- Email: [email protected]
50: Exploring the life of young adolescent black women with HIV: The intersection of race, class, gender, and age
S40
Abstracts / 40 (2007) S19 –S54
sures were classified according to guidelines outlined in Pediatrics, August 2004. The data are described by frequencies and percents. Results: The mean age of the participants was 15.8 years. Seventy percent were female, and 94% were African American. The average BMI was in the normal range for both males and females. Twenty percent of participants reported having a history of prior elevated blood pressure. Forty five percent of participants whose blood pressures were read were noted to have prehypertension or greater at the time of the survey. Seventy one percent reported a family history of hypertension. Overall, 91% reported engaging in some form of physical activity and 45% report watching greater than 6 hours of television per week. Seventy three percent reported eating at fast food restaurants two or more times per week. Sixty percent of participants correctly identified the definition of hypertension in a multiple choice question. A score was created to evaluate the number of correct answers to a series of questions on lifestyle modifications to lower blood pressure, symptoms, and consequences of hypertension. The mean score out of a possible 13 was 7.15 with a SD of 4. The adolescents scored most poorly on the questions regarding symptoms of hypertension. Conclusions: The population surveyed has a high incidence of family history of hypertension and a high incidence of disease. The participants had a fair amount of knowledge regarding preventative measures and consequences of hypertension, but are less aware of the symptoms of hypertension. Continuing our data analysis will allow us to determine the characteristics of those with decreased knowledge of hypertension. This information can aid us in focusing our efforts to educate an urban population of adolescents regarding symptoms and consequences of hypertension, and help them to initiate appropriate lifestyle modifications.
SESSION II: ADOLESCENTS AND HIV/AIDS 49. RECRUITMENT AND RETENTION IN HEALTHY CHOICES: A MOTIVATIONAL INTERVENTION (MI) FOR HIVⴙ YOUTH Sylvie Naar-King, PhD, Phebe Lam, MA, Kathryn Wright, DO. Wayne State University, Detroit, Michigan, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions Purpose: To present strategies to overcome challenges in recruiting and retaining HIV⫹ youth in behavioral intervention trials. We present recruitment and retention rates of youth with adherence, substance use, or sexual risk behavior problems into a randomized trial of a Motivational Interviewing intervention conducted at five sites in the U.S. Methods: As of August 2, 2006, 187 participants were enrolled into the study and randomized. Participants were recruited from four Adolescent Medicine Trials Network (ATN) sites and one non-ATN site. All five sites offer comprehensive medical care and ancillary services in the same setting. Eligibility criteria included HIV⫹ status, ages 16 to 24, demonstrating at least one problem level behavior in the previous 3 months (substance use problem on the CRAAFT, self-reported antiretroviral adherence ⬍90%, or unprotected intercourse), and having had experience with one other behavior (prescribed antiretroviral medications, sexually active, tried substances). Participants randomized to the intervention group participated in four sessions of MI targeting two risk
behaviors over approximately 3 months. They also received standard care plus individualized referrals. Intervention sessions were videotaped for quality assurance. The control group received standard care and individualized referrals. Participants completed post-tests at 3, 6, 9, and 12 months. Strategies to promote retention included: flexible appointments, extensive outreach, incremental incentives for assessments, small incentives for intervention sessions, an individualized and non-confrontational intervention, and an introduction to the interventionist at baseline, either in person or by viewing a videotape. Results: Of 187 participants consented and randomized, 100 (53%) had unprotected intercourse in the previous 3 months, 68% had a substance use problem, and 41% reported less than 90% adherence. Eighteen participants were taken off study -- 15 did not complete baseline data collection and three were removed because of death or threat to self or others. Of the 96 participants who were randomized to treatment (including those off study), 89% attended at least one intervention session. To date, 87% to 90% of participants were retained for each follow-up assessment. Conclusions: HIV⫹ youth with problem behaviors can be recruited and retained in a multi-session behavioral intervention trial with multiple strategies to promote retention. Videotaping of sessions did not appear to be a barrier to recruitment. Interventions designed to avoid confrontation while reinforcing change may help in building adolescents’ motivation to engage in the resources offered by adolescent medicine programs. Sources of Support: The National Institutes of Health.
50. EXPLORING THE LIFE OF YOUNG ADOLESCENT BLACK WOMEN WITH HIV: THE INTERSECTION OF RACE, CLASS, GENDER, AND AGE Joette Lambert PhDc, ACRN. Wayne State University, Detroit, Michigan Purpose: Since little is known about young women with HIV even though half of all new HIV infections are among people under age 25; and according to the CDC, among teens ages 13-19, 64% of HIV cases are in females, and the majority of them are Black; this study seeks to explore how living at the intersection of social locations such as race, gender, class & age affects the lives of adolescent & young women both before & after diagnosis of HIV. Study Design: The framework of intersectionality is used to guide this phenomenological exploration. Face to face interviews and participant observation were conducted at a Ryan White - funded project for ⬎150 HIV⫹ youth ages 13-24 years in an urban setting. At this project, the youth receive comprehensive medical, psychological & social services. The small convenience sample snowballed from purposive selection. Participants/Setting: 20 young women and 4 young men were interviewed in their homes or where they chose. Observation occurred from 2004 -2006 of some 75 young people who attend clinic, facilitated ‘jam sessions’, parties, & workshops. Analysis: Intraparticipant microanalysis (line by line; often word by word)- using Morse & Field (1995) synthesizing, theorizing, recontextualizing. Results: Findings suggest that for young women who are engaged in meaningful activity, HIV serves as a character-building phenomenon. In contrast, young women who are childless, disconnected, and have few future goals, refer to living a “shadow life”; and “just
Abstracts / 40 (2007) S19 –S54
waiting to die”. As the young women balance their multiple social locations they use vigilant juggling consciously and unconsciously. Other broad themes include: ‘Traversing a minefield: Do not attempt alone’; ‘Disclosure: It’s a really big deal’; ‘Men & relationship: What’s that?’; ‘Women: You can’t trust ‘em’; ‘Mothers are a different kind of woman’; and ‘God & I have a mutual understanding.’ Conclusions: HIV is now called ‘the fifty year disease’. Health care workers must assist HIV positive young women to live their fifty years. To accomplish this task, health care providers must a) Ask (& listen); b) Respect the juggling that young HIV⫹ women must do to raise themselves & their children, finish their education, etc.; and c) Appreciate the strength and courage with which these young women traverse the many minefields that our culture creates. Sources of Support: Sigma Theta Tau (local chapter) & Dean’s Intramural Fund.
51. ”A LONG TIME AGO I HAD AIDS”: CLINICAL AND IMMUNOLOGIC RECOVERY IN ADOLESCENTS PREVIOUSLY DIAGNOSED WITH AIDS Lawrence J. D’Angelo, MD, MPH, Constance L. Trexler, BSN, CPN, Stephanie Crane, BA, MPH. Division of Adolescent and Young Adult Medicine, Children’s National Medical Center, Washington, DC Purpose: With the advent of highly active antiretroviral therapy (HAART), HIV infected children and adolescents are living longer. This includes individuals who may have once been very ill. We sought to determine the clinical and immunologic status of HIV infected adolescents previously diagnosed as having AIDS. Methods: The medical records of 161 HIV infected adolescents in care at a major urban adolescent HIV clinic were reviewed. Previous and current medical and immunologic status was determined and patients were categorized as to whether they had ever met clinical or immunologic criteria for the diagnosis of AIDS. Patients who had qualified for this diagnosis were further reviewed to determine their current status and factors possibly contributing to this status explored. Appropriate comparisons were made. Results: Seventy-six, or 47% of the patients in care had at one time met either clinical or immunologic criteria for AIDS. Of patients infected perinatally, 61% were classified as having AIDS. By comparison, 25% of those infected behaviorally met similar criteria [p⬍0.05]. Of all those who had met diagnostic criteria, 72% currently had had no opportunistic infection within 3 years and had CD4 lymphocyte counts that were now ⬎200cells/mm3. While perinatally infected teens were less likely to have achieved this new healthier status than were those who were behaviorally infected, this difference was not statistically significant (70% perinatal vs. 82% behavioral). Perinatally infected teens who had “recovered” were no more likely to have had their clinical AIDS diagnosis made earlier (Early AIDS) in life than in those who had later progression to AIDS (Progressive AIDS) (66% vs. 60%). Patients in either group who had improved their clinical or immunologic status were more likely to be rated as adherent to therapy by their providers. Conclusions: Many HIV infected adolescents show significant improvement in their clinical and immunologic status. While new medications and patient adherence contribute to this change, other intrinsic factors in the patient-virus interface may also contribute to these changes. New ways of classifying “recovered patients need to be explored.
S41
52. SELF REPORTED ATTITUDES AND STRATEGIES REGARDING MEDICATION TAKEN BY HIV POSITIVE ADOLESCENTS: A QUALITATIVE STUDY Pierre-Andre´ Michaud, MD, Jean-Jacques Cheseaux, MD, Ralph Thomas, MA, Joan-Carles Suris, MD, PhD, and the MoCHiV group. Institute for Social & Preventive Medicine, Lausanne, Switzerland Purpose: Factors which may inhibit or improve adherence with medical treatment of adolescents are usually conceived from a doctor’s point of view. The aim of this qualitative study was to investigate the attitudes and strategies developed by HIV positive adolescents to comply with their medication. Methods: Twenty nine HIV positive adolescents (7 males) aged 13 to 20 years followed up in the main paediatric hospitals of Switzerland were interviewed face to face (average duration: one hour) by an experienced psychologist about their representations, their lifestyles and their treatment. All interviews were recorded and transcribed verbatim. Results: The majority stated to be able to discuss regularly the issue of treatment (doses, schedule, strategies and side effects) and found it useful. Most of them did not report specific strategies to remind them to take their medication and presented it as part of their daily routine. There was a clear developmental shift in the sample from the idea of “I must take my medication” or “my mother says it’s good for me” among the younger ones to a more self-controlling attitude, among older patients, such as “I am lucky to be able to be provided with this medication to keep me alive, while others infected individuals elsewhere in the world can’t” or “this is my body and I want to do all I can to preserve my health”. As a reminder, few adolescents reported using a cell phone, while some of them associated the routine of taking medication with pissing in the morning (“everyone has to do it, you know”) or other events (“I love the sunset and take my medication when the night is coming”). When going out for an evening or participating in a camp, adolescents tended to keep a sample of medication in a anonymous box; many of them, especially the younger ones, said they would go to the toilet to swallow their medication (“you know, this is privacy: after all, when one goes to the toilet, he doesn’t leave the door open”). Conclusion: Since poor compliance is a frequent reason for treatment failure, openly discussing this issue with HIV positive adolescents is essential. Apparently, very few patients have been given an opportunity to discuss practical strategies and tricks to improve their medical adherence. Asking them about his/her own vision on how to improve medication taking and discussing practical strategies he/she can think of, may be important and effective parts of their treatment. Sources of Support: The research is funded by the Swiss Mother & Child HIV Cohort Study.
53. I DON’T WANT TO BE DISAPPOINTED: HIV(ⴙ) ADOLESCENTS’ REASONS FOR NOT DISCLOSING THEIR DISEASE: A QUALITATIVE STUDY JC Suris, MD, PhD, Ralph Thomas, MA, Jean-Jacques Cheseaux, MD, Pierre-Andre´ Michaud, MD, and Swiss Mother & Child HIV Cohort Study. University of Lausanne, Switzerland
Abstracts / 40 (2007) S19 –S54
sures were classified according to guidelines outlined in Pediatrics, August 2004. The data are described by frequencies and percents. Results: The mean age of the participants was 15.8 years. Seventy percent were female, and 94% were African American. The average BMI was in the normal range for both males and females. Twenty percent of participants reported having a history of prior elevated blood pressure. Forty five percent of participants whose blood pressures were read were noted to have prehypertension or greater at the time of the survey. Seventy one percent reported a family history of hypertension. Overall, 91% reported engaging in some form of physical activity and 45% report watching greater than 6 hours of television per week. Seventy three percent reported eating at fast food restaurants two or more times per week. Sixty percent of participants correctly identified the definition of hypertension in a multiple choice question. A score was created to evaluate the number of correct answers to a series of questions on lifestyle modifications to lower blood pressure, symptoms, and consequences of hypertension. The mean score out of a possible 13 was 7.15 with a SD of 4. The adolescents scored most poorly on the questions regarding symptoms of hypertension. Conclusions: The population surveyed has a high incidence of family history of hypertension and a high incidence of disease. The participants had a fair amount of knowledge regarding preventative measures and consequences of hypertension, but are less aware of the symptoms of hypertension. Continuing our data analysis will allow us to determine the characteristics of those with decreased knowledge of hypertension. This information can aid us in focusing our efforts to educate an urban population of adolescents regarding symptoms and consequences of hypertension, and help them to initiate appropriate lifestyle modifications.
SESSION II: ADOLESCENTS AND HIV/AIDS 49. RECRUITMENT AND RETENTION IN HEALTHY CHOICES: A MOTIVATIONAL INTERVENTION (MI) FOR HIVⴙ YOUTH Sylvie Naar-King, PhD, Phebe Lam, MA, Kathryn Wright, DO. Wayne State University, Detroit, Michigan, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions Purpose: To present strategies to overcome challenges in recruiting and retaining HIV⫹ youth in behavioral intervention trials. We present recruitment and retention rates of youth with adherence, substance use, or sexual risk behavior problems into a randomized trial of a Motivational Interviewing intervention conducted at five sites in the U.S. Methods: As of August 2, 2006, 187 participants were enrolled into the study and randomized. Participants were recruited from four Adolescent Medicine Trials Network (ATN) sites and one non-ATN site. All five sites offer comprehensive medical care and ancillary services in the same setting. Eligibility criteria included HIV⫹ status, ages 16 to 24, demonstrating at least one problem level behavior in the previous 3 months (substance use problem on the CRAAFT, self-reported antiretroviral adherence ⬍90%, or unprotected intercourse), and having had experience with one other behavior (prescribed antiretroviral medications, sexually active, tried substances). Participants randomized to the intervention group participated in four sessions of MI targeting two risk
behaviors over approximately 3 months. They also received standard care plus individualized referrals. Intervention sessions were videotaped for quality assurance. The control group received standard care and individualized referrals. Participants completed post-tests at 3, 6, 9, and 12 months. Strategies to promote retention included: flexible appointments, extensive outreach, incremental incentives for assessments, small incentives for intervention sessions, an individualized and non-confrontational intervention, and an introduction to the interventionist at baseline, either in person or by viewing a videotape. Results: Of 187 participants consented and randomized, 100 (53%) had unprotected intercourse in the previous 3 months, 68% had a substance use problem, and 41% reported less than 90% adherence. Eighteen participants were taken off study -- 15 did not complete baseline data collection and three were removed because of death or threat to self or others. Of the 96 participants who were randomized to treatment (including those off study), 89% attended at least one intervention session. To date, 87% to 90% of participants were retained for each follow-up assessment. Conclusions: HIV⫹ youth with problem behaviors can be recruited and retained in a multi-session behavioral intervention trial with multiple strategies to promote retention. Videotaping of sessions did not appear to be a barrier to recruitment. Interventions designed to avoid confrontation while reinforcing change may help in building adolescents’ motivation to engage in the resources offered by adolescent medicine programs. Sources of Support: The National Institutes of Health.
50. EXPLORING THE LIFE OF YOUNG ADOLESCENT BLACK WOMEN WITH HIV: THE INTERSECTION OF RACE, CLASS, GENDER, AND AGE Joette Lambert PhDc, ACRN. Wayne State University, Detroit, Michigan Purpose: Since little is known about young women with HIV even though half of all new HIV infections are among people under age 25; and according to the CDC, among teens ages 13-19, 64% of HIV cases are in females, and the majority of them are Black; this study seeks to explore how living at the intersection of social locations such as race, gender, class & age affects the lives of adolescent & young women both before & after diagnosis of HIV. Study Design: The framework of intersectionality is used to guide this phenomenological exploration. Face to face interviews and participant observation were conducted at a Ryan White - funded project for ⬎150 HIV⫹ youth ages 13-24 years in an urban setting. At this project, the youth receive comprehensive medical, psychological & social services. The small convenience sample snowballed from purposive selection. Participants/Setting: 20 young women and 4 young men were interviewed in their homes or where they chose. Observation occurred from 2004 -2006 of some 75 young people who attend clinic, facilitated ‘jam sessions’, parties, & workshops. Analysis: Intraparticipant microanalysis (line by line; often word by word)- using Morse & Field (1995) synthesizing, theorizing, recontextualizing. Results: Findings suggest that for young women who are engaged in meaningful activity, HIV serves as a character-building phenomenon. In contrast, young women who are childless, disconnected, and have few future goals, refer to living a “shadow life”; and “just
Abstracts / 40 (2007) S19 –S54
waiting to die”. As the young women balance their multiple social locations they use vigilant juggling consciously and unconsciously. Other broad themes include: ‘Traversing a minefield: Do not attempt alone’; ‘Disclosure: It’s a really big deal’; ‘Men & relationship: What’s that?’; ‘Women: You can’t trust ‘em’; ‘Mothers are a different kind of woman’; and ‘God & I have a mutual understanding.’ Conclusions: HIV is now called ‘the fifty year disease’. Health care workers must assist HIV positive young women to live their fifty years. To accomplish this task, health care providers must a) Ask (& listen); b) Respect the juggling that young HIV⫹ women must do to raise themselves & their children, finish their education, etc.; and c) Appreciate the strength and courage with which these young women traverse the many minefields that our culture creates. Sources of Support: Sigma Theta Tau (local chapter) & Dean’s Intramural Fund.
51. ”A LONG TIME AGO I HAD AIDS”: CLINICAL AND IMMUNOLOGIC RECOVERY IN ADOLESCENTS PREVIOUSLY DIAGNOSED WITH AIDS Lawrence J. D’Angelo, MD, MPH, Constance L. Trexler, BSN, CPN, Stephanie Crane, BA, MPH. Division of Adolescent and Young Adult Medicine, Children’s National Medical Center, Washington, DC Purpose: With the advent of highly active antiretroviral therapy (HAART), HIV infected children and adolescents are living longer. This includes individuals who may have once been very ill. We sought to determine the clinical and immunologic status of HIV infected adolescents previously diagnosed as having AIDS. Methods: The medical records of 161 HIV infected adolescents in care at a major urban adolescent HIV clinic were reviewed. Previous and current medical and immunologic status was determined and patients were categorized as to whether they had ever met clinical or immunologic criteria for the diagnosis of AIDS. Patients who had qualified for this diagnosis were further reviewed to determine their current status and factors possibly contributing to this status explored. Appropriate comparisons were made. Results: Seventy-six, or 47% of the patients in care had at one time met either clinical or immunologic criteria for AIDS. Of patients infected perinatally, 61% were classified as having AIDS. By comparison, 25% of those infected behaviorally met similar criteria [p⬍0.05]. Of all those who had met diagnostic criteria, 72% currently had had no opportunistic infection within 3 years and had CD4 lymphocyte counts that were now ⬎200cells/mm3. While perinatally infected teens were less likely to have achieved this new healthier status than were those who were behaviorally infected, this difference was not statistically significant (70% perinatal vs. 82% behavioral). Perinatally infected teens who had “recovered” were no more likely to have had their clinical AIDS diagnosis made earlier (Early AIDS) in life than in those who had later progression to AIDS (Progressive AIDS) (66% vs. 60%). Patients in either group who had improved their clinical or immunologic status were more likely to be rated as adherent to therapy by their providers. Conclusions: Many HIV infected adolescents show significant improvement in their clinical and immunologic status. While new medications and patient adherence contribute to this change, other intrinsic factors in the patient-virus interface may also contribute to these changes. New ways of classifying “recovered patients need to be explored.
S41
52. SELF REPORTED ATTITUDES AND STRATEGIES REGARDING MEDICATION TAKEN BY HIV POSITIVE ADOLESCENTS: A QUALITATIVE STUDY Pierre-Andre´ Michaud, MD, Jean-Jacques Cheseaux, MD, Ralph Thomas, MA, Joan-Carles Suris, MD, PhD, and the MoCHiV group. Institute for Social & Preventive Medicine, Lausanne, Switzerland Purpose: Factors which may inhibit or improve adherence with medical treatment of adolescents are usually conceived from a doctor’s point of view. The aim of this qualitative study was to investigate the attitudes and strategies developed by HIV positive adolescents to comply with their medication. Methods: Twenty nine HIV positive adolescents (7 males) aged 13 to 20 years followed up in the main paediatric hospitals of Switzerland were interviewed face to face (average duration: one hour) by an experienced psychologist about their representations, their lifestyles and their treatment. All interviews were recorded and transcribed verbatim. Results: The majority stated to be able to discuss regularly the issue of treatment (doses, schedule, strategies and side effects) and found it useful. Most of them did not report specific strategies to remind them to take their medication and presented it as part of their daily routine. There was a clear developmental shift in the sample from the idea of “I must take my medication” or “my mother says it’s good for me” among the younger ones to a more self-controlling attitude, among older patients, such as “I am lucky to be able to be provided with this medication to keep me alive, while others infected individuals elsewhere in the world can’t” or “this is my body and I want to do all I can to preserve my health”. As a reminder, few adolescents reported using a cell phone, while some of them associated the routine of taking medication with pissing in the morning (“everyone has to do it, you know”) or other events (“I love the sunset and take my medication when the night is coming”). When going out for an evening or participating in a camp, adolescents tended to keep a sample of medication in a anonymous box; many of them, especially the younger ones, said they would go to the toilet to swallow their medication (“you know, this is privacy: after all, when one goes to the toilet, he doesn’t leave the door open”). Conclusion: Since poor compliance is a frequent reason for treatment failure, openly discussing this issue with HIV positive adolescents is essential. Apparently, very few patients have been given an opportunity to discuss practical strategies and tricks to improve their medical adherence. Asking them about his/her own vision on how to improve medication taking and discussing practical strategies he/she can think of, may be important and effective parts of their treatment. Sources of Support: The research is funded by the Swiss Mother & Child HIV Cohort Study.
53. I DON’T WANT TO BE DISAPPOINTED: HIV(ⴙ) ADOLESCENTS’ REASONS FOR NOT DISCLOSING THEIR DISEASE: A QUALITATIVE STUDY JC Suris, MD, PhD, Ralph Thomas, MA, Jean-Jacques Cheseaux, MD, Pierre-Andre´ Michaud, MD, and Swiss Mother & Child HIV Cohort Study. University of Lausanne, Switzerland