Parenting considerations in young adults with perinatally acquired HIV

Abstract

An increasing number of children born with perinatally acquired HIV (PAH) are surviving into late adolescence and early adulthood. At this developmental stage, developing intimate relationships and having children are potentially important goals with associated normative challenges. Young people with PAH face a variety of additional HIV-related stressors that may be associated with relationships and parenting. These may include managing HIV disclosure to their partner and adherence to antiretroviral medication to (a) prevent transmission to partners and future offspring and (b) maintain their own health. Some of these challenges may be impacted upon by issues associated with having been born with HIV, for example, managing long-standing secrecy about HIV and having been told from a young age that life expectancy could be shortened. To date, there has been limited research into the procreational and parenting reflections of young people with PAH. This study examined the hopes and the concerns that a group of young people with PAH have regarding having children. Seven participants (five females and two males) currently or previously in an intimate relationship, aged 18-23 years, two of whom were parents, were recruited from a UK hospital clinic. They were interviewed using a semi-structured interview, with data analysed according to the principles of Interpretative Phenomenological Analysis. Four main themes were elicited: the perceived impact of having a child on intimate relationships, the effect of normative beliefs on parenting intentions and expectations, the thoughts and feelings about disclosing parental HIV status to one's children in the future, and the perceived impact of HIV on procreational intentions. Implications for supporting young people with PAH in parenting decision-making are explored.

Pregnancy incidence and outcomes in women with perinatal HIV infection

“…In the United Kingdom, one single-centre cohort reported that 78% of young people with PHIV aged 16–25 were sexually active [29], and the adolescents and adults living with perinatal HIV cohort reported lower sexual activity in adolescents with PHIV compared with HIV-negative adolescents [30]. A qualitative study of young people with PHIV showed a high rate of procreational intent, likely reflecting perceived improvements in HIV treatment and MTCT risk [31]. A small, single-centre cohort of young women with PHIV found that 14% had a diagnosis of infertility [32].…”

“…As cohorts of women with PHIV continue to age, and as younger women and adolescents with PHIV have accessed better treatment and therefore have improved health status, the incidence of planned pregnancy in women with PHIV is likely to rise, in keeping with high rates of procreational intent reported in young people with PHIV in the United Kingdom [31]. However, the current cohort of adolescents with PHIV have reported low rates of sexual activity; if recent work on improving transition from paediatric to adult services increases access to and use of effective contraception [38], incidence of unplanned pregnancy in this group may fall.…”

Children and Young People Living with HIV/AIDS

“…Evangeli et al ( 2014 ) had similar study fi ndings where perinatally-infected young adults in the United Kingdom expressed wanting to become parents even though they had been infected since birth and grew up HIV-positive. Given that most of the participants were sexually inexperienced, the youth claimed that their HIV-positive status has had little impact on their lives, and minimized the burden of managing the stigma of their condition, and negotiating disclosure.…”

“When Should I Tell?”: Perspectives on Disclosure to Their Children among Parents with Perinatally Acquired HIV

“…To date, limited literature has explored disclosure to children of parents with PHIV. In a small qualitative study, Evangeli et al ( 19 ) found that four out of seven participants discussed disclosing their HIV status to their children frequently reflecting upon their own disclosure experiences. However, it is unclear whether they were parents at the time of the study.…”