Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling^†

Abstract

Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the “Youth Counseling Needs Survey” (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths’ psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010–July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11–18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths’ psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling.

The Happy Teen programme: a holistic outpatient clinic‐based approach to prepare HIV‐infected youth for the transition from paediatric to adult medical care services in Thailand

“…CDC Collaboration (TUC) developed an intervention programme for HIV‐positive youth called the Happy Teen 1 (HT1) programme [9]. The programme was developed for paediatric practices that were caring predominantly for perinatally HIV‐infected children and youth.…”

“…The HT2 programme aims to assess and improve skills and knowledge in four strategies areas consistent with the HT1 programme [9,10,12]: health knowledge, coping skills, sexual risk reduction, and life goals (Table 1) but the activities were designed for older youth. Interventions included a one‐day weekend workshop, two half‐day meetings, and three individual sessions.…”

“…The two half‐day meetings (2–3 h) and three individual sessions were organized during regular HIV care clinic visits (usually every 2–3 months) and were conducted by project staff. The individual sessions lasted 30–60 min [9] and allowed counsellors to explore participants individual risks, assess prerequisite knowledge for transition to adult HIV care, provide reproductive health and risk reduction counselling, promote increased self‐esteem, and provide psychological support to HIV‐positive youth. If a youth was unable to answer a question correctly, project staff would provide the correct answers, discuss techniques to remember information, and how to find information needed for a successful transition to an adult medical clinic.…”

“…During 2009-2011, the Happy Teen Working Group, a multidisciplinary team including specialists in psychology, adolescent medicine, HIV medicine, and counsellors from Siriraj Hospital, Queen Sirikit National Institute of Child Health (QSNICH), and the Thailand MOPH-U.S. CDC Collaboration (TUC) developed an intervention programme for HIV-positive youth called the Happy Teen 1 (HT1) programme [9]. The programme was developed for paediatric practices that were caring predominantly for perinatally HIV-infected children and youth.…”

“…The sessions focused on four main areas including health knowledge, coping skills, sexual risk reduction, and life goals. The aim was to address these issues in HIV-infected youth in an effort to reduce behavioural risk and secondary HIV transmission [9]. An evaluation of the HT1 programme in 2011 [10], showed that participation was associated with a modest but statistically significant improvement in knowledge and attitudes regarding ART management, reproductive health, and HIV-associated risk behaviours, but the intervention did not have an effect on alcohol use or sexual behaviour and did not address issues related to the transition from youth to adult HIV care services.…”