| Chapter 1: | Introduction |
|
|
With the advent of highly active antiretroviral therapy (HAART), a large proportion of children with HIV/AIDS are surviving into adolescence and early adulthood. Clinical reports from U.S. medical centers indicate substantial mental health and behavioral problems among adolescents with HIV infection, including depression and perceived medication nonadherence. Nonadherence threatens to extinguish a population that has been kept alive by medical technology. It is the psychological component, that is, the meaning that is attached to these medicines, that must be explored and understood if these adolescents are to survive. This work will significantly improve our understanding of the mental health functioning and behavior of adolescents with HIV1 infection, and will promote the design and implementation of more sensitive and individualized mental health and adherence interventions that will, potentially, save lives.
Adolescents with perinatal HIV infection are at high risk of experiencing mental health problems and poor medication adherence due to a confluence of disease-related, genetic, and environmental factors. These include, but are not limited to, the progression of HIV disease, neurocognitive deficits, family histories of substance abuse and psychiatric illness, and development in the context of poverty and limited resources. The etiology of mental health and behavioral problems also may include discontinuities in attachment relationships, which are not uncommon among children with HIV infection. The impact of early histories of separation, loss, and trauma on the quality of attachment relationships in adolescents with HIV infection has not been fully explored, nor has the effect of attachment disruptions upon the development of depression—a known risk factor for poor adherence.