Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
Malawi Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi.
BMC Pediatr. 2022 May 6;22(1):253. doi: 10.1186/s12887-022-03292-4.
BACKGROUND: Of the 1.8 million adolescents between the ages of 10 and 19 living with HIV globally in 2020; approximately 1.5 million of these live in sub-Saharan Africa. These adolescents living with HIV (ALHIV) are at higher risk of experiencing mental health problems than those without; in Malawi, 18.9% have a depressive disorder. ALHIV can face numerous psychosocial challenges, but little is known about how ALHIV in Malawi perceive these stressors. Understanding psychosocial challenges of ALHIV is a key step in ensuring good mental health care. The aim of this study was to assess the psychosocial challenges faced by ALHIV attending adolescent-specific ART program in Zomba, Malawi. METHODS: Between April and May 2019, we engaged a purposive sample of ALHIV ages 12-18 (n = 80) in a series of eight focus groups drawing from four Teen Clubs linked to an adolescent-specific ART program. Data were analyzed inductively and deductively to identify themes related to ALHIV psychosocial experiences. RESULTS: Two themes that emerged from the study include: 1) stigma and discrimination within communities and families; 2) non-adherence to medications. HIV-related stigma was associated with increased psychological distress; physical and emotional/verbal abuse; low social support, isolation, and a feeling of rejection; and risky health behaviors such as medication hiding and non-adherence to ART. Discriminatory actions were manifested in a form of being given separate utensils for their meals and mistreatment at school. Furthermore, some parents did not allow their children to play with the participants out of fear that HIV transmission. CONCLUSIONS: Stigma and discrimination are overlooked potential barriers to HIV treatment and care. If HIV services are to effectively meet ALHIVs' needs, mental health interventions are needed to prevent and manage depression and improve adherence to ART. These findings highlight the crucial need to develop culturally relevant mental interventions aimed at helping ALHIV to cope with these diverse challenges.
背景：2020 年，全球有 180 万 10 至 19 岁的青少年携带艾滋病毒；其中约 150 万生活在撒哈拉以南非洲地区。这些携带艾滋病毒的青少年（ALHIV）比没有携带艾滋病毒的青少年更容易出现心理健康问题；在马拉维，18.9%的人患有抑郁症。ALHIV 可能面临许多心理社会挑战，但人们对马拉维的 ALHIV 如何看待这些压力源知之甚少。了解 ALHIV 的心理社会挑战是确保良好精神卫生保健的关键步骤。本研究旨在评估在马拉维宗巴参加青少年特定抗逆转录病毒治疗方案的 ALHIV 面临的心理社会挑战。
方法：2019 年 4 月至 5 月期间，我们从与青少年特定抗逆转录病毒治疗方案相关的四个青少年俱乐部中，采用目的抽样法，选取了 80 名年龄在 12 至 18 岁的 ALHIV 参加了一系列 8 个焦点小组。使用归纳和演绎分析方法对数据进行分析，以确定与 ALHIV 心理社会经历相关的主题。
结果：研究中出现了两个主题：1）社区和家庭内的耻辱和歧视；2）不遵守药物治疗规定。与艾滋病毒相关的耻辱感与增加的心理困扰、身体和情感/言语虐待、低社会支持、孤立和被拒绝感以及隐藏药物和不遵守抗逆转录病毒治疗等危险健康行为有关。歧视行为表现为给他们的饭菜单独提供餐具和在学校受到虐待。此外，一些父母不允许他们的孩子与参与者一起玩耍，因为害怕艾滋病毒传播。
结论：耻辱和歧视是艾滋病毒治疗和护理中被忽视的潜在障碍。如果艾滋病毒服务要有效地满足 ALHIV 的需求，就需要进行心理健康干预，以预防和管理抑郁，并提高对 ART 的遵守率。这些发现强调了迫切需要制定文化相关的精神干预措施，帮助 ALHIV 应对这些多样化的挑战。
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