HIV Disease

More than 65 million people worldwide, including 1 million children, have been infected with HIV, the cause of AIDS. An estimated 39.5 million people worldwide are living with HIV. During 2003, about 4.3 million were newly infected, including 2.8 million in sub-Saharan Africa. Rates of infection have risen more than 50% in Eastern Europe and Central

Asia (Joint United Nations Programme on HIV/ AIDS 2004). Although common in developing countries, mother-to-child transmission occurs rarely in the United States due to voluntary screening for pregnant women and antiretroviral treatments for HIV-positive mothers and their children. Since the development of antiretroviral therapies, many children who were infected with HIV congenitally have become young adults. Approximately 40% of all new HIV infections in the United States occur in individuals younger than age 25, and HIV is the sixth leading cause of death among adolescents. Because highly active antiretroviral therapy has transformed HIV illness into a chronic condition, youngsters now struggle with its associated medical and psychological morbidities while coping with issues of identity and maturation. Young people living with HIV have reported lower quality of life and heightened psychological distress (Lightfoot et al. 2005).

Studies examining prevalence of depression among HIV-positive youth who have acquired their illnesses through vertical transmission estimate that these youngsters exhibit higher rates of depression than healthy peers, with rates ranging from 25% to 47% (Misdrahi et al. 2004; Scharko 2006). In contrast, other studies have found no association between congenital HIV infection and behavioral symptoms (Mellins et al. 2003). Although highly active antiretroviral therapy has transformed HIV into a chronic illness, it remains a progressive and chronic illness without a cure. Adolescents are living longer with HIV and its complicated medication and lifestyle requirements at a time when the establishment of relationships and intimacy is develop-mentally appropriate. Understandably, these adolescents report high levels of psychological distress, despite better overall physical health (Lightfoot et al. 2005).

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