Adolescents living with HIV/AIDS: A case study from Rio de Janeiro, Brazil

Background: Brazil was the first developing country to provide free access to antiretroviral therapy (ART), currently providing ART to ~200,000 patients. Adolescents/young adults represent an increasing proportion of HIV/AIDS cases in Brazil. Furthermore, HIV-positive youth from disenfranchised populations face multiple lifestyle and psychosocial burdens.
 Objective: To explore HIV-positive young adults’ lifestyles, behaviors and HIV-related knowledge that might influence their effective adherence to ART and maintenance of safer behaviors over time.

Methods: Semi-structured in-depth interviews were carried out with 18 adolescents/young adults infected with HIV perinatally, who were under HIV treatment and care at a university-based public outpatient unit from Rio de Janeiro, Brazil. Interview topics included sexual risk behavior, HIV/STI knowledge and attitudes, access and adherence to HAART.

Results: Participants were 15-20 years old with around 8 years of formal education, all participants were on HAART, and eight reported being sexually active. The vast majority of participants didn’t know what is HIV/AIDS (N=15). Sexually active participants reported that disclosure difficulties influenced their ability to negotiate condom use. Concerns about the possibility of finding a cure to AIDS were frequent, as well as internalized angry due to the positive diagnosis, fear of stigma/discrimination and feeling of being indestructible, in spite of adopting risky behaviors such as unsafe sex and/or skipping ARV pills.

 Conclusion: Lack of proper knowledge about HIV/AIDS might deeply jeopardize youth adherence to ARV, a complex and life-long treatment. A comprehensive prevention and care approach targeting HIV+ youth from Brazil is urgently needed. The intervention should integrate psychosocial support with clinical care, targeting specific youth-related barriers to increase adherence to HAART. Findings highlight the need for intensified interventions addressing youth low risk perception and a broad range of risk-taking behaviors highly prevalent during adolescence and youth (e.g. unsafe sex, binge drinking etc); interventions should try to empower HIV-positive youth.