Key Cultural & Psychosocial Challenges of HIV-Infected Youth

Mental Health & Adherence

Mental health issues are often associated with poor adherence to treatment regimens among adolescents. Without maximal viral suppression through proper adherence to an effective treatment regimen, improved health outcomes for HIV-infected children and adolescents will not be achieved. Adherence rates for adolescents and young adults taking antiretroviral medications range from about 29% to 61%. For adolescents, many factors affect long-term HIV medication adherence. Adherence issues are addressed in greater detail in the Antiretroviral Treatment and Adherence module, but in the context of psychosocial issues, it is important to understand that adherence is influenced greatly by disclosure issues, peer relationships, difficult social conditions, substance use, family belief systems, psychological distress, depression, complications with day-to-day routines, and family perceptions of the value of the medication regimen.

It is possible that some youth may have concerns regarding how well medications work for people from their racial/ethnic group. These concerns may originate with adults or caregivers in the family who have misgivings about the treatment of minorities in health care facilities. It is very important to assess whether young people have any beliefs about their medications that might make them less likely to adhere. Black/African American, AI/AN, AA/PI, and Latino cultural groups often rely on traditional approaches to healing. Find out whether youth are using herbs or other interventions that might impact the efficacy of the medication or their adherence to the regimen. Additionally, common side effects of HIV treatment include rashes and unusual deposits of body fat (lipodystrophy), and poor body image resulting from these side effects can be a significant barrier to adherence. Including adolescents in therapeutic decisions and listening to what they have to say about treatment-related body changes will contribute toward greater adherence to proposed interventions and may improve their quality of life.20

References

20. Santos CP, Felipe YX, Braga PE, et al. Self-perception of body changes in persons living with HIV/AIDS: prevalence and associated factors. AIDS. 2005 Oct;19 Suppl 4:S14-21.