Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe

Abstract

BackgroundThere is a recognized gap in the evidence base relating to the nature and components of interventions to address the psycho-social needs of HIV positive young people. We used mixed methods research to strengthen a community support group intervention for HIV positive young people based in Harare, Zimbabwe.MethodsA quantitative questionnaire was administered to HIV positive Africaid support group attendees. Afterwards, qualitative data were collected from young people aged 15–18 through tape-recorded in-depth interviews (n = 10), 3 focus group discussions (FGDs) and 16 life history narratives. Data were also collected from caregivers, health care workers, and community members through FGDs (n = 6 groups) and in-depth interviews (n = 12). Quantitative data were processed and analysed using STATA 10. Qualitative data were analysed using thematic analysis.Results229/310 young people completed the quantitative questionnaire (74% participation). Median age was 14 (range 6–18 years); 59% were female. Self-reported adherence to antiretrovirals was sub-optimal. Psychological well being was poor (median score on Shona Symptom Questionnaire 9/14); 63% were at risk of depression. Qualitative findings suggested that challenges faced by positive children include verbal abuse, stigma, and discrimination. While data showed that support group attendance is helpful, young people stressed that life outside the confines of the group was more challenging. Caregivers felt ill-equipped to support the children in their care. These data, combined with a previously validated conceptual framework for family-centred interventions, were used to guide the development of the existing programme of adolescent support groups into a more comprehensive evidence-based psychosocial support programme encompassing caregiver and household members.ConclusionsThis study allowed us to describe the lived experiences of HIV positive young people and their caregivers in Zimbabwe. The findings contributed to the enhancement of Africaid’s existing programme of support to better promote psychological well being and ART adherence.

Evaluation of Psychosocial Adjustment and Self-Esteem in Perinatally HIV-Infected Adolescents

“…Stigmatization and discrimination may be one of the factors that these adolescents have experienced so that these could affect peer relationship and Prosocial behaviors [14,27]. In this study, adolescents with HIV infection were found to be at increased risks of having low self-esteem.…”

“…These may interfere with their independence and also their self-esteem. Psychosocial support should address ART adherence, future orientation, long-term consequences of risk behaviors, sexual and reproductive health and the coping ability of adolescents with HIV infection [7,14,28].…”

“…Stigma and depression was found to be related to the quality of life of adolescents with HIV infection [13]. Effects on physical, social and psychological well-being have involved negative feelings such as depression [14], distress and anxiety, which interfere with their self-esteem. Sixty-five percent of adults living with HIV/AIDS reported depressive symptoms which were significantly negatively correlated with their self-esteem [15].…”

Caregiving and Experiences of Health, Illness and Coping in the Context of Paediatric and Adolescent HIV and Poverty

“…This has stimulated interventions that can enhance positive parenting in HIV-positive caregivers in low-and middle-income countries. While evidence suggests that maternal illness is considered a risk for poor outcome in their children, where HIV-positive mothers were given the opportunity to enhance their capacity to deal with their illness and to strengthen parent-child relationship, the outcomes proved to beneit both the mental health of the caregiver and the child [33,39]. A few studies that emerged have started looking at the resilience in young children whose mothers are living with HIV in an atempt to improve developmental and psychosocial outcomes for both the HIV-infected mother and the child [17,33,39,47,58].…”

“…While evidence suggests that maternal illness is considered a risk for poor outcome in their children, where HIV-positive mothers were given the opportunity to enhance their capacity to deal with their illness and to strengthen parent-child relationship, the outcomes proved to beneit both the mental health of the caregiver and the child [33,39]. A few studies that emerged have started looking at the resilience in young children whose mothers are living with HIV in an atempt to improve developmental and psychosocial outcomes for both the HIV-infected mother and the child [17,33,39,47,58]. In the study with HIV-positive mothers from South Africa, there were also HIV-positive mothers who were able to express their own desires to live positively, for themselves and their children; they were also able to recognise how their own behaviour was afecting their children, and this had a positive impact on their ability to parent and communicate efectively with their children [58].…”