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Section 10
Treating HIV Positive Adolescents, Part 2

Question 10 | Answer Booklet | Table of Contents | HIV/AIDS CEU Courses
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Relationships
Responses of the participants that fit into this category reflect difficulties they have experienced in their social and emotional relationships. Difficulties occur in the establishment of relationships with people who do notFriends HIV Therapeutic Strategies mft CEU know the participant has HIV as well as difficulties in their existing relationships since the diagnosis. Five participants (2 males, 3 females), 63% of the sample, indicated that they had some type of difficulties with relationships. Because the difficulties experienced may be specific to the type of relationship, three subcategories of relationships are delineated: friends/peers, families, and intimate/dating relationships.

Friends and peers. The responses in this subcategory represent the difficulties the participants have experienced in their relationships with friends and/or peers within the context of HIV. Self-isolation and distancing from friends appear to be common themes voiced by the participants. This distancing appears self-protective in that by avoiding friendships the participants can avoid the pain that may be inflicted by friends who are unsupportive of their HIV status. "Since I was diagnosed, I never usually interact with people that much, I interact but not on a friend to friend basis ... I don't keep a lot of friends." "So, by being positive, you look at people a lot different ... now I know I really need to get my life together and start looking at my friends ... the kind of stuff so-called friends have used hurts you."

Families. Responses in this subcategory reflect the difficult experiences that the participants have had with either their own family members or their significant other's family. Rejection by family members appeared to be a theme for the participants. Some participants felt exiled, either from their own families or the families of their significant others. "I think maybe, well, everybody [in my family] is turning against me and trying to push me away," said one. Another commented, "[His mother] loved me at first ... then once she found out, she didn't want me in her house anymore. It's like I'm killing her son."

Intimate/dating partners. These responses reflect the difficulties that the participants have had either in contemplating or establishing intimate relationships. One theme that appeared concerns infecting a partner. This concern might reflect the participant's fear, or perhaps the participant is being told by those around him or her that he or she should not become sexually involved with a partner. "I mean, personally, I don't want to get in no relationship, especially that I'm HIV positive and can infect somebody. I don't want no relationship at all." "The difficult part of it is, okay, it's like I found somebody but certain people are trying to stop us from being together [because of HIV], and that's difficult for me."

Another theme that is related to the difficulties of intimate relationships is the fear of rejection by a partner due to HIV status. Participants voiced concerns about having to tell a partner, with the fear that a partner will find out about their status from someone else, and that the partner will ultimately reject them because of their HIV infection. "Dating is a pain. Such a pain. No matter if I, if I find this special person or something, I'll always have to worry about them not falling in love with me because I'm positive. Or having to find out that I am. That's what worries me."

Finally, one theme questions whether anyone would be willing to be in an intimate relationship with an HIV-infected person. One participant mentioned the difficulties inherent in such a relationship, as well as the risks.
   
"This disease isolates you ... it's so definite, so final. And it, you don't know if you could, give a person, if they find out, I think this is one of my ultimate tests of love. That I could love you so much that I could die and leave you alone. I love you so much that I could inadvertently kill you myself. I don't know that any man is willing to put up with that. And that scares me."

Psychological Burden of HIV
Responses made by the participants that are included in this category represent some of the psychological manifestations of HIV. These psychological symptoms are often associated with the difficulties of having a chronic illness, particularly living with HIV. Five participants (2 males, 3 females), 63% of the sample, had responses that fit this category. Two themes are presented within these responses: HIV and stress, and HIV and negative affect.

HIV and stress. These responses allude to the stressful nature of living with a life-threatening illness. Participants indicated that life was stressful before they found out they were HIV-positive; the HIV diagnosis either created stress or compounded the stress they were already experiencing. "I was going through a lot of stressful things and then I found out I was HIV positive, that just made it harder for me." Another response was, "I got an attitude problem now ... I guess with all the stress and everything."

HIV and negative affect. This theme encompasses some of the psychological responses to HIV, particularly those that create negative affective states. Negative-affect responses can include depression, anxiety, loneliness, and helplessness. Most of the participants report having experiences with these emotions. Some of those responses were: "My life was different, it wasn't a lot different, but it was different because I didn't have to think about this, to take special care and stuff like that ... when I found out about this, I was depressed and stuff like that, that make it worse." "I mean, it's kinda, it's not, it doesn't really give you a headache, but when you think about this life that you have now and your life that you had before, it was, well, it was just so much easier, that other life." "I think I'm more tolerant toward certain things ... it definitely changed my views of sickness ... I understand that kind of helplessness," and "You know, I don't want to stay alone all my life. I want to stay with somebody. Yeah, friends or relationship, or somebody. I don't want to stay alone."

Discussion
Based on these results, it is evident that many of the difficulties that have been identified in adult HIV populations also impact adolescents. All of the adolescents interviewed had experienced difficulties in at least two of the response/thematic categories that were developed. These results imply that there are still a tremendous number of difficulties and obstacles for individuals with HIV to overcome. Understanding these difficulties is the first step toward making changes.
- Hosek, Sybil, Gary Harper, and Rocco Domanico; Psychological and Social Difficulties of Adolescents Living With HIV: A Qualitative Analysis; Journal of Sex Education & Therapy; 2000; Vol. 25 Issue 4
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #4
The preceding section contained information about treating HIV positive adolescents.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 10
In Hosek’s study, what are three themes common to HIV positive adolescents’ concerns regarding intimate relationships? Record the letter of the correct answer the Answer Booklet

 
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The article above contains foundational information. Articles below contain optional updates.
Interaction between antiretroviral boosters and corticosteroids can lead to development of Cushing's syndrome
An interaction between antiretroviral boosting agents and corticosteroids can lead to Cushing’s syndrome, according to French research published in the Journal of Antimicrobial Chemotherapy. Almost all the cases of Cushing’s syndrome identified among people with HIV were due to drug interactions between the boosting agents ritonavir or cobicistat and a corticosteroid. Moreover, the interaction was more likely to be serious among people with HIV than in HIV-negative individuals. Cushing’s syndrome sometimes emerged after only two weeks of taking the interacting medications.
Guidelines fail to address needs of adolescents living with HIV transitioning to adult health care in low- and middle-income countries
Only five of 12 low- and middle-income countries had transition guidelines, according to a systemic review of adolescents living with HIV transitioning from paediatric to adult health care published in AIDS and Behavior. The authors believe this to be the first review to survey the literature on barriers and facilitators of transition for adolescents living with HIV in low- and middle-income countries and to compare these factors to countries’ current guidelines.
Same-day initiation of ART feasible and safe without CD4 counts, Thai study shows
Three models of same-day antiretroviral therapy (ART), tested in different hospitals in Thailand, are feasible and safe, researchers report. The models have been implemented in Thailand since 2017, following a World Health Organization recommendation that all individuals diagnosed as HIV positive should receive ART on the same day of diagnosis, if they are ready.
Ageing population of people living with HIV in sub-Saharan Africa associated with cardiovascular risk factors
An ageing population of people living with HIV on antiretroviral therapy in countries in sub-Saharan Africa is associated with a significant increase in the prevalence of diabetes and obesity, according to an analysis of 44 countries with data from 2000 to 2016, published in the Journal of the International AIDS Society.
San Francisco HIV cases fall to a new low
The annual number of new HIV diagnoses in San Francisco has dipped below 200, falling to its lowest level since the peak of the epidemic in the early 1990s, according to the city's HIV Epidemiology Annual Report for 2018. Total new diagnoses fell to 197, with decreases seen in most population groups. However, diagnoses among African-American and Latino men showed an increase after declining for several years.

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