Thesis: Group Therapy With HIV Positive Teenagers

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Therapy and Adolescents Who are HIV +

Teens and HIV

The need for quality psychological support -- including group therapy -- is a very compelling one when considering the number of adolescents who are HIV+ in the world today. According to the peer-reviewed journal AIDS Care (Bakeera-Kitaka, et al., 2008) about 6,000 young people are HIV infected worldwide every day of the year. Bakeera-Kitaka asserts that in Uganda around 100,000 children younger than 15 years of age are HIV+ and of all newly infected individuals around the world some 67% are between the ages of 15 and 24 years (p. 426). In New York City some 64% of children living with HIV (through Perinatal infection) are older than 12 years of age (Mellins, et al., 2009), according to research published in The Journal of Child Psychology and Psychiatry. Clearly there is -- and has been for some time -- a need for psychological interventions with young people who are HIV positive (+). This paper will review the available literature vis-a-vis group counseling / therapy for adolescents that are HIV+.

Literature Review:

There is far more literature relative to the number of youths who are HIV+, and the need for medical and psychological support for them, than there is information on the outcomes of psychological interventions via group therapy. However, there are data and results from group therapy and they will be included in This paper. Meantime, Claude Ann Mellins is an Associate Professor of Clinical Psychology in the Department of Psychiatry and Sociomedical Sciences at Columbia University. She writes that HIV+ youths are far more likely to have been in the care of a therapist than youths who are not HIV+. Indeed the most common psychiatric diagnoses for disorders among HIV+ youths are: anxiety disorders (both special phobias and social phobias); separation anxiety; agoraphobia (fear of public places or of places where there may not be an easy escape); panic attacks; obsessive-compulsive behaviors; and generalized anxiety (Mellins, 1134).

Other disorders found commonly among HIV+ adolescents are ADHD and conduct disorders, according to Mellins, who is also a research scientist at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute. Mellins (1136) asserts that several evidence-based interventions designed to reduce mental health issues with HIV+ adults have been conducted but "few" have involved HIV+ youths. Such interventions are "urgently needed" in order to promote the well being of HIV+ youth, Mellins writes -- in the sense of helping the infected youth and in preventing the transmission of HIV to other young people.

The research reported by Bakeera-Kitaka, et al., was conducted at the Paediatric Infectious Disease Clinic in Kampala, Uganda. The theoretical guidance provided to youth (between the ages of 11-21) utilized the Information-Motivation-Behavioral Skills Model; eight "focus groups" (sessions where adolescents were given therapy by trained healthcare professionals in an open environment for discussion) were held for a total of 75 young people. Thirty-five were female and participation in the sessions was voluntary. Through these sessions it was learned that the motivation for most of the participants was the hope that: there would soon be a cure for HIV-AIDS; that they would live long enough to get finished with schooling and get a job; they would be able to get married and have a family (Bakeera-Kitaka, 2008, p. 428).

The very young among the participants (under 16 years of age) were quite misinformed as to the realities of being HIV+. For example, some admitted that they had believed a boy who had not yet reached puberty could not become infected; some younger girls said they had believed the HIV would be watered down in their bodies while they lose blood during menstruation (Bakeera-Kitaka, 428). The health care providers (HCP) (psychological counselors) reported after the sessions that the adolescents "rarely mentioned the issue of sexual exploitation by caregivers" (parents, guardians, older siblings) but that in fact many of the young people living with HIV (YPLV) were vulnerable. The HCP reported that YPLH needed support from several sources, including caregivers, teachers, spiritual / religious leaders, and health care staff. The sessions revealed that HCP need "specific tools" to be able to identify risky sexual behaviors engaged in by YPLV, and then counseling should be used as an intervention (429).

A huge barrier to avoiding sexual relations notwithstanding the danger to others was said to be peer pressure -- the strong urge to be just like their friends, who were having sex and enjoying it. Generally speaking the 75 youths who participated were motivated both by hope and by fear. Many of them were orphans and/or had been under the supervision of several caregivers. In conclusion the authors report that when future researchers are devising specific interventions for YPLH, emphasis on condom use and on realistic counseling -- including the avoidance of early parenthood and giving young people accurate and consistent information about sexuality.

Meanwhile, research published in the Journal for Specialists in Pediatric Nursing reflects the fact that caring for adolescents who are HIV+ is a "complex process…further complicated by a wide range of adolescents' psychosocial needs" (Major-Wilson, et al., 2008, p. 296). Without the collaboration of several disciplines, the authors insist, optimal and comprehensive healthcare cannot be provided to this subpopulation of youthful individuals.

The article reports on a university-based Special Adolescent Clinic (SAC) -- it was not identified as to where it is located -- is effective in working with HIV+ adolescents because it is a "one-stop-shop" specifically tailored to their needs. The SAC in this research serves young people ages 14-25 and the majority of participants are African-American or Latino. Most of these patients were infected through "unprotected sex" but some were infected with the HIV through sexual abuse or through Perinatal transmission (Major-Wilson, 295). Interestingly most of the youth using this facility are living in poverty and some are homeless. "Very few" of them have disclosed to their families that that are indeed HIV+. The fact that the participants receive all their medical and psychosocial needs in one place results in a "higher retention in care of HIV-infected adolescents" (296).

Professionals present at the clinic include: a physician; two nurse practitioners; a social worker; a psychologist; a peer educator and a dietician. The social worker is there to welcome the adolescents to the facility and achieve a comfort level with them. Indeed just having a social worker on staff -- well before any group therapy takes place -- is comforting for most of the adolescents because they feel that the SAC is a "place of refuge" (296).

The adolescent can feel free to talk openly about his or her HIV issues without being harassed or ridiculed by anyone. The social worker provides a coordinator's perspective, giving the adolescent an initial mental health screening and recommending further actions in terms of psychosocial support. In effect the social worker is a kind of liaison between the adolescent and the psychologist; the social worker is also an advocate for the adolescent and the social worker assists the SAC team in planning and implementing an appropriate treatment plan "with realistic goals for both the client and the healthcare team" (296).

Among the options in this collaborative environment are peer support groups, "life skills workshops," individual and group counseling and even parenting classes for those adolescents with dependent children (296)

Meantime in the Journal of Palliative Medicine (Lyon, et al., 2009, p. 363) several group therapy sessions involving family, counseling professionals, and HIV+ adolescents are part of a program of intervention called Family/Adolescent-Centered (FACE). In this model -- which involved 38 HIV+ yet "medically stable adolescents" ages 14 to 21 (92% were African-American) -- adolescents are engaged in end-of-life discussions (EOL). The authors explain that FACE is an evidence-based approach designed to facilitate conversations that integrate the… [END OF PREVIEW]

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