Teen Health 411
Teen Health 411

HIV Infection and Teens

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FOCUS: A Guide to AIDS Research and Counseling for the AIDS Health Project entitled "Facing Adult Life with HIV" that really brought home what it would mean for children or teens to be infected with HIV.

UNICEF estimates that 1,800 children are infected with HIV each day worldwide, and half of all new HIV infections occur among youth. Young Black youth, and youth living in the South and Northeast are at the highest risk. Almost all young women were infected through heterosexual sexual contact, and the risk factors continue to include early sexual behavior, high numbers of sexual partners, and sexually transmitted infections, which increase the likelihood of contracting HIV.

Parents and professionals acknowledge that adolescence includes experimentation along with developing skills needed to be adults, but when most parents were teens an error in judgment did not mean a lifetime of illness and sexuality did not bring issues of disclosure and transmission of HIV. HIV-positive youth confront the same challenges as other teens and young adults, but they do it in the context of a life-altering and highly stigmatized disease. This context compounds a young person's difficulty making decisions about life goals, intimate relationships, and sexual activities, and medical care, and in particular their career choices and future planning.

There is considerable evidence that adolescents with HIV who already have to manage the physical and medical consequences of HIV also experience more emotional and behavioral disorders, and psychiatric illness when compared to young people without HIV. Compared to the general population, HIV positive children 4 to 17 years old have higher rates of anxiety, depression, and attention deficit hyperactivity disorder. The higher rates of depression are of concern in part, because depressed people are more likely to be non-adherent with their HIV antiviral treatment.

If children were infected with HIV as children, the disease may change as children enter adolescence. It is common that new physical symptoms present, medications may become less effective, and teens can be less than consistent in receiving the care they need. In addition, given their body image is already changing, the impact of the disease may be harder on them. Teens with HIV may be smaller than their peers, struggle with recurrent thrush, medication side effects, abdominal distress, muscular swelling, headaches, and other physical problems, which may lead to feared rejection from peers or social isolation.

It is important that adults who care for these teens be alert to physical and neurological effects of the disease as well as an adolescent's emotional response to these effects. In particular, a personal crisis such as a family fight, a breakup with a friend, problems in school, and the HIV-related body changes may trigger unusually strong emotional reactions in these teens, undermining their well-being and medication adherence. Loss and bereavement are important issues that may repeat if a teen is also dealing with the infection or loss of a parent. Teens may experience anxiety, depression, guilt, quit performing well in school, or just feel "lost."

As part of the support provided to teens, disclosure decisions may need to be revisited as well. Research suggests that that adolescents who disclose their HIV status to friends and professionals tend to have fewer symptoms of post traumatic stress disorder (PTSD), perceive themselves as more competent, and have higher rates of disclosure to sexual and romantic partners.

Sexuality and dating can bring about a crisis as well. HIV+ teens have similar rates of sexual behavior and substance abuse as HIV- teens, but they experience more stress associated with the transition to sexual behavior. They are also likely to have the same lack of knowledge about their bodies and HIV transmission as other teens, requiring clinicians with whom they share a trusting relationship to provide additional sexuality education. Growing up is hard enough, but doing it with a stigmatizing disease, makes these teens fragile and needing additional support.

Resources for HIV+ teens: Camp Heartland, Photo credit: numberstumper

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About the Author

Dr. Brown is a developmental psychologist specializing in adolescent health.

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