Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges

Abstract

IntroductionAcross the globe, children born with perinatal HIV infection (PHIV) are reaching adolescence and young adulthood in large numbers. The majority of research has focused on biomedical outcomes yet there is increasing awareness that long-term survivors with PHIV are at high risk for mental health problems, given genetic, biomedical, familial and environmental risk. This article presents a review of the literature on the mental health functioning of perinatally HIV-infected (PHIV+) adolescents, corresponding risk and protective factors, treatment modalities and critical needs for future interventions and research.MethodsAn extensive review of online databases was conducted. Articles including: (1) PHIV+ youth; (2) age 10 and older; (3) mental health outcomes; and (4) mental health treatment were reviewed. Of 93 articles identified, 38 met inclusion criteria, the vast majority from the United States and Europe.ResultsThese studies suggest that PHIV+ youth experience emotional and behavioural problems, including psychiatric disorders, at higher than expected rates, often exceeding those of the general population and other high-risk groups. Yet, the specific role of HIV per se remains unclear, as uninfected youth with HIV exposure or those living in HIV-affected households displayed similar prevalence rates in some studies, higher rates in others and lower rates in still others. Although studies are limited with mixed findings, this review indicates that child-health status, cognitive function, parental health and mental health, stressful life events and neighbourhood disorder have been associated with worse mental health outcomes, while parent–child involvement and communication, and peer, parent and teacher social support have been associated with better function. Few evidence-based interventions exist; CHAMP+, a mental health programme for PHIV+ youth, shows promise across cultures.ConclusionsThis review highlights research limitations that preclude both conclusions and full understanding of aetiology. Conversely, these limitations present opportunities for future research. Many PHIV+ youth experience adequate mental health despite vulnerabilities. However, the focus of research to date highlights the identification of risks rather than positive attributes, which could inform preventive interventions. Development and evaluation of mental health interventions and preventions are urgently needed to optimize mental health, particularly for PHIV+ youth growing up in low-and-middle income countries.

HIV and Child Mental Health: A Case-Control Study in Rwanda

“…16,17 Although the elevated risks facing HIV/ AIDS-affected orphans and vulnerable children are well documented, the risk in HIV-negative children who live with HIV-positive caregivers compared with HIV-positive children and children unaffected by HIV is less clear. 18 Child health status, cognitive function, parental health and mental health, stressful life events, and neighborhood disorder have been associated with poor mental health, whereas parent-child involvement and communication, and peer, parent, and teacher social support have been associated with better mental health outcomes. 19,20 The objective of this study was to assess the distribution of mental health problems and protective and risk factors in a sample of HIV-positive, HIV-affected, and HIVunaffected children in Rwanda.…”

Enrolling HIV-positive adolescents in mental health research: A case study reflecting on legal and ethical complexities

“…[19] There is a higher prevalence of HIV infection among orphans due to AIDS causes than among non-orphans and orphans of non-AIDS causes, together with earlier sexual debut, an increased risk of intergenerational sex, and increased family violence and exploitation. [10,[34][35][36][37] OVCY are increasingly recognised as a special population for HIV risk and transmission. [35] OVCY, child-headed households and children and youth without an official guardian are a unique and contemporary issue placing many SA institutions (including government) under tremendous pressure.…”

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

“…Adolescents with HIV infection share similar stressors experienced by youths with other chronic diseases, including ongoing medical treatment, hospitalizations, and exposure to various procedures [1,2]. Moreover, they often have to cope with grief and loss in the family, stigmatization and illness transmission which may make transition through adolescence more difficult than other chronic illnesses [3,4]. Challenges of adolescent issues including nonadherance, long-term care, and psychosocial issues have been of increasing concerns [3,[5][6][7][8].…”

“…Moreover, they often have to cope with grief and loss in the family, stigmatization and illness transmission which may make transition through adolescence more difficult than other chronic illnesses [3,4]. Challenges of adolescent issues including nonadherance, long-term care, and psychosocial issues have been of increasing concerns [3,[5][6][7][8]. Children and adolescents living with HIV infection frequently have to deal with illness or death of a parent, poverty and disclosure of their own or their parents' HIV status to others.…”