Lowe G A, Gibson R C, Christie C D C
Department of Community Health and Psychiatry, The University of the West Indies, Kingston 7, Jamaica.
West Indian Med J. 2008 Jun;57(3):307-11.
Children and adolescents with HIV/AIDS often have psychological/psychiatric issues that require specialist intervention. We explored whether HIV infection acquired through sexual abuse led to particularly negative psychiatric outcomes and whether good social support is a protective factor in the development of undesirable psychiatric sequelae.
This study consists of a case series of five persons referred from the Paediatric Infectious Diseases Clinic to the Child Psychiatry Clinic, both at the University Hospital of the West Indies (UHWI) in Jamaica, during July 1 to November 30, 2005. The patients were clinically assessed and diagnosed by a psychiatrist using the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM IV) criteria. Cases were compared according to gender, age, likely route of HIV infection, level offamily/social support and nature of psychiatric outcome.
Adolescents who acquired HIV infection through sexual abuse reported more intense feelings of sadness and suicidal ideations. Those with good social support reported less intense feelings of sadness with no suicidal ideations and were more optimistic about their future regardless of the route of acquisition. Two of three adolescents who acquired HIV infection through sexual abuse and one of two who was perinatally infected required ongoing supportive psychotherapy to augment their social support, the characteristic most associated with favourable outcome.
Both sexual abuse and HIV/AIDS are likely to have negative psychological consequences in children and adolescents. This psychological impact may be intensified when HIV infection results from sexual assault as opposed to other methods of transmission. The findings support the practice of providing HIV prophylaxis to all sexual assault victims of known or suspected HIV-positive perpetrators and of encouraging utilization of existing social support networks.
感染艾滋病毒/艾滋病的儿童和青少年往往存在需要专业干预的心理/精神问题。我们探讨了通过性虐待感染艾滋病毒是否会导致特别负面的精神后果，以及良好的社会支持是否是不良精神后遗症发展过程中的一个保护因素。
本研究包括2005年7月1日至11月30日期间从牙买加西印度群岛大学医院（UHWI）的儿科传染病诊所转诊至儿童精神病诊所的5例病例系列。由一名精神科医生根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准对患者进行临床评估和诊断。根据性别、年龄、可能的艾滋病毒感染途径、家庭/社会支持水平以及精神后果的性质对病例进行比较。
通过性虐待感染艾滋病毒的青少年报告有更强烈的悲伤情绪和自杀念头。社会支持良好的青少年报告的悲伤情绪不那么强烈，没有自杀念头，并且无论感染途径如何，对自己的未来都更乐观。通过性虐待感染艾滋病毒的三名青少年中的两名以及两名围产期感染的青少年中的一名需要持续的支持性心理治疗，以增强他们的社会支持，这是与良好结果最相关的特征。
性虐待和艾滋病毒/艾滋病都可能对儿童和青少年产生负面心理后果。当艾滋病毒感染是由性侵犯而非其他传播方式导致时，这种心理影响可能会加剧。这些发现支持了对所有已知或疑似艾滋病毒阳性犯罪者的性侵犯受害者提供艾滋病毒预防措施，并鼓励利用现有的社会支持网络的做法。
