Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor's Name

Elena Bastida

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

H. Virginia McCoy

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Consuelo Beck-Sague

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Mario De La Rosa

Fourth Advisor's Committee Title

Committee Member

Fifth Advisor's Name

Silvia E. Rabionet

Fifth Advisor's Committee Title

Committee Member

Keywords

Adolescents, Puerto Rico, HIV perinatally infected, interpretative phenomenological analysis (IPA), family, antiretroviral therapy (ART), disclosure

Date of Defense

11-3-2014

Abstract

The effectiveness of antiretroviral therapy (ART) transformed the pediatric HIV epidemic. The disease changed significantly over the course of three decades: while early in the epidemic it was almost always fatal, it has become a chronic condition.

This study examined how perinatally-infected youth experience the impact of HIV in their lives. A qualitative study using interpretative phenomenological analysis (IPA) was conducted. Twenty in-depth interviews were carried out among 12 women and 8 men aged 18 to 30 years in Puerto Rico. These were conducted in Spanish, audio-recorded, transcribed and translated into English. While narrating their experiences, participants were interpreting what the situation meant to them and how they make sense of it.

Three topics emerged: (1) perception and response to treatment and illness, particularly their lived experiences with ART; (2) disclosure experiences; and (3) family matters. Most participants challenged their therapy, in most cases to force their caregivers to disclose their status. Problems with adherence were attributed to busy schedules or forgetfulness. Participants experienced the disfiguring adverse effects of ART, which they endured for years without being informed that ART was the cause of these. Participants’ experiences with disclosure demonstrated the importance of validating them as individuals capable of managing their health. The paternalistic approach of withholding their diagnosis to spare them suffering resulted in increased anxiety. Participants acknowledged the difficulties of revealing their HIV status to their partners. They referred to family and friends as essential in coping with HIV. However, some encountered discrimination and stigma within their families. Participants who had suffered the loss of their parents found other parental figures such as adoptive parents or other family members. Most participants expressed a desire to have children.

Perinatally HIV-infected youth will require health services for the rest of their lives. The adult health care into which they transition should consider their needs and journey. Services should consider including family members. This study underscores the need for improved access to mental health services. It is also essential to transcend medical treatment and develop a broader perspective of health care. Health care services should include reproductive decision-making counselling services.

Identifier

FI14110726

 

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