Psychosocial snapshots: perinatally infected HIV+ adolescents' sexual behaviors and pregnancies

US Provider Perceptions of Differences in the Sexual and Reproductive Health Needs of Adolescents with Perinatally Acquired and Behaviorally Acquired HIV: A Mixed Methods Study

This study explores health care providers' perceptions of similarities and differences in the sexual and reproductive needs of adolescents with perinatally acquired HIV (PHIV) and behaviorally acquired HIV (BHIV). Interviews (n = 13) and online surveys (n = 46) were completed by medical and social service providers (n = 30, n = 29, respectively) who care for adolescents with HIV. Eligible providers were recruited using snowball sampling. Responses to open-ended questions were coded for emergent themes. Sixty-eight percent of participants perceived differences in the sexual and reproductive health needs of adolescents with PHIV and BHIV. Differences included factors related to psychosocial, sexual, and medical needs. Providers believed adolescents with PHIV had integrated their diagnosis into their identity, were more adept at communicating with providers, and were more sexually cautious than youth with BHIV. Providers perceived adolescents with BHIV as more comfortable discussing sex-related issues, and suggested youth with PHIV were more comfortable accessing health care. Adolescents with PHIV were thought to have complex medical histories/treatment and greater knowledge of illness/medications. Existing research on adolescent-reported sexual and reproductive health knowledge and experiences in care suggests that provider and adolescent perspectives do not always align. Mode of transmission may provide some information about psychosocial functioning and sexual behavior. However, assumptions about sexual and reproductive health needs based solely on mode of transmission may contribute to gaps in sexual and reproductive health care. Future research is needed to examine whether these differing perspectives indeed lead to discrepancies in the care provided to adolescents with HIV.

Experiences of Young Parents with Perinatally Acquired HIV

This research explores the perceptions of adolescents and young adults (AYA) living with perinatally acquired HIV (PHIV) as they transition into parenthood. We conducted hour-long, semistructured audio-recorded interviews with a purposive sample of 17 AYA parents with PHIV who were current or former patients at two US pediatric/adolescent infectious diseases clinics. Participants were asked about challenges/rewards of parenting and anticipated future fertility desires/intentions. Analysis of the transcribed interviews was guided by grounded theory. Mean age of participants was 22 years. The majority were African American (n = 8) or Hispanic (n = 6) and female (n = 14). Two participants were pregnant and others had a range of 1-3 children (mean = 1.4), one of whom was HIV positive. Analyses revealed that time with their child was a valuable commodity. Participants expressed concerns about not "being there" for their child due to sickness and worries that their child may experience HIV-related discrimination once a parent's HIV status was disclosed. The importance of being a role model and present in their child's life over time was emphasized and served as motivation to pursue education and employment opportunities. Those parents who intended to have another child were motivated by a strong desire to create a legacy and a family of their own as a way to deal with HIV-related losses and stigma. Participants reported the importance of emotional support offered by providers, as well as concrete social services available in that care setting even if they had transitioned to adult care. AYA also expressed parenting rewards/challenges similar to those of their uninfected peers. As youth with PHIV continue to mature, increasing numbers will become parents. It is incumbent upon both pediatric and adult providers to support newly formed families living in the context of intergenerational HIV infection.

"When Should I Tell?": Perspectives on Disclosure to Their Children among Parents with Perinatally Acquired HIV

Adolescents and young adults (AYA) with perinatally acquired HIV (PHIV) engage in developmentally expected behaviors, such as establishing relationships and having children. Previous research has focused on pregnancy management/outcomes of AYA with PHIV. However, little research has focused on the parenting experiences of this emerging cohort and on their views of disclosure to their offspring. This article examines data from a pilot study of five AYA parents with PHIV on disclosure to their child(ren) (n = 7, 6 HIV-negative). Disclosure of their own HIV status to their children is on the minds of parents with PHIV. However, few currently have children old enough to understand the parent's diagnosis. Three parents indicated they would disclose their HIV status when their child was "old enough to understand" so that their child would be knowledgeable about HIV. One father also noted that he currently had more pressing parenting responsibilities beyond disclosure. When discussing their perspectives on disclosure, many referenced their personal stories indicating a link between their decision to disclose/not disclose to their child and their own disclosure narrative. One mother cited she did not plan to reveal her diagnosis to her son because he was uninfected, while another mother explained she did not want to worry her child. The mother of the only infected child "did not want to wait like my mother did" and planned to tell her son at an earlier age than when she learned of her own diagnosis. Clinical implications related to disclosure will be discussed and future areas of research identified.

Do sexual risk behaviors differ between heterosexual youth infected with HIV perinatally versus sexually?

PURPOSE

To determine if sexually active heterosexual HIV-infected 15- to 24-year-old youth have different sexual or other risk behaviors depending on whether they were infected perinatally or heterosexually.

METHODS

We compared youth aged 15 to 24 years who acquired HIV perinatally or sexually and were interviewed in-person or by phone for partner services by the New York City Department of Health and Mental Hygiene. We included heterosexually active youth with at least one sexual partner of the opposite sex in the past 12 months, and excluded men who have sex with men and injection drug users. We used χ(2) tests and t tests to compare demographics, sexual risk behaviors, partner services outcomes, and viral loads.

RESULTS

Both groups reported few partners (median 1, mean 2), and only 12% of partners of perinatally infected youth were previously diagnosed (18% of sexually infected youths' partners). A minority reported always using condoms. Both groups had similar rates of sexually transmitted infections and median HIV plasma RNA (perinatally infected: 5,140 copies/mL; sexually infected: 6,835 copies/mL). Despite these similarities, among tested partners not previously HIV diagnosed, none of 17 named by perinatally infected youth was newly HIV diagnosed, whereas 21% (8/39, p = .09) of those named by sexually infected youth were newly diagnosed.

CONCLUSIONS

Though perinatally infected youth did not transmit HIV infection to previously undiagnosed partners, they had similar HIV-related risk behaviors to youth infected sexually who reported on risks that led to their infection. HIV prevention among HIV-infected youth remains a critical challenge.

Pregnancies in perinatally HIV-infected young women and implications for care and service programs

A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Twenty-six percent of the cohort experienced a pregnancy during the study period, with a rate of 125 per 1,000 person years in 2006. The age of first pregnancy ranged from 15-25; 24% were younger than 18. Fourteen pregnancies (42%) were terminated. Nineteen pregnancies resulted in live births, and all infants tested negative for HIV. The success of preventing vertical HIV transmission is attributed to interdisciplinary family-centered services, including reproductive health education, family planning, obstetric-gynecologic services and psychosocial support. Such approach is most likely to be effective at promoting healthy reproductive decisions and reducing morbidity in perinatally infected mothers and their children.

The Changing Horizons of U.S. Families Living With Pediatric HIV

Although HIV is considered a chronic pediatric illness that is on the wane in the United States, challenges remain for those affected. The purpose of this longitudinal qualitative study was to examine the phenomenon of raising an HIV-positive child in the United States from the parental perspective. This study incorporated a longitudinal, phenomenological approach. The purposive sample included parents and guardians from 10 families from the northeast region of the United States with children diagnosed with asymptomatic HIV infection at the study onset. The researcher conducted in-depth interviews with the parents over a 7-year period. The common themes identified included: balancing normalcy with uncertainty, facing the multifaceted dilemmas associated with disclosure, and addressing the evolving medication and treatment challenges. The findings of this study can enhance the understanding of nurses and other health care professionals to improve policies, standards of care, and interventions for children and families living with pediatric HIV infection.