A qualitative exploration of psychosocial challenges of perinatally HIV-infected adolescents and families in Bangkok, Thailand

ABSTRACT

Thailand has the highest HIV prevalence in Asia, with 9600 HIV+ adolescents and thousands of additional younger HIV+ children. Studies from other settings suggest perinatally HIV-infected (PHIV+) adolescents are at high risk for mental health problems and engagement in risk behaviors that threaten individual and public health. Yet, few studies exist in Thailand, and few evidence-based psychosocial interventions have been developed for and studied in this population, despite great need. The current study qualitatively explored psychosocial issues among Thai PHIV+ adolescents to inform development or adaptation of interventions. Thai and US-based researchers and clinicians conducted two focus group discussions with PHIV+ adolescents aged 12–16 and their adult caregivers, and six in-depth key informant interviews with health/social work providers at a large clinic for PHIV+ youth in Bangkok, Thailand. Data were analyzed thematically using framework analysis. Multiple challenges for PHIV+ youth and caregivers were identified. Adherence to antiretroviral treatment was a significant challenge attributed to lack of adult support, side effects, feeling too well to take medicines and avoiding acknowledging sickness. Poor child–caregiver communication and conflict was a key concern, explained in part by cultural expectation of obedience and generation gaps. Concerns about societal stigma and discrimination emerged strongly and influenced delay or avoidance of disclosing HIV status to children and others. Respondents identified positive approaches to addressing these issues and highlighted the need for interventions to improve child–caregiver communication and generate peer and community support for PHIV+ youth. Thai PHIV+ adolescents and families experience significant psychosocial challenges, similar to those seen in other contexts. Cultural adaptation of an existing evidence-based clinic-based family group intervention is recommended to rapidly address these needs.

KEYWORDS:

• Perinatal HIV infection
• adolescents
• psychosocial support
• Thailand
• adherence

Acknowledgements

The authors would also like to acknowledge the significant time, effort and guidance of all of the participants in this project, including the tremendous support of the young people living with HIV and their families and care providers. A portion of these findings was presented in a poster at the 2016 International AIDS Conference in Durban, South Africa.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

The content of and the views expressed in this publication are solely the responsibility of the authors and should not be construed to represent the positions of the U.S. Army or the Department of Defense or any of the other institutions mentioned above.

Additional information

Funding

Funding support was provided by and through a grant to amfAR, The Foundation for AIDS Research, from the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Cancer Institute, as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA; U01AI069907). This research was also supported by grants from the National Institute of Nursing Research (NINR grant # R21NR10474; PI: Claude Ann Mellins, Ph.D.) and the National Institute of Child Health and Development (NICHD grant # R01 HD074052; PI Mary McKay, PhD), as well as a centre grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Robert Remien). Drs. Ananworanich and Mellins were partly supported by a Henry M. Jackson Foundation grant [#R01MH102151].