A qualitative exploration of psychosocial challenges of perinatally HIV-infected adolescents and families in Bangkok, Thailand

Abstract

Thailand has the highest HIV prevalence in Asia, with 9,600 HIV+ adolescents and thousands additional younger HIV+ children (World Bank, 2015; UNICEF, 2015). Studies from other settings suggest perinatally HIV-infected (PHIV+) adolescents are at high risk for mental health problems and engagement in risk behaviors that threaten individual and public health. Yet, few studies exist in Thailand, and few evidence-based psychosocial interventions have been developed for and studied in this population, despite great need. The current study qualitatively explored psychosocial issues among Thai PHIV+ adolescents to inform development or adaptation of interventions. Thai and US-based researchers and clinicians conducted two focus group discussions with PHIV+ adolescents aged 12-16 and their adult caregivers, and six in-depth key informant interviews with health/social work providers at a large clinic for PHIV+ youth in Bangkok, Thailand. Data were analyzed thematically using framework analysis. Multiple challenges for PHIV+ youth and caregivers were identified. Adherence to antiretroviral treatment was a significant challenge attributed to lack of adult support, side effects, feeling too well to take medicines, and avoiding acknowledging sickness. Poor child-caregiver communication and conflict was a key concern, explained in part by cultural expectation of obedience and generation gaps. Concerns about societal stigma and discrimination emerged strongly and influenced delay or avoidance of disclosing HIV status to children and others. Respondents identified positive approaches to addressing these issues and highlighted the need for interventions to improve child-caregiver communication and generate peer and community support for PHIV+ youth. Thai PHIV+ adolescents and families experience significant psychosocial challenges, similar to those seen in other contexts. Cultural adaptation of an existing evidence-based clinic-based family group intervention is recommended to rapidly address these needs.

Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review

“…Twenty-four studies were conducted in sub-Saharan Africa, including South Africa [58,61,62,65,71,73,74,81,82,84], Uganda [59,67,69,80], Zimbabwe [60,75,77,78], Malawi [46,88], Democratic Republic of Congo [63], Botswana [76], Tanzania [80], Kenya [79], Nigeria [80], and Togo [85]. Eight were conducted in Asia, including India [64,70], Thailand [68,72,83,89], Cambodia [83], China [86] and Vietnam [87], and one in South America, in Ecuador [66]. Eleven studies focused on adults [46,58,61,64,66,74,75,78,80,83,86]; one of these also included children …”

“…Botswana [76], Tanzania [80], Kenya [79], Nigeria [80], and Togo [85]. Eight were conducted in Asia, including India [64,70], Thailand [68,72,83,89], Cambodia [83], China [86] and Vietnam [87], and one in South America, in Ecuador [66]. Eleven studies focused on adults [46,58,61,64,66,74,75,78,80,83,86]; one of these also included children [75].…”

“…Eleven studies focused on adults [46,58,61,64,66,74,75,78,80,83,86]; one of these also included children [75]. Twenty-three studies focused on infants, children and adolescents ranging in age from newborn to eighteen years [59,60,62,63,65,[67][68][69][70][71][72][73][75][76][77]79,81,82,84,85,[87][88][89].…”

Preventing mental health conditions in adolescents living with HIV: an urgent need for evidence

“…Social and environmental stressors include experiencing heightened stigma and isolation; adolescents may also be increasingly required to manage their own treatment adherence [15,16]. ALHIV engaging in romantic and sexual relationships for the first time need to grapple with how to disclose their status to partners and protect against potential fears of rejection [17]. Additionally, adolescents living in vulnerable households with others who are also living with HIV may have additional mental health needs that intersect with experiences of poverty and illness [18].…”

Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta‐analysis

“…Many AYPLHIV face additional psychosocial challenges during this transitional time, including stigmatization, isolation and fears of rejection [9,10]. For AYPLHIV who enter romantic and sexual relationships, learning to navigate issues of disclosure and safe sexual practices becomes particularly important [11]. Youth newly diagnosed with HIV, or who have been newly disclosed to, may also face challenges with accepting their status, which can be stressful and result in familial conflict, especially if young people blame their parents for their illness [12].…”