AFISE Are Romanian HIV+ youth gambling with death?
Are Romanian HIV+ youth
gambling with death?
Background While the Romanian
COE was able to achieve
very low mortality rates
in the previous years,
(less than 1%) there are
some puzzling situations
regarding lack of
adherence and patients’
limited cooperation
with the care team,
which lead to their
death; we consider that
these situations require
better analysis from a
psychosocial perspective.
Objectives This presentation aims to share experiences, identify possible common factors in the profiles of
the target group and raise further questions that might become relevant for other BIPAI centers
delivering youth services in terms of psychosocial services design.
Design/ methods The Baylor Romania psychosocial team has retrospectively analyzed a sum of case studies
comprised of all patients that died in 2008 as well as cases that are currently in our care and
have a very high probability of death due to ill health. We have also analyzed some cases that
accepted the therapy on their own initiative after years of refusal of care.
Finally, we tried to identify some common factors, dilemmas and issues that might be relevant
for psychosocial programs design.
Results There are two categories of patients:
• those that were chronically ill, hospitalized
and have lost hope and trust in medication
and medical care,
• those who were immunologically ill for
long time, but kept a good life quality and
died “unexpectedly “ in spite of all warnings
and efforts to be brought back into care.
While the family support is important, it
seems that other factors are stronger, such as:
personality type, cognitions and beliefs.
The issues that arose in connection with the delivery of psychosocial services refer to: intensity
and nature of support, timing and type of warnings regarding illness related dangers, ways of
dealing with professionals’ feelings of helplessness.
Conclusions It seems that medical success (ie achieving good clinical result) can be tricky when working
with adolescents and young people. They tend to develop cognitions that link their good
health to other factors than the ARVs such as luck or invincibility. Also, there is a peer pressure
among adolescent patients themselves,
especially in regard to therapy and it’s
effects. Therefore, we recommend shaping
psychosocial support upon personality
type and identifying patterns of social
networking within the patients groups in
order to identify role models that might be
copied; also, we consider that other BIPAI
centers need to think about best ways of
supporting “success” cases, in a manner
that will develop and keep their trust in
the health professionals and ARVs.
Authors:
L. Vlahopol
A. M. Schweitzer
A. Caraveteanu