. JMIR Form Res 2022; 6:e38354. [PMID: 36074551 PMCID: PMC9501675 DOI: 10.2196/38354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background
HIV status disclosure is an important decision with barriers specific to young men who have sex with men (YMSM), who have the highest rates of new HIV infections in the United States. Behavioral and social determinants of the difficulty to disclose can include fear of rejection, stigma, loss of financial stability, and lack of communication skills. Once able to disclose, a person may have increased access to social support and improved informed risk reduction conversations and medication adherence. Despite the known challenges and advantages of disclosure, there are few effective tools supporting this behavior.
Objective
To address this gap in disclosure interventions, the Tough Talks (TT) app, an mHealth intervention using artificial intelligence (AI)–facilitated role-playing scenarios, was developed for YMSM. This paper reports stages of development of the integrated app and results of the usability testing.
Methods
Building on the successful development and testing of a stand-alone interactive dialogue feature in phases 1-3, we conducted additional formative research to further refine and enhance the disclosure scenarios and develop and situate them within the context of a comprehensive intervention app to support disclosure. We assessed the new iteration for acceptability and relevance in a usability study with 8 YMSM with HIV. Participants completed a presurvey, app modules, and a semistructured qualitative interview.
Results
TT content and activities were based on social cognitive theory and disclosure process model framework and expanded to a 4-module curriculum. The AI-facilitated scenarios used dialogue from an utterance database developed using language crowdsourced through a comic book contest. In usability testing, YMSM reported high satisfaction with TT, with 98% (31/33) of activities receiving positive ratings. Participants found the AI-facilitated scenarios and activities to be representative and relevant to their lived experiences, although they noted difficulty having nuanced disclosure conversations with the AI.
Conclusions
TT was an engaging and practical intervention for self-disclosure among YMSM with HIV. Facilitating informed disclosure decisions has the potential to impact engagement in sexual risk behaviors and HIV care. More information is needed about the ideal environment, technical assistance, and clinical support for an mHealth disclosure intervention. TT is being tested as a scalable intervention in a multisite randomized controlled trial to address outstanding questions on accessibility and effect on viral suppression.
Trial Registration
ClinicalTrials.gov NCT03414372; https://clinicaltrials.gov/ct2/show/NCT03414372
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Affiliation(s)
- Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zach Soberano
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew T Rosso
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | - Kelly Knudtson
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Alyssa Vecchio
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM, United States
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Toska E, Zhou S, Laurenzi CA, Haghighat R, Saal W, Gulaid L, Cluver L. Predictors of secondary HIV transmission risk in a cohort of adolescents living with HIV in South Africa. AIDS 2022; 36:267-276. [PMID: 34342294 PMCID: PMC8702447 DOI: 10.1097/qad.0000000000003044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preventing secondary HIV transmission from adolescents and young people living with HIV (AYPLHIV) to their partners and children is critical to interrupting the HIV infection cycle in sub-Saharan Africa. We investigated predictors of secondary HIV transmission risk (past-year sexual risk combined with past-year viremia) among AYPLHIV in South Africa. DESIGN A prospective cohort of AYLPHIV in South Africa recruited n = 1046 participants in 2014-2015, 93.6% of whom were followed up in 2016-2017 (1.5% mortality). Questionnaires used validated scales where available and biomarkers were extracted from n = 67 health facilities. METHODS Multivariate logistic regressions tested baseline factors associated with secondary HIV transmission risk, controlling for covariates, with marginal effect modelling combinations. RESULTS About 14.2% of AYPLHIV reported high secondary HIV transmission risk. High-risk AYPLHIV were more likely to be sexually infected [adjusted odds ratio (aOR) 2.79, 95% confidence interval (95% CI) 1.66-4.68, P < 0.001], and report hunger (aOR 1.93, 95% CI 1.18-3.14, P = 0.008) and substance use (aOR 2.19, 95% CI 1.19-4.02, P = 0.012). They were more likely to be in power-inequitable relationships (aOR 1.77, 95% CI 1.08-2.92, P = 0.025) and be parents (aOR 4.30, 95% CI 2.16-8.57, P < 0.001). Adolescents reporting none of these factors had a 4% probability of secondary transmission risk, rising to 89% probability with all five identified factors. Older age and early sexual debut were also strongly associated with a higher risk of secondary HIV transmission. CONCLUSION It is essential to identify and support AYPLHIV at a high risk of secondary transmission. Screening for factors such as mode of infection and parenthood during routine healthcare visits could help identify and provide resources to the most at-risk adolescents.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research
- Department of Sociology, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | | | - Christina A. Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University
| | - Roxanna Haghighat
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | | | | | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Abiodun O, Jagun O, Sodeinde K, Bamidele F, Adekunle M, David A. Socioeconomic, clinical, and behavioral characteristics of adolescents living with HIV in Southwest Nigeria: implication for preparedness for transition to adult care. AIDS Care 2021; 34:315-323. [PMID: 33764812 DOI: 10.1080/09540121.2021.1906402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a need to generate data that demonstrate preparedness (or a lack of it) of adolescents to crossover to adult care to inform policy and create appropriate models in LMICs. This cross-sectional survey of 252 adolescents (15-19 years) receiving HIV-care assessed sociodemographic characteristics, clinical and ART status, and HIV-related behaviors. Also, the study appraised HIV status awareness, and disclosure, and access to healthcare. The mean age of the participants was 16.41 (SD = 1.41) years, and 128 (50.8%) of them were female. The mean adherence level (by VAS) reported was 73.05 ± 16.75. The most frequently reported reasons for missing medications were forgetting (39.6%), falling asleep (37.7%), being away from home (33.8%), and being too busy with other endeavors (32.6%). Most (93.7%) of the participants paid for health care services out-of-pocket. Many (38.1%) of them did not know how they acquired HIV infection. About half (44.8%) of them had boy/girlfriends, but only 25 (9.9%) reported ever having sex. Only 4% disclosed their HIV status to their boy/girlfriends. Critical gaps exist in adolescents' preparedness for transition to adult HIV-care, necessitating the need for specific transition preparedness programs within the HIV-care cascade to address the peculiar needs of adolescents at this stage.Trial registration: ClinicalTrials.gov identifier: NCT03394391.
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Affiliation(s)
- Olumide Abiodun
- Department of Community Medicine, School of Clinical Sciences, Babcock University, Ilishan-Remo, Nigeria.,Centre for Epidemiology and Clinical Research, Sagamu, Nigeria
| | - Omodele Jagun
- Department of Ophthalmology, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Kolawole Sodeinde
- Department of Community Medicine, School of Clinical Sciences, Babcock University, Ilishan-Remo, Nigeria
| | - Fikayo Bamidele
- Department of Community Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Motunrayo Adekunle
- Department of Pediatrics, Lagos State University College of Medicine, Ikeja, Nigeria
| | - Agatha David
- Clinical Sciences Department, Nigerian Institute Medical Research, Yaba, Lagos, Nigeria
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Kidman R, Violari A. Growing up positive: adolescent HIV disclosure to sexual partners and others. AIDS Care 2020; 32:1565-1572. [PMID: 32122168 PMCID: PMC7483538 DOI: 10.1080/09540121.2020.1736260] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/03/2020] [Indexed: 01/08/2023]
Abstract
Over three million youth live with HIV worldwide. Very little is known about whether youth disclose their HIV status to family, friends or sexual partners, and what risks and benefits may accrue from doing so. This study characterizes HIV disclosure among 250 youth with perinatally-acquired HIV (PHIV; age 13-24 years) living in Soweto, South Africa. A third had self-disclosed their HIV status to at least one person; similarly, only a third of sexually-active PHIV had disclosed their HIV status to their most recent partner. It is not clear whether HIV disclosure alone leads to positive impact: we found perceived social support from the family was negatively associated with disclosure (aOR 0.81, 95% 0.70-0.94). PHIV who spoke to a provider about disclosure were more likely to share their HIV status with a sexual partner (aOR 2.48; 95% CI 1.28-4.81). However, those PHIV who disclosed their status were no more likely to use a condom. The World Health Organization recommends that health providers advise adolescent patients on safe disclosure, but we still lack evidence on the consequences for young people and effective tools to help them weigh benefits and risks.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Evangeli M, Foster C, Musiime V, Fidler S, Seeley J, Gnan G. A randomised feasibility trial of an intervention to support sharing of HIV status for 18-25-year olds living with perinatally acquired HIV compared with standard care: HIV Empowering Adults' Decisions to Share-UK/Uganda Project (HEADS-UP). Pilot Feasibility Stud 2020; 6:141. [PMID: 32999731 PMCID: PMC7517800 DOI: 10.1186/s40814-020-00688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract Background Young adults with perinatally acquired HIV (PAH) face several challenges, including adhering to antiretroviral therapy (ART), managing the risk of onward HIV transmission and maintaining positive well-being. Sharing one’s HIV status with others (onward HIV disclosure) may assist with these challenges by facilitating emotional and practical support. Rates of HIV status sharing are, however, low in this population. There are no existing interventions focused on sharing one’s HIV status for young adults living with PAH. The HEADS-UP study is designed to develop and test the feasibility of an intervention to help the sharing of HIV status for young adults with PAH. Methods The study is a 30-month multi-site randomised feasibility study across both a high-income/low-HIV prevalence country (UK) and a low-income/high-HIV prevalence country (Uganda). Phase 1 (12 months) will involve developing the intervention using qualitative interviews with 20 young people living with PAH (ten in the UK—18 to 29 years; ten in Uganda—18 to 25 years), 20 of their social network (friends, family, sexual partners as defined by the young person; ten in the UK, ten in Uganda) and ten professionals with experience working with young adults with PAH (five in the UK, five in Uganda). Phase 2 (18 months) involves conducting a randomised feasibility parallel group trial of the intervention alongside current standard of care condition in each country (main study) with 18- to 25-year olds with PAH. A sample size of 94 participants per condition (intervention or standard of care; 188 participants in total: 47 in each condition in each country) with data at both the baseline and 6-month follow-up time points, across UK and Ugandan sites will be recruited. Participants in the intervention condition will also complete measures immediately post-intervention. Face-to-face interviews will be conducted with ten participants in both countries immediately post-intervention and at 6-month follow-up (sub-study). Discussion This study will be the first trial that we are aware of to address important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH. Trial registration ISRCTN Registry, ISRCTN31852047, Registered on 21 January, 2019. Study sponsor: Royal Holloway University of London. Sponsor contact: alicen.nickson@rhul.ac.uk. Date and version: April 2020. Protocol version 3.5.
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Affiliation(s)
| | | | - Victor Musiime
- Makerere University, Kampala, Uganda.,Joint Clinical Research Centre, Lubowa, Uganda
| | - Sarah Fidler
- Imperial College London, Department of Infectious Disease, London, UK.,Imperial College NIHR BRC, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Georgina Gnan
- Royal Holloway University of London, Egham, Surrey, UK
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Mengwai K, Madiba S, Modjadji P. Low Disclosure Rates to Sexual Partners and Unsafe Sexual Practices of Youth Recently Diagnosed with HIV; Implications for HIV Prevention Interventions in South Africa. Healthcare (Basel) 2020; 8:healthcare8030253. [PMID: 32756349 PMCID: PMC7551467 DOI: 10.3390/healthcare8030253] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023] Open
Abstract
The study investigated the motivation to disclose or the decision to withhold one’s HIV serostatus to one’s partners and assessed the implications of non-disclosure on young peoples’ sexual behaviour and access to treatment. This was a cross-sectional survey conducted with 253 youth aged 18–25 years receiving antiretroviral therapy in a health district in North West Province, South Africa. The majority were female (75%), the mean time since the HIV diagnosis was 22 months, 40% did not know their partner’s HIV status, 32% had more than two sexual partners, and 63% had not used a condom during the last sexual act. The prevalence of disclosure was 40%, 36% delayed disclosure for over a year, and most disclosed to protect the partner from HIV transmission, to receive support, and to be honest and truthful. The prevalence of non-disclosure was high, as 60% withheld disclosure due to fear of abandonment, stigma and discrimination, accusations of unfaithfulness, and partner violence. Over half (55%) had no intentions to disclose at all. The lower disclosure rates imply that HIV transmission continues to persist among sexual partners in these settings. The findings suggest that high levels of perceived stigma impact on disclosure and HIV treatment, which increases the risk of on-going HIV transmission among youth receiving long-term antiretroviral therapy (ART) in South Africa.
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Abstract
Self-disclosure of HIV serostatus by youth has been considered an essential component of HIV prevention and medication adherence efforts. Therefore, a comprehensive investigation of disclosure goals, processes, and outcomes is warranted. We conducted a global systematic review in accordance with the 2015 Preferred Items for Reporting Systematic Reviews and Meta-Analysis tool to assess HIV self-disclosure among youth ages 13-24. We identified 5881 articles during our initial search. After screening titles and abstracts and examining articles in greater detail, 33 studies (35 articles) were included in the synthesis. The disclosure process model was used to highlight antecedent goals to self-disclosure including common avoidance goals such as fear of rejection and isolation. While disclosure was associated with negative and positive emotional outcomes and improved medication adherence, there remain concerns regarding the impact of self-disclosure on sexual behaviors. Implications for practice and future directions for research are presented.PROSPERO registration number: CRD42018097250.
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Yi S, Tuot S, Pal K, Khol V, Sok S, Chhoun P, Ferguson L, Mburu G. Characteristics of adolescents living with HIV receiving care and treatment services in antiretroviral therapy clinics in Cambodia: descriptive findings from a cross-sectional study. BMC Health Serv Res 2018; 18:781. [PMID: 30326882 PMCID: PMC6192163 DOI: 10.1186/s12913-018-3580-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 09/28/2018] [Indexed: 01/15/2023] Open
Abstract
Background Adolescents living with HIV experience worse HIV care outcomes compared to adults, especially during transition from pediatric to adult care. However, data regarding adolescents are limited. This paper describes and compares characteristics of male and female adolescents living with HIV preparing for transition from pediatric to adult care in Cambodia. Methods This cross-sectional study was conducted in August 2016 among 328 adolescents aged 15–17, randomly selected from 11 antiretroviral therapy (ART) clinics. Data were collected using a structured questionnaire, and descriptive analyses were conducted to compare characteristics of male and female adolescents. Results Of total, 55.2% were male, and 40.8% were living with parents. Majority (82.6%) got HIV infection from their mothers. Overall, adolescents had received ART for an average of 8.4 years, and HIV care for 9.5 years. Additionally, 82.4% were on first line ART regimen. Mean CD4 count from the most recent test was 672 cells/mm3, and viral load was 7686 copies/mL. Overall, 95.6% were adherent to ART on Visual Analogue Scale. About half (50.7%) had never disclosed their HIV status to anyone, while the remaining had disclosed it to their siblings (24.2%), friends (13.0%), schoolteachers (2.4%), or other (5.8%). A fifth reported having had boy or girlfriends, but few (2.1%) had ever had sexual intercourse. Females were more likely to have been engaged in sexual intercourse, and none reported having used a condom in their last intercourse. Few participants reported having ever used tobacco (1.8%), or any kind of illicit drugs (0.9%), but almost a fifth (20.7%) had a history of alcohol use. The majority (82.1%) were aware that they were receiving ART. HIV-related knowledge was suboptimal among the sample. Conclusions This study provides a snapshot of immunological, virological, adherence, and disclosure outcomes that should be tracked during and following healthcare transition to evaluate the effectiveness of the transition program. Findings showed high ART adherence, low likelihood of disclosure outside of family circles, sub-optimal condom use, and poor knowledge of HIV. To provide individualized support for healthcare transition, pediatric and adult clinics need to ensure that these characteristics are taken into account.
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Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. .,KHANA Center for Population Health Research, No. 33, Street, Phnom Penh, 71, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, CA, USA.
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street, Phnom Penh, 71, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, No. 33, Street, Phnom Penh, 71, Cambodia
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Say Sok
- KHANA Center for Population Health Research, No. 33, Street, Phnom Penh, 71, Cambodia.,Department of Media and Communication, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street, Phnom Penh, 71, Cambodia
| | - Laura Ferguson
- Institute for Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK
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13
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Sehnem GD, Pedro ENR, Ressel LB, Vasquez MED. Adolescentes que vivem com HIV/aids: experiências de sexualidade. Rev Gaucha Enferm 2018. [DOI: 10.1590/1983-1447.2018.2017-0194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
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.
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14
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Toth G, Mburu G, Tuot S, Khol V, Ngin C, Chhoun P, Yi S. Social-support needs among adolescents living with HIV in transition from pediatric to adult care in Cambodia: findings from a cross-sectional study. AIDS Res Ther 2018; 15:8. [PMID: 29592818 PMCID: PMC5872568 DOI: 10.1186/s12981-018-0195-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Understanding the circumstances of adolescents living with HIV is critical in designing adolescent-friendly services that will facilitate successful transition from pediatric to adult care. This study describes access, utilization and ongoing social support needs among adolescents living with HIV aged 15-17 in transition from pediatric to adult HIV care in Cambodia. METHODS A cross-sectional study was conducted among 328 adolescents, randomly selected from 11 antiretroviral therapy (ART) clinics across the country. Descriptive analyses were conducted to summarize their characteristics, access to social support and ongoing support needs among male and female adolescents. RESULTS Mean age of the study participants was 15.8 (SD = 0.8) years. Just over half (55.2%) were male. Most had at least one deceased parent (mother 50.9%; father 60.5%), and majority were living with biological parents (40.8%) or relatives (49.3%). A third came from families with an ID poor card, and 21.0% were working for pay. Almost half (46.6%) reported that their family had received social support for their health care, including food support (76.5%), school allowance (62.1%), transport allowance to ART clinics (53.6%), psychosocial counseling (35.3%), vocational training (22.9%) or home visits (11.1%). Several ongoing social support needs were identified, including ongoing inability to cover health expenses unless they are supported by health insurance or health equity fund (55.0%). In addition, adolescents reported having been asked to come back earlier than their scheduled appointment (13.7%), having had to purchase their own drugs (2.7%), experiencing HIV stigma (32.0%), having been denied housing or food due to HIV (8.2%) or failing to attend school within the past month partly because of HIV (16.8%). Two-thirds did not have access to peer support groups. CONCLUSIONS Social protection mechanisms are reaching some adolescents in need, while other remain without social support due to discontinuities in health and social care. Multi-sectoral interventions, supporting school attendance, adolescent-friendly clinic scheduling, reductions in child employment, mitigation of HIV-related stigma and strengthening of peer-to-peer support are required to improve coverage of social protection interventions for adolescents in transition.
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Affiliation(s)
- Graham Toth
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Chanrith Ngin
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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15
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Okawa S, Mwanza-Kabaghe S, Mwiya M, Kikuchi K, Jimba M, Kankasa C, Ishikawa N. Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study. Reprod Health 2018; 15:55. [PMID: 29587791 PMCID: PMC5869779 DOI: 10.1186/s12978-018-0493-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents living with HIV face challenges, such as disclosure of HIV status, adherence to antiretroviral therapy, mental health, and sexual and reproductive health (SRH). These challenges affect their future quality of life. However, little evidence is available on their sexual behaviors and SRH needs in Zambia. This study aimed at assessing their sexual behaviors and SRH needs and identifying factors associated with marriage concerns and a desire to have children. METHODS This cross-sectional study was conducted at the University Teaching Hospital from April to July 2014. We recruited 200 adolescents aged 15-19 years who were aware of their HIV-positive status. We collected data on their first and recent sexual behavior, concerns about marriage, and desire to have children. We used the Generalized Linear Model to identify factors associated with having concerns about marriage and desire to have children. We performed thematic analysis with open-ended data to determine their perceptions about marriage and having children in the future. RESULTS Out of 175 studied adolescents, 20.6% had experienced sexual intercourse, and only 44.4% used condoms during the first intercourse. Forty-eight percent had concerns about marriage, and 87.4% desired to have children. Marriage-related concerns were high among those who desired to have children (adjusted relative risk [ARR] = 2.51, 95% CI = 1.02 to 6.14). Adolescents who had completed secondary school were more likely to desire to have children (ARR = 1.35, 95% CI = 1.07 to 1.71). Adolescents who had lost both parents were less likely to want children (ARR = 0.80, 95% CI = 0.68 to 0.95). Thematic analysis identified that major concerns about future marriage were fear of disclosing HIV status to partners and risk of infecting partners and/or children. The reasons for their willingness to have children were the desire to be a parent, having children as family assets, a human right, and a source of love and happiness. CONCLUSIONS Zambian adolescents living with HIV are at risk of engaging in risky sexual relationships and have difficulties in meeting needs of SRH. HIV care service must respond to a wide range of needs.
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Affiliation(s)
- Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sylvia Mwanza-Kabaghe
- Department of Educational Psychology, Sociology, and Special Education, School of Education, University of Zambia, Lusaka, Zambia
- Paediatric HIV Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Mwiya Mwiya
- Paediatric HIV Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Kimiyo Kikuchi
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chipepo Kankasa
- Paediatric HIV Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Naoko Ishikawa
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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16
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Mackworth-Young CR, Bond V, Wringe A, Konayuma K, Clay S, Chiiya C, Chonta M, Sievwright K, Stangl AL. "My mother told me that I should not": a qualitative study exploring the restrictions placed on adolescent girls living with HIV in Zambia. J Int AIDS Soc 2018; 20. [PMID: 29219248 PMCID: PMC5810345 DOI: 10.1002/jia2.25035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Adolescent girls in sub‐Saharan Africa are disproportionately affected by HIV due to a range of social and structural factors. As they transition to adulthood, they are recipients of increasing blame for HIV infection and ‘improper’ sex, as well as increasing scrutiny, restrictions and surveillance. This study used a qualitative and participatory approach to explore the messaging and restrictions imposed on adolescent girls living with HIV in Zambia. Methods Thirty‐four in‐depth interviews and four participatory workshops were carried out with 24 adolescent girls aged 15 to 19 years old living with HIV in Lusaka, Zambia. Key themes explored included experiences living with HIV, finding out about HIV status, disclosure, experiences with antiretroviral treatment, and support needs. Data were organized, coded and analysed using a grounded theory approach to thematic analysis. This analysis uses data on participants’ experiences of living with HIV and their interactions with their parents, guardians and healthcare providers. Results Family and healthcare providers, partly in a quest to protect both the health of adolescent girls living with HIV and also to protect them from blaming discourse, imposed restrictions on their behaviour around three main topics: don't disclose your HIV status, don't have sex, and don't miss your medicines. These restrictions were often delivered using tactics of fear, and usually disconnected from other options. Participants responded to these messages in several ways, including internalizing the messages, changing their behaviour either to comply with or resist the restrictions, by remaining silent and anxious when restrictions were broken, and developing concerns around their own health and sexual and reproductive aspirations. Participants also sometimes experiencing stigma when restrictions could not be maintained. Conclusions Restrictive messages were delivered to adolescent girls living with HIV through the broader social discourses of stigma, religion, and global and local narratives about HIV. Programmes aiming to support adolescent girls living with HIV need to work together with parents and healthcare providers to reflect on the impact of sanctioning messages, and to encourage more enabling and empowering messaging for adolescent girls living with HIV.
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Affiliation(s)
- Constance Rs Mackworth-Young
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Social Science Department, Zambart, Lusaka, Zambia
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Social Science Department, Zambart, Lusaka, Zambia
| | - Alison Wringe
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sue Clay
- 3Cs Regional Consultants, Lusaka, Zambia
| | | | | | | | - Anne L Stangl
- International Center for Research on Women, Washington, DC, USA
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17
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Stigma Management Trajectories in Youth with Perinatally Acquired HIV and Their Families: A Qualitative Perspective. AIDS Behav 2017; 21:2682-2692. [PMID: 28058566 DOI: 10.1007/s10461-016-1667-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study explores how family, secrecy and silence contribute to the adoption of stigma management strategies among youth with perinatally acquired HIV (PAHIV). A qualitative method was used. Eighteen youths with PAHIV aged 13-22 years old took part in a semi-structured interview. An exploratory content analysis was performed. Analyses of interviews allowed identification of two HIV stigma management trajectories, both sensitive to the family context: [1] a consolidation of family ties, which contributes to solidarity in stigma management; and [2] a weakening or dissolution of family ties, which contributes to solitary stigma management strategy. Family conditions that support the children in their efforts to develop active stigma management strategies are described. Children likely to experience weakening or dissolution family ties must build strong bonds in the clinical environment and maintain these into adulthood so as to afford them the support they need.
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18
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Echenique M, Bookman RS, Rodriguez VJ, LaCabe RP, Potter JE, Jones DL. HIV is always with me: men living with perinatally acquired HIV and planning their families. Open Access J Contracept 2017; 8:35-43. [PMID: 28751827 PMCID: PMC5523133 DOI: 10.2147/oajc.s137789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Once expected to not survive childhood, youth with perinatally acquired HIV (YPHIV) have now reached young adulthood and are of reproductive age and sexually active. Given the health impact of pregnancy among YPHIV, understanding reproductive decision making may inform preconception counseling strategies. Most literature regarding reproductive health among YPHIV focuses on women, overlooking one of the most important factors influencing the reproductive decision-making process, male sexual partners. This study examined attitudes, perceptions, and experiences of young men with perinatally acquired HIV (YMPHIV) regarding family planning and relationships, safer sex, disclosure, stigma, and psychological health. Participants (n=21) were YMPHIV aged 18–24 years recruited in Miami, Florida. Focus groups (n=4) were conducted; qualitative data were analyzed using grounded theory. HIV disclosure, stigma, fertility intentions, safer preconception knowledge, attitudes and practices, family planning communication with medical providers and family, and mental health emerged as themes. Results suggest that despite accurate knowledge regarding healthy preconception practices, psychopathology, substance use, and stigma impact the uptake of HIV health care interventions. Effective interventions on preconception counseling may require more tailored approaches than knowledge-based psychoeducation alone, such as inclusion of psychological treatment, which could be offered in HIV health care settings to optimize health outcomes.
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Affiliation(s)
- Marisa Echenique
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | - Rachel S Bookman
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | - Richard P LaCabe
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | - JoNell Efantis Potter
- Department of Obstetrics & Gynecology, University of Miami Miller School of Medicine
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
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19
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Ndongmo TN, Ndongmo CB, Michelo C. Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study. Pan Afr Med J 2017; 26:71. [PMID: 28451048 PMCID: PMC5398862 DOI: 10.11604/pamj.2017.26.71.11312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/26/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. Methods This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. Results A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). Conclusion The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.
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Affiliation(s)
| | - Clement Bertin Ndongmo
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
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20
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Patterns and Correlates of Serostatus Disclosure to Sexual Partners by Perinatally-Infected Adolescents and Young Adults. AIDS Behav 2017; 21:129-140. [PMID: 26874846 DOI: 10.1007/s10461-016-1337-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Similar to same-age peers, perinatally HIV-infected (PHIV+) youth in the US are engaging in sex, including condomless sex. Understanding decisions about serostatus disclosure to sexual partners is important to domestic and global HIV prevention efforts, since large numbers of PHIV+ children are entering adolescence and becoming sexually active. Using Social Action Theory (SAT) to inform variable selection, we examined correlates of disclosure among 98 PHIV+ adolescents/young adults in New York City. Over half of these youth reported not disclosing to any casual partners (59 %) or to any partners when using condoms (55 %). In bivariate analyses, increased disclosure was associated with older age; being female; earlier age of learning one's serostatus; and increased STD knowledge, disclosure intentions, and parent-child communication. Multiple regression analyses revealed a strong fit with the SAT model. As with adults, disclosure to sexual partners is difficult for PHIV+ youth and challenges prevention efforts. Effective interventions that help youth with disclosure decisions are needed to curb the epidemic.
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21
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Grainger C. Understanding disclosure behaviours in HIV-positive young people. J Infect Prev 2016; 18:35-39. [PMID: 28989501 DOI: 10.1177/1757177416680871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022] Open
Abstract
Disclosure of sero-status is part of living with HIV and involves a complex decision-making process. Disclosure is not a one-off event and can be viewed as a sequential process and, while affording opportunities for individuals to access appropriate physical and psychological support, it is also an important part of secondary prevention. It is, however, often fraught with emotional challenges, and there is a considerable amount of evidence demonstrating the barriers that individuals face to making a disclosure. Adolescents are one such group that face challenges over disclosing their HIV status. Many adolescents are choosing not to disclose their status, through fear of potentially adverse outcomes, such as rejection and stigma, which could amplify onward transmission rates. In order to better support young people through disclosure journeys, it is essential to understand the reasons and motivations behind why young people choose not to disclose their sero-status in order to develop interventions which may facilitate supporting young people through the disclosure process.
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Affiliation(s)
- Carrie Grainger
- College of Nursing, Midwifery and Healthcare, University of West London, UK
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22
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Galano E, Turato ER, Succi RC, de Souza Marques HH, Della Negra M, da Silva MH, do Carmo FB, Gouvea ADFB, Delmas P, Côté J, Machado DM. Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV. AIDS Care 2016; 29:394-398. [PMID: 27802773 DOI: 10.1080/09540121.2016.1248891] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.
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Affiliation(s)
- Eliana Galano
- a Universidade Federal de São Paulo - Escola Paulista de Medicina , São Paulo , Brazil.,b Centro de Referência e Treinamento DST/Aids , São Paulo , Brazil
| | - Egberto Ribeiro Turato
- c Departamento de Psicologia Médica e Psiquiatria - Faculdade de Ciências Médicas , Universidade Estadual de Campinas , São Paulo , Brazil
| | - Regina Célia Succi
- a Universidade Federal de São Paulo - Escola Paulista de Medicina , São Paulo , Brazil
| | - Heloisa Helena de Souza Marques
- d HC/FMUSP- Instituto da Criança - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | | | | | | | | | - Philippe Delmas
- f La Source, School of Nursing , University of Applied Sciences , Lausanne , Switzerland
| | - José Côté
- g Faculty of Nursing , Université de Montréal , Montreal , Canada
| | - Daisy Maria Machado
- a Universidade Federal de São Paulo - Escola Paulista de Medicina , São Paulo , Brazil
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23
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Rosenfeld D, Ridge D, Catalan J, Delpech V. Age and life course location as interpretive resources for decisions regarding disclosure of HIV to parents and children: Findings from the HIV and later life study. J Aging Stud 2016; 38:81-91. [PMID: 27531455 DOI: 10.1016/j.jaging.2016.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/20/2022]
Abstract
Studies of disclosure amongst older people living with HIV (PLWH) are uninformed by critical social-gerontological approaches that can help us to appreciate how older PLWH see and treat age as relevant to disclosure of their HIV status. These approaches include an ethnomethodologically-informed social constructionism that explores how 'the' life course (a cultural framework depicting individuals' movement through predictable developmental stages from birth to death) is used as an interpretive resource for determining self and others' characteristics, capacities, and social circumstances: a process Rosenfeld and Gallagher (2002) termed 'lifecoursing'. Applying this approach to our analysis of 74 life-history interviews and three focus groups with older (aged 50+) people living with HIV in the United Kingdom, we uncover the central role that lifecoursing plays in participants' decision-making surrounding disclosure of their HIV to their children and/or older parents. Analysis of participants' accounts uncovered four criteria for disclosure: the relevance of their HIV to the other, the other's knowledge about HIV, the likelihood of the disclosure causing the other emotional distress, and the other's ability to keep the disclosed confidential. To determine if these criteria were met in relation to specific children and/or elders, participants engaged in lifecoursing, evaluating the other's knowledge of HIV, and capacity to appropriately manage the disclosure, by reference to their age. The use of assumptions about age and life-course location in decision-making regarding disclosure of HIV reflects a more nuanced engagement with age in the disclosure decision-making process than has been captured by previous research into HIV disclosure, including on the part of people aging with HIV.
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Affiliation(s)
- Dana Rosenfeld
- Keele University School of Social Science and Public Policy, Keele, Stafford ST55BG, United Kingdom
| | - Damien Ridge
- University of Westminster Faculty of Science and Technology, 115 New Cavendish Street, London W1W 6UW, United Kingdom
| | - Jose Catalan
- South Kensington and Chelsea Mental Health Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NG, United Kingdom
| | - Valerie Delpech
- HIV/STI Department, Public Health England, 61 Colindale Ave, London NW9 5EQ, United Kingdom
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Abstract
Objective: Explore the meanings attributed by young individuals about "living as an adolescent with HIV" in a group of patients that acquired the infection at birth and the elements involved with the adherence to antiretroviral treatment. Methods: Qualitative study, involving 20 subjects (aged 13-20 years), followed at services specialized in the treatment of pediatric AIDS in São Paulo, Brazil. Semi-structured interviews were carried out of which script consisted of questions about their personal histories, experiences and difficulties they must face while living with HIV/AIDS. Results: Being "normal" and "different" were central issues voiced by the participants. However, a normal life situation is guaranteed by being responsible with one's health, the condition that the diagnosis be kept secret and concerns about HIV transmission and dissemination to a sexual partner. The answers about treatment show that adherence is a dynamic process and involves moments of greater or lesser interest in relation to care for one's health. The adolescents have plans and projects and although HIV is considered a stressor, positive perspectives for the future prevailed. Conclusions: To live as an adolescent with HIV involves subtle dimensions that need to be recognized and legitimized by professionals who follow the trajectory of these young individuals. It is necessary to allow a space in which the adolescents can reflect and find support regarding issues related to the construction of their sexuality and care of one's own body.
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Galano E, Turato ER, Delmas P, Côté J, Gouvea ADFTB, Succi RCDM, Machado DM. [Experiences of adolescents seropositive for HIV/AIDS: a qualitative study]. REVISTA PAULISTA DE PEDIATRIA 2015; 34:171-7. [PMID: 26611887 DOI: 10.1016/j.rpped.2015.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Explore the meanings attributed by young individuals about "living as an adolescent with HIV" in a group of patients that acquired the infection at birth and the elements involved with the adherence to antiretroviral treatment. METHODS Qualitative study, involving 20 subjects (aged 13-20 years), followed at services specialized in the treatment of pediatric Aids in São Paulo, Brazil. Semi-structured interviews were carried out of which script consisted of questions about their personal histories, experiences and difficulties they must face while living with HIV/Aids. RESULTS Being "normal" and "different" were central issues voiced by the participants. However, a normal life situation is guaranteed by being responsible with one's health, the condition that the diagnosis be kept secret and concerns about HIV transmission and dissemination to a sexual partner. The answers about treatment show that adherence is a dynamic process and involves moments of greater or lesser interest in relation to care for one's health. The adolescents have plans and projects and although HIV is considered a stressor, positive perspectives for the future prevailed. CONCLUSIONS To live as an adolescent with HIV involves subtle dimensions that need to be recognized and legitimized by professionals who follow the trajectory of these young individuals. It is necessary to allow a space in which the adolescents can reflect and find support regarding issues related to the construction of their sexuality and care of one's own body.
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Affiliation(s)
- Eliana Galano
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Egberto Ribeiro Turato
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Philippe Delmas
- Institut et Haute Ecole de la Santé La Source (HES-SO), Lausanne, Suíça
| | - José Côté
- Université du Québec à Montréal (UQAM), Montreal, Canadá
| | | | | | - Daisy Maria Machado
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.
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Newman CE, Persson A, Miller A, Brown RJ. "Just take your medicine and everything will be fine": Responsibilisation narratives in accounts of transitioning young people with HIV into adult care services in Australia. AIDS Care 2015; 28:131-6. [PMID: 26477602 DOI: 10.1080/09540121.2015.1069790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Young people who have grown up with perinatally acquired HIV in wealthy nations are increasingly transitioning into adult care settings which expect more independence and self-regulation than paediatric care. Drawing on the first qualitative study on growing up with HIV in Australia, this paper examines "responsibilisation" narratives in semi-structured interviews conducted with young people with HIV and their paediatric and adult care providers. Three dominant narratives were identified: responsibilisation as imperative, practice and contest. This suggests that while young people growing up with HIV in an advanced liberal setting such as Australia may value the independence of adult care, and appreciate the need to take responsibility for their health, the practices involved in becoming a responsible health citizen are shaped by individual histories and circumstances, and in some cases, can lead to serious contestation and conflict with care providers. Placing a stronger emphasis on what young people can gain from taking an active role in managing their health may more successfully foster responsibilisation, rather than focusing on what they will lose. Clinicians could benefit from greater support regarding how to engage young people with the elements of responsibilisation likely to resonate more meaningfully at different points in their lives.
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Affiliation(s)
- Christy E Newman
- a Centre for Social Research in Health , UNSW Australia , Sydney , Australia
| | - Asha Persson
- a Centre for Social Research in Health , UNSW Australia , Sydney , Australia
| | - Angela Miller
- b Short St Centre Sexual Health Service , South East Sydney Local Health District , Sydney , Australia.,c Paediatric HIV Service , Sydney Children's Hospital , Sydney , Australia
| | - Rebecca J Brown
- a Centre for Social Research in Health , UNSW Australia , Sydney , Australia
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Mbalinda SN, Kiwanuka N, Eriksson LE, Wanyenze RK, Kaye DK. Correlates of ever had sex among perinatally HIV-infected adolescents in Uganda. Reprod Health 2015; 12:96. [PMID: 26475268 PMCID: PMC4609043 DOI: 10.1186/s12978-015-0082-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the correlates of ever had sex among perinatally HIV-infected (PHIV) adolescents. METHODS A cross-sectional survey of sexual behaviour was conducted with 624 PHIV adolescents living three regions (12 districts) of Uganda. Data was collected on socio demographic characteristics (age, sex, occupation, religion and education status), sexual practices and behaviours (Intimate relationships, sexual intercourse, age of sexual debut, condom use, multiple and concurrent sexual partners), consequences of sexual behaviours (pregnancy and STI's) and life style factors (use of alcohol, psychoactive substances and peer influence). Multivariable logistic-regression was used to ascertain the determinants of sexual activity. RESULTS The majority of PHIV were female (59.3 %) and the mean age of the sample was 16.2 (±2.1) years. The mean age of sexual debut was 15.8 years; 16.2 % (101/624) reported symptoms for sexually transmitted infections (STI) and more than a third (213/624) reported ever had sex.Of these 76.5 % (165/213) used condoms inconsistently; and 49.3 % (105/213) had been pregnant or made someone pregnant. Of those in relationships, 56.3 % (223/396) did not disclose and were not aware of their partners' HIV status. Adolescents aged 15-19 years were more likely to have ever been sexually active (Adjusted odds ratio (AOR) 6.28, 95 % Confidence interval (CI): 2.63-14.99) compared to those aged 10-14 years. Adolescents who were living alone were more likely to have ever been sexually active compared to those living with one or both parents (AOR 4.33, 95 % CI: 1.13-16.62). The odds of being sexually active were lower among adolescents in school compared to those out of school (AOR 0.2, 95 % CI: 0.13-0.30), who had never been treated for STI (compared to those who had never been treated for STI) (AOR 0.19, 95 % 0.11-0.32) and adolescents who never drank alcohol (AOR 0.49, 95 % CI 0.28-0.87). CONCLUSION PHIV adolescents have risky sexual behaviours characterized by being sexually active, inconsistent condom use, and having partners of unknown status. Risk reduction interventions are required to minimize unplanned pregnancies, STI, and HIV transmission by PHIV adolescents.
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Affiliation(s)
| | - Noah Kiwanuka
- School of Public Health, Makerere University, Kampala, Uganda.
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
- School of Health Sciences, City University London, London, UK.
| | | | - Dan Kabonge Kaye
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
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De Santis JP, Garcia A, Chaparro A, Beltran O. Integration versus disintegration: a grounded theory study of adolescent and young adult development in the context of perinatally-acquired HIV infection. J Pediatr Nurs 2014; 29:422-35. [PMID: 24486128 PMCID: PMC4096608 DOI: 10.1016/j.pedn.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 11/18/2022]
Abstract
Adolescents/young adults with perinatally-acquired HIV infection experience a number of issues that impact developmental tasks. No study to date has described the process by which this occurs. The purpose of this grounded theory study was to describe the process by which HIV infection impacts adolescent/young adult development. Interviews were conducted and analyzed with 25 participants age 18 to 24. Six core categories emerged that were used to generate a theory, integration versus disintegration, that describes how perinatal HIV impacts participants' development. The results of this study provide unique clinical considerations for pediatric and adult clinicians providing care for this population.
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Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies, Coral Gables, FL.
| | - Ana Garcia
- University of Miami Miller School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Miami, FL
| | - Aida Chaparro
- University of Miami Miller School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Miami, FL
| | - Oscar Beltran
- University of Texas at El Paso College of Health Sciences/School of Nursing, El Paso, TX
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Van Nuil JI, Mutwa P, Asiimwe-Kateera B, Kestelyn E, Vyankandondera J, Pool R, Ruhirimbura J, Kanakuze C, Reiss P, Geelen SPM, van de Wijgert JH, Boer KR. "Let's talk about sex": a qualitative study of Rwandan adolescents' views on sex and HIV. PLoS One 2014; 9:e102933. [PMID: 25093572 PMCID: PMC4122382 DOI: 10.1371/journal.pone.0102933] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/26/2014] [Indexed: 01/08/2023] Open
Abstract
Objective This qualitative study explored the views and experiences of adolescents with perinatally acquired HIV in Kigali, Rwanda, regarding sex, love, marriage, children and hope for the future. Design The study enrolled 42 adolescents who had received combination antiretroviral therapy for at least 12 months, and a selection of their primary caregivers. Study methods included 3 multiple day workshops consisting of role-playing and focus group discussions (FGDs) with adolescents, 8 in-depth interviews with adolescents, and one FGD with caregivers. Results The adolescents reported experiencing similar sexual needs and dilemmas as most other adolescents, but with an added layer of complexity due to fears related to HIV transmission and/or rejection by partners. They desired more advice from their parents/caregivers on these topics. Although they struggled with aspects of sex, love, marriage and having children, most agreed that they would find love, be married and have children in the future. The two most discussed HIV-related anxieties were how and when to disclose to a (potential) sex/marriage partner and whether to have children. However, most adolescents felt that they had a right to love and be loved, and were aware of prevention-of-mother-to-child-transmission (PMTCT) options in Rwanda. Adolescents generally spoke about their future role in society in a positive manner. Conclusion Strengthening the life skills of HIV-positive adolescents, especially around HIV disclosure and reduction of HIV transmission, as well as the support skills of parents/caregivers, may not only reduce onward HIV transmission but also improve quality of life by reducing anxiety.
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Affiliation(s)
| | - Philippe Mutwa
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
- Department of Pediatrics, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Brenda Asiimwe-Kateera
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - Evelyne Kestelyn
- Rinda Ubuzima, Kigali, Rwanda
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - Joseph Vyankandondera
- Rinda Ubuzima, Kigali, Rwanda
- Department of Obstetrics and Gynecology, King Faisal Hospital, Kigali, Rwanda
| | - Robert Pool
- Center for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Peter Reiss
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - Sibyl P. M. Geelen
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
- Utrecht University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Janneke H. van de Wijgert
- Rinda Ubuzima, Kigali, Rwanda
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - Kimberly R. Boer
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
- Utrecht University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Biomedical Research, Epidemiology Unit, Royal Tropical Institute, Amsterdam, The Netherlands
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Proulx-Boucher K, Fernet M, Blais M, Lévy JJ, Otis J, Thériault J, Samson J, Morin G, Lapointe N, Trottier G. Bifurcations biographiques : l’expérience du dévoilement du diagnostic du point de vue d’adolescents infectés par le VIH en période périnatale. ENFANCES, FAMILLES, GÉNÉRATIONS 2014. [DOI: 10.7202/1025966ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dans le cas de la transmission de la mère à l’enfant du VIH, l’un des principaux enjeux concerne le dévoilement du diagnostic aux jeunes infectés (Champion et al., 1999; Murphy et al., 2002; Wiener et al., 2007), qui pourrait être vécu comme un point de bifurcation biographique. L’objectif est d’explorer l’expérience du dévoilement du diagnostic du point de vue d’adolescents vivant avec le VIH depuis la naissance. Vingt-neuf jeunes (10-18 ans) VIH+ ont accordé une entrevue individuelle semi-dirigée portant sur le dévoilement du statut sérologique. Les données recueillies ont fait l’objet d’une analyse de contenu (Paillé et Mucchielli, 2005; Sabourin, 2008). Le dévoilement du statut sérologique s’inscrit dans une trajectoire en trois temps : 1) une réalité cachée où les adolescents ignorent leur statut sérologique; 2) une réalité enfin dévoilée où ils apprennent, vers l’âge de 11 ans, qu’ils sont infectés par le VIH et; 3) une réalité à intégrer progressivement où le dévoilement participe à leur construction identitaire personnelle et sociale. Le dévoilement s’inscrit dans une continuité biographique en légitimant les traitements ARV reçus alors qu’une transformation progressive semble être envisagée par les jeunes quant à leur intimité et leur sexualité.
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Affiliation(s)
| | - Mylène Fernet
- Professeure, Département de sexologie, Université du Québec à Montréal (Canada)
| | - Martin Blais
- Professeur, Département de sexologie, Université du Québec à Montréal (Canada)
| | - Joseph Josy Lévy
- Professeur, Département de sexologie, Université du Québec à Montréal (Canada)
| | - Joanne Otis
- Professeure, Département de sexologie, Université du Québec à Montréal (Canada)
| | - Jocelyne Thériault
- Professeure, Département de sexologie, Université du Québec à Montréal (Canada)
| | - Johanne Samson
- Coordonnatrice de recherche, Centre maternel et infantile sur le sida, Centre hospitalier universitaire de Sainte-Justine (Canada)
| | - Guylaine Morin
- Travailleuse sociale, Centre maternel et infantile sur le sida, Centre hospitalier universitaire de Sainte-Justine (Canada)
| | - Normand Lapointe
- Médecin, Centre maternel et infantile sur le sida, Centre hospitalier universitaire de Sainte-Justine (Canada)
| | - Germain Trottier
- Professeur retraité, École de service social, Université Laval (Canada)
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Who, then what? The need for interventions to help young people with perinatally acquired HIV disclose their HIV status to others. AIDS 2014; 28 Suppl 3:S343-6. [PMID: 24991907 DOI: 10.1097/qad.0000000000000334] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mburu G, Hodgson I, Kalibala S, Haamujompa C, Cataldo F, Lowenthal ED, Ross D. Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes. J Int AIDS Soc 2014; 17:18866. [PMID: 24629845 PMCID: PMC3956312 DOI: 10.7448/ias.17.1.18866] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 01/07/2014] [Accepted: 01/20/2014] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. METHODS In 2010, we conducted a qualitative study among adolescents aged 10-19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents' disclosure of their status to others; and the impact of both forms of disclosure on adolescents. RESULTS Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents' disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents' sexual relationships, although it did not always lead to rejection. CONCLUSIONS There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process.
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Affiliation(s)
- Gitau Mburu
- International HIV/AIDS Alliance, Hove, UK; Division of Health Research, Lancaster University, UK;
| | - Ian Hodgson
- Center for Global Health, Trinity College, Dublin, Ireland, UK
| | | | | | - Fabian Cataldo
- Research Department, Dignitas International, Zomba, Malawi
| | - Elizabeth D Lowenthal
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, PA, USA; Children's Hospital of Philadelphia, PA, USA
| | - David Ross
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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MacCarthy S, Rasanathan JJK, Ferguson L, Gruskin S. The pregnancy decisions of HIV-positive women: the state of knowledge and way forward. REPRODUCTIVE HEALTH MATTERS 2013. [PMID: 23177686 DOI: 10.1016/s0968-8080(12)39641-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.
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Affiliation(s)
- Sarah MacCarthy
- The Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
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Renaud TC, Bocour A, Tsega A, Sepkowitz KA, Udeagu CCN, Shepard CW. Do sexual risk behaviors differ between heterosexual youth infected with HIV perinatally versus sexually? J Adolesc Health 2013; 53:222-7. [PMID: 23628136 DOI: 10.1016/j.jadohealth.2013.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 01/10/2023]
Abstract
PURPOSE To determine if sexually active heterosexual HIV-infected 15- to 24-year-old youth have different sexual or other risk behaviors depending on whether they were infected perinatally or heterosexually. METHODS We compared youth aged 15 to 24 years who acquired HIV perinatally or sexually and were interviewed in-person or by phone for partner services by the New York City Department of Health and Mental Hygiene. We included heterosexually active youth with at least one sexual partner of the opposite sex in the past 12 months, and excluded men who have sex with men and injection drug users. We used χ(2) tests and t tests to compare demographics, sexual risk behaviors, partner services outcomes, and viral loads. RESULTS Both groups reported few partners (median 1, mean 2), and only 12% of partners of perinatally infected youth were previously diagnosed (18% of sexually infected youths' partners). A minority reported always using condoms. Both groups had similar rates of sexually transmitted infections and median HIV plasma RNA (perinatally infected: 5,140 copies/mL; sexually infected: 6,835 copies/mL). Despite these similarities, among tested partners not previously HIV diagnosed, none of 17 named by perinatally infected youth was newly HIV diagnosed, whereas 21% (8/39, p = .09) of those named by sexually infected youth were newly diagnosed. CONCLUSIONS Though perinatally infected youth did not transmit HIV infection to previously undiagnosed partners, they had similar HIV-related risk behaviors to youth infected sexually who reported on risks that led to their infection. HIV prevention among HIV-infected youth remains a critical challenge.
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Affiliation(s)
- Tamar C Renaud
- New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, Long Island City, NY, USA.
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35
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Self-disclosure of serostatus by youth who are HIV-positive: a review. J Behav Med 2013; 37:276-88. [DOI: 10.1007/s10865-012-9485-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
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Elkington KS, Bauermeister JA, Robbins RN, Gromadzka O, Abrams EJ, Wiznia A, Bamji M, Mellins CA. Individual and contextual factors of sexual risk behavior in youth perinatally infected with HIV. AIDS Patient Care STDS 2012; 26:411-22. [PMID: 22694193 PMCID: PMC3432574 DOI: 10.1089/apc.2012.0005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study prospectively examines the effects of maternal and child HIV infection on youth penetrative and unprotected penetrative sex, as well as the role of internal contextual, external contextual, social and self-regulatory factors in influencing the sexual behaviors of HIV-infected (PHIV+), HIV-affected (uninfected with an HIV+ caregiver), and HIV unaffected (uninfected with an HIV- caregiver) youth over time. Data (N=420) were drawn from two longitudinal studies focused on the effects of pediatric or maternal HIV on youth (51% female; 39% PHIV+) and their caregivers (92% female; 46% HIV+). PHIV+ youth were significantly less likely to engage in penetrative sex than HIV- youth at follow-up, after adjusting for contextual, social, and self-regulatory factors. Other individual- and contextual-level factors such as youth alcohol and marijuana use, residing with a biological parent, caregiver employment, caregiver marijuana use, and youth self-concept were also associated with penetrative sex. Youth who used alcohol were significantly more likely to engage in unprotected penetrative sex. Data suggest that, despite contextual, social, and self-regulatory risk factors, PHIV+ youth are less likely to engage in sexual behavior compared to HIV- youth from similar environments. Further research is required to understand delays in sexual activity in PHIV+ youth and also to understand potential factors that promote resiliency, particularly as they age into older adolescence and young adulthood.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, 10032, USA.
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Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors. Curr Opin Obstet Gynecol 2012; 23:321-7. [PMID: 21836510 DOI: 10.1097/gco.0b013e32834a581b] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Because of widespread availability of highly active antiretroviral therapy in the developed world, a large proportion of children with perinatally acquired HIV have survived to adolescence and young adulthood. Although their survival is remarkable, many now experience the long-term effects of HIV infection and its treatment. Further, as these youths have entered adolescence, more is known about the impact of normative developmental transitions on health maintenance behaviors. RECENT FINDINGS Although perinatally infected adolescents are healthier than they were a decade or more ago, they are significantly experienced with antiretroviral therapy, with increased virological resistance and other consequences of extended antiretroviral use. Three behavioral health challenges have been documented in the first cohort of long-term survivors: decreased medication adherence, sexual debut and accompanying pregnancy and transmission risk, and mental health problems. These issues are consistent with a developmental press for autonomy, mature sexual relationships and future planning, but must be carefully managed to preserve health. SUMMARY Adolescents with perinatally acquired HIV require coordinated multidisciplinary support services - including adherence support, reproductive health counseling addressing both pregnancy planning and disease transmission, and mental health and educational/vocational planning - so that they can fully benefit from treatment advances.
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