Fact Sheet: HIV/AIDS in Children and Adolescents
The human immunodeficiency virus (HIV) is a retrovirus that attacks vital cells in the immune system and is transferred through specific bodily fluids (e.g., blood, semen, breast milk). Transmission may occur via unprotected sex, sharing infected drug needles, through breast milk, and from infected mother to fetus during birth. AIDS (acquired immunodeficiency syndrome) is the most advanced stage of HIV infection, resulting in failure of the immune system to fend off opportunistic infections.
Prevalence and Course
In 2008, an estimated 1.1 million people 13 years or older were infected with HIV in the United States, with an estimated 50,000 new infections per year. Of these new infections, 39 percent were in people 13-29 years of age. For children younger than 13, the Centers for Disease Control and Prevention estimates that there were 166 new cases of HIV in 2009. With improved treatment, HIV mortality rates have decreased and patients are living longer lives; however, HIV is a chronic disease with no cure at this time and treatment is life-long.
Health and Psychosocial Consequences
HIV-infected youth experience increased risk for dysfunction in multiple systems (e.g., renal, GI), opportunistic infections and cognitive deficits. They may also experience a high level of stress from demanding treatment regimens, stigma associated with the disease and acquisition, and deficits in social support, particularly when one’s status may be undisclosed. Youth with HIV may also experience increased disruption in mood and symptoms of anxiety, grief related to the loss of loved ones (parents or siblings) due to infection, and other contextual and environmental factors that place disadvantaged children at higher risk.
Since HIV/AIDS can impact cognitive functioning, standardized cognitive and neuropsychological assessment is important to monitor disease effects and assist in academic planning. In addition, assessment of mood and anxiety is important to address any psychological difficulties associated with living with HIV/AIDS. Substance use and abuse, as well as high-risk sexual behavior, are also important to monitor.
Culture, Diversity, Demographic and Developmental Factors
HIV disproportionately affects African American and Latino youth and young gay and bisexual males. Young African American heterosexual females also represent one of the fastest growing groups. Perinatally infected children who have lived with HIV longer are at higher risk for negative consequences versus older behaviorally-infected youth. In addition, younger children are more dependent on caregivers for treatment adherence. Since HIV is a chronic illness, transition of services from pediatric to adult care has become an important issue and potential obstacle in providing continuity of care.
Given the complex treatment demands to maintain optimal virus suppression, adherence represents a primary intervention target. Strategies to support adherence include intensive youth-focused case management and behavioral strategies that provide reminders and reduce treatment-related anxiety (e.g., pill swallowing training). Therapeutic support and problem-solving approaches can address psychosocial, mood and anxiety issues that can impact adherence. Community-based programs can also help to promote responsible decision making, prevent transmission, and improve the quality of life for infected youth.
Elkington, K.S., Robbins, R.N., Bauermeister, J.A., Abrams, E.J., McKay, M., & Mellins, C.A. (2011). Mental health in youth infected and affected by HIV: the role of caregiver HIV. Journal of Pediatric Psychology, 36(3), 360-373.
McBride, C.K., Baptiste, D., Traube, D., Paikoff, R.L., Madison-Boyd, S., Coleman, D., Bell, C.C., Coleman, I., & McKay, M.M. (2007). Family-based HIV preventive intervention: Child level results from the CHAMP family program. Social Work in Mental Health, 5(1-2), 203-220.
Wiener, L.S., Kohrt, B., Battles, H.B., & Pao, M. (2011). The HIV experience: Youth identified barriers for transitioning from pediatric to adult care. Journal of Pediatric Psychology, 36(2), 141-154.