Stigma Management Trajectories in Youth with Perinatally Acquired HIV and Their Families: A Qualitative Perspective.

This study explores how family, secrecy and silence contribute to the adoption of stigma management strategies among youth with perinatally acquired HIV (PAHIV). A qualitative method was used. Eighteen youths with PAHIV aged 13-22 years old took part in a semi-structured interview. An exploratory content analysis was performed. Analyses of interviews allowed identification of two HIV stigma management trajectories, both sensitive to the family context: [1] a consolidation of family ties, which contributes to solidarity in stigma management; and [2] a weakening or dissolution of family ties, which contributes to solitary stigma management strategy. Family conditions that support the children in their efforts to develop active stigma management strategies are described. Children likely to experience weakening or dissolution family ties must build strong bonds in the clinical environment and maintain these into adulthood so as to afford them the support they need.

Romantic relationships and sexual activities of the first generation of youth living with HIV since birth.

HIV-infected children, now maturing into adolescence and adulthood, must cope not only with adolescent developmental issues, but also with a chronic, socially stigmatised and sexually transmittable illness. Little research on this first generation of survivors has focused on romantic involvement and sexuality. This study, which employs a mixed-method embedded strategy (qualitative supported by quantitative), describes the perspectives of youth living with HIV since birth concerning: (1) romantic involvement and sexuality; and (2) risk management including the risk of HIV transmission and partner serostatus disclosure. Eighteen adolescents aged 13-22 from Montreal, Canada, participated in individual semi-structured interviews and completed self-report questionnaires. Most youths participated in non-penetrative sexual activities. Ten participants reported having had vaginal and three anal intercourses, at an average age of 14 for girls and 15 for boys. All sexually active youth reported having used a condom at least once. Of those who reported that their first sexual relationship was protected, over half had taken risks in subsequent relationships (e.g., unprotected sex, multiple partners, etc.). Interviews conducted with sexually inactive youths illustrate the interrelatedness of romantic involvement, sexual initiation and potential serostatus disclosure. Involvement in a sexual relationship would not be conceivable unless the partner was informed of their serostatus. For sexually active participants, risk management implies HIV transmission and partner disclosure. These youths have emotional issues regarding disclosure in romantic relationships and few risked potential rejection by disclosing. Condom use acts as a reminder of the infection and a barrier to intimacy. The narratives illustrate how risk perception changes and becomes relative with time and experience, especially when the viral load is undetectable and when past experience has convinced the adolescent that his/her partner might not become infected. Findings reinforce the need to prioritise sexual health issues for young people with perinatally acquired HIV.

[Not Available]. / Silence et divulgation dans des familles d'adolescents vivant avec le VIH depuis la naissance : une exploration qualitative.

OBJECTIVE: Studies targeting children born with HIV have principally focused on the period preceding the announcement of the diagnosis to the child. The objective of the present study was to explore intrafamilial communication dynamics following the announcement of the diagnosis. METHODOLOGY: Twenty-nine youths (10 to 18 years of age) living with HIV since birth participated in individual semistructured interviews about the following: 1) serostatus disclosure, 2) family relations and 3) sexual education within the family. The testimonials underwent a content analysis. RESULTS: The youths learned of their HIV-positive diagnosis at the average age of 11 years. The dynamic established after the announcement appears to be regulated by silence: the exchanges that follow mainly involve questions related to medication and prevention of sexual transmission of the virus. This silence preserves the familial equilibrium by performing three functions: protecting the mother from a feeling of guilt regarding transmission, assuring family harmony and feeling normal compared with others. The adolescent's diagnosis is generally not revealed to the extended family, thus preserving their integration within the family by protecting them from rejection, betrayal and judgement. DISCUSSION: The functions of silence and the secret serve as important stabilizers within the family. However, they contribute to the isolation of the adolescents in the form of emotional support that they still need. Suggestions for intervention are presented.