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from Medical Issues
Researchers Survey Psychiatric Challenges In Helping Youths With HIV/AIDS
August 25, 2005 -
Drs. Geri Donenberg with the University of Illinois and Maryland Pao, with the
National Institute of Mental Health have recently published a survey of research
on psychiatric problems relating to youths with HIV/AIDS and children whose
parents are HIV infected.
The survey, "Youths and HIV/AIDS/: psychiatry's role
in a changing epidemic," was published in the Journal Of The American Academy Of
Child And Adolescent Psychiatry, August 1, 2005, 44(8): 728-747.
The authors state that their objective was to survey the past 10 years of
published research on HIV/AIDS including the psychiatric risk factors,
prevention strategies, and treatments provided for those infected with the
disease or those who live with others who are HIV infected.
They observe that "HIV/AIDS has significant mental health implications, and
psychiatry can play a critical role in curbing the epidemic."
Three groups of young people are most affected by HIV: Those born with the
infection; those who acquire the disease through risky sexual behavior and drug
use; and those whose parents or family members are infected.
The researchers note that "Most young people today acquire HIV through
unprotected sexual intercourse and other high-risk sexual behavior, such as sex
with multiple partners and frequent sexual activity."
According to the Centers for Disease Control, teenagers account for 50% of new
HIV infections and 25% of new sexually transmitted diseases reported annually.
In the U.S. alone, 110,000 youths represent 18% of those infected with HIV.
Youths with high-risk behaviors are most at risk for acquiring HIV. In addition,
youths with mental problems are "at even greater risk of exposure because they
engage in the same behaviors as their school-age peers but at higher rates."
When compared to their school-age peers, teens with mental problems are twice as
likely to be sexually active, to not use condoms, and to use intravenous drugs.
The authors say that "childhood sexual abuse is consistently associated with
elevated rates of HIV risk behavior. Sexually abused youths report earlier
sexual debut, more frequent sexual activity, less consistent condom use, lower
self-efficacy for condom use, increased concern with conforming to peer sexual
norms, anxiety about partner rejection, and more lifetime sexual partners than
non-abused peers." They are also more likely to have gotten someone pregnant or
engaged in coercive sex.
Moreover, few teens with HIV disclose their status to sexual partners. Among
HIV-positive males with hemophilia, for example, 58% did not disclose their HIV
status to their most recent sexual partner.
Donenberg and Pao suggest that mental health professionals have wrongly regarded
HIV/AIDS as a public health problem and not a psychiatric issue. As a result,
teenage sexual activity has been considered outside the bounds of psychotherapy.
"Yet, HIV/AIDS has significant mental health implications, and HIV prevention
programs are more effective when they include a mental health component."
Mental health professionals are in a unique position to influence sexual
behavior and drug use among youths in psychiatric care. Risk-reduction
strategies should be incorporated into traditional clinical settings. The
authors urge psychiatrists to help youths reduce the likelihood of risky sex and
"practice assertive communication with peers and romantic partners." In
addition, "Clinicians can address appropriate role responsibilities for youths
and issues related to HIV disclosure (e.g., to whom, where, when)."
Additional Reading: "Risky Sex and the Adolescent Brain:
Implications for School Counseling Programs," by Linda A. Nicolosi;
"Homosexuality and Mental Health Problems," by N.E. Whitehead, Ph.D.
Updated: 8 February 2008
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