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Globally, it was estimated that in the
year 2008 there were 33.4 million people living with HIV, out of which children
below 15 years constituted 2.1 million. It was estimated that India has an
overall prevalence of 0.31%. Approximately 50,000 children below 15 years are
infected by HIV every year. The increased access to antiretroviral
treatment resulted in increased survival rates among the children infected with
HIV/AIDS and also led to the improved quality of life of sero-positive
children. This continues to have an increased impact on the mental health of
children and adolescents living with HIV. Children with any chronic illness, in
general, are found to be at greater risk of psychiatric problems, including
depression, anxiety, and feelings of isolation. A major factor that
distinguishes HIV/AIDS from other chronic or terminal illness is the stigma.
Too often many HIV infected children and their families live in shame
associated with AIDS.
Illness is often kept as a secret. Parents delay
disclosing child’s as well as their own HIV/AIDS illness status due to stigma
and possible psychological consequences. Internalizing problems such as
anxiety, withdrawn behaviour, depression and somatic complaints are more in
younger children with HIV and externalizing problems such as rule breaking,
aggressive behaviour, and conduct disorders are common among older adolescent
living with HIV. Further, children with HIV/AIDS have additional
factors in the complexity of their illness and treatment as well as in the
adverse psychological circumstances and poverty in which many live. These
children who know about their HIV status live in fear of their disease, and
fear of loss of parents with HIV/AIDS. Moreover, given the nature of HIV
transmission, if both parents infected with HIV, then many children become
‘double orphans’. Children not only have to endure the pain and loss of losing
parents, and also have to face stigma and survive without the emotional support
of their parents. Following the death of the parents most of these infected
children end up in living in orphan homes for long term care and protection.
This has immediate as well as longer term emotional consequences. As a
result the mental health, needs and concerns of the children and adolescents
with HIV infection need to be an essential part of their care even with
advancements in HAART.
When it comes to the disclosure of HIV/AIDS infection
status to the children, there is no clear consensus among the practitioners and
parents on when to disclose the HIV positive status to the child. Most of the
disclosure guidelines address on illness aspect and treatment adherence and not
on addressing the mental health impact of disclosure of HIV status to the child. Once the HIV diagnosis has been disclosed to the infected child, there is
a need to monitor in every follow-up visit, the child’s level of functioning,
behavioural changes, emotional and psychological adjustment by the health care
provider. Moreover, health care providers who work directly with HIV infected
children are not being trained with adequate skills to handle the psychosocial
and mental health issues of children infected with HIV/AIDS. This adds to
the woes of the children in vulnerable situations and affects their not address
the psychological and mental health issues of children either infected or
affected with HIV/AIDS. The existing services in the ART centers in India are
more generic than specific needs of infected children and adolescents.
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