HIV in Youth: Another Area for Cultural Competence

Adolescents and young adults aged 13 to 24 years old are particularly vulnerable to HIV infection, representing 21% of newly infected individuals in most recent data. Roughly 40% of youths with HIV are aware of their diagnosis, and just 6% of those treated have reached virologic suppression.

Researchers from the Johns Hopkins School of Medicine addressed the unique concerns of HIV infections in youths in a study published in the October 2017 issue of AIDS Care. According to the authors, younger individuals with HIV have many competing needs that distract them from fully engaging in care, including unstable housing, under-employment, and co-morbid physical and mental health issues.

The researchers aimed to address these challenges by understanding where and how youths with HIV receive care. Although this population accounts for an increasingly disproportionate share of infections, clinicians provide care in a variety of settings that generally have larger patient volumes and more comprehensive services than pediatric clinics. Despite the array of services, youths have poorer outcomes than adults treated in these settings. Their outcomes also lag behind those treated at pediatric HIV clinics.

Most pediatric/adolescent clinics have limited capacities. The researchers noted that better interventions are needed, citing combination antiretroviral therapy, contingency management, nurse-derived interventions, and co-located substance abuse treatment as care gaps.

The researchers advocate for youth-friendly multidisciplinary teams and additional training for adult providers. While this study does not identify youth-friendly interventions specifically, other research indicates that this may involve:

• Educating staff to be culturally competent and avoid mentally assigning youths to stereotypes
• Provision of integrated services in locations where youths gather
• Acknowledging fear and anxiety without overemphasizing it
• Respecting the youth’s autonomy and confidentiality needs
• Being patient, positive, and nonjudgmental

Youths also like seeing the same health care providers at every encounter. In pharmacies, staff can establish trusting relationships with youths and promote retention in care.

Reference

Griffith DC, Agwu AL. Caring for youth living with HIV across the continuum: turning gaps into opportunities. AIDS Care. 2017 Oct;29(10):1205-1211.