Impact of HIV/AIDS on Child Mental Health

1312 words (5 pages) Essay in Psychology

23/11/17 Psychology Reference this

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Chapter 1

  1. Introduction

Since the advent of HIV/AIDS epidemic in the 80’s, over 75 million persons have been infected with the deadly virus. Recent statistics shows that there were about 38.8 million people living with HIV/AIDS in 2012 [1]. Over 36 million AIDS related deaths has been recorded since the start of the epidemic, with a reduction in AIDS related mortality from 2.3 million deaths in 2005 to about 1.6 million deaths in 2012.

Though the number of new infections remains high, it has actually fallen from the peak in 2001 of about 3.7 million to 2.7 million in 2012. Women are more at risk of acquiring HIV infection than men in sub-Saharan Africa mainly due to Gender inequality, this relatively increases the risk of children acquiring HIV through mother-to-child-transmission [2]. According to available statistics about30% of babies born in sub-Saharan Africa to HIV positive mothers will themselves be infected with the virus either through childbirth or through breast-feeding [ref]. However, there is a reduction in the number of children infected with HIV, from 620,000 children in 2001 to about 320,000 children in 2012 [1].

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Efforts aimed at preventing HIV transmission are increasingly prioritizing the protection of children from acquiring the virus from mothers during the process of delivery and after birth. Thus, considerable resources have been committed towards testing pregnant mothers to establish their sero-status and enrolling them on ART, once confirmed positive. This serves as a protective measure against the risk of transmitting the virus to the child, while at the same time protecting the mother.

Despite, the appreciable achievements in reducing the spread of the HIV virus, the virus is still on rampage all over the world, leading to adverse economic and psychosocial concerns. Sub-Saharan Africa where the impact is the strongest is experiencing a multi-dimensional effects of the disease in terms of economic loss and a declining quality of life.

1.2. Background and Context

According to recent statistics there are about 3.2 million children living with HIV, 91% of these children living with HIV are found in sub-Saharan Africa [2]. The WHO recommendations stipulates that children below the age of 5 diagnosed with HIV should be placed on ART regardless of what there CD4 count is. About 28% of children living with HIV worldwide, requiring antiretroviral treatment (ART) currently have access to these drugs [2]. Nevertheless, 76% of HIV infected children living in resource poor-settings, sub-Saharan Africa inclusive, lack access to the necessary treatments [3].

For most of the history of the epidemic, the majority of children born with HIV in resource poor settings did not survive past infancy, let alone early childhood [4, 5]. Now, however, recent studies indicate that 36 percent of infants living with HIV have a median life expectancy of 16 years [6]. Furthermore, advances in HIV testing for exposed infants and children and in providing antiretroviral therapy (ART) are increasingly enabling children living with HIV to live longer and healthier lives[7, 8 ]. For these children, HIV is a chronic disease requiring a lifetime of continuous treatment, care, and support to ensure their physical and mental development, as well as their emotional and psychological well-being. For example, recent studies indicate that living with a life-threatening and stigmatizing illness is also difficult and creates great psychological distress for children with HIV [9]. Children living with HIV are often confronted with fears/thoughts about their own death, most of them are stigmatized and discriminated against [9]. There is also consistent evidence of cognitive difficulties for HIV positive children [10].

Some research has tried to establish the effects of HIV and ART on psychosocial and brain development of perinatally HIV infected children. One study [11] conducted with Ugandan HIV positive babies followed over a period of one year, showed that 30% of the babies on ART exhibited impaired motor functions while about 26% of the babies displayed impaired cognitive functions, this is in contrast to about 5-6% of HIV negative babies that exhibited the same conditions. In another study [12] it was shown that early abnormalities in children’s neurological development is attributable to HIV infection and no other factors like environmental and biological risks.

Moreover, other studies have shown that perinatal HIV infected children are at greater risk of experiencing abnormalities in brain development [13], these abnormalities include delayed motor and cognitive development [12] and in some cases short-term amnesia and mental retardation as a result of the infection [13, 14].

Furthermore, as adult infected with HIV are prone to psychosocial and psychological stressors so are children infected with the virus. They are faced with anxiety associated with living with a chronic illness and the possibilities of death from the infection. High on the list for psychosocial stressor, is the issue of discrimination and stigmatization, as well as struggles with other challenges like malnutrition, poverty and diminished social support [15]. Psychosocial difficulties experienced by HIV infected children as reported in some studies include; depression, attention deficit disorder, hyperactivity and social withdrawal [16]. However, it has not been established whether these symptoms are neurological or psychological correlated.

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The term “psychosocial” can simple be specified as connecting social environments to mental health, this is particularly interesting and most relevant to this discourse especially in the sub-Saharan African context; where stigmatization of people living with HIV or persons with diagnosed mental illness prevails. Additionally, the psychosocial theory alludes that mental health is interwoven to culture, interactions and traditions. In that regards, stigmatization and discrimination are some of the prominent psychosocial threats and portends adverse mental health outcomes for children living with HIV/AIDS.

According to Avert HIV related stigma can be defined as “prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV/AIDS. HIV related stigmatization is deeply rooted in culture, myths, and misconceptions, and in many cases religious ideologies. The lack of right knowledge about modes of HIV infection is where the crux of the matter lies. Children and adolescents living with HIV/AIDS has been identified as most affected by stigmatization [17].

Goffman [18] who is among the leading scholars that explained the theory of stigma and disease. He defined stigma as those extreme traits that diminishes the self-worth of an individual whose image has been tarnished and hence disparaged. Stigma is a global health issue and endangers psychological well-being of individuals [19]. Goffman’s postulation sees stigmatization as power play that leads stereotyping of certain individuals as defiled, but many research on HIV and stigmatization maintains that HIV related stigma is individual based [19, 20].

1.3. Rationale

With increasing access to ART, children born with perinatal HIV infection (PHIV) are reaching adolescence and young adulthood in large numbers. These children in most cases share stressors experienced by other children living with other chronic illness, including on-going medical treatment, hospitalizations, exposure to pain and sheltered life experiences. They also face a host of unique issues related to the psychosocial impact of HIV, a highly stigmatized and transmittable illness that may make transition through adolescence difficult. Until recently however, the majority of research has focused on biomedical outcomes, adherence to antiretroviral therapy (ART) and prevention of HIV transmission to others. Yet there is increasing awareness that long-term survivors with PHIV are at high risk for mental health problems, given biomedical, familial and environmental risk.

Given the significant association of mental health problems with substance use, sexual risk and poor healthcare behaviours in other population, there is a critical need to understand mental health functioning in children perinatally-infected with HIV, identify risk and protective factors associated with mental health outcomes. This is necessary to inform mental health treatment and prevention programmes.

1.4. Objective

To review and provide a synthesis of research on the mental health and psychological functioning/outcomes of children who are perinatally-infected with HIV, corresponding risk and protective factors, treatment modalities and critical needs for future interventions and research.

 

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