Mylène Fernet

Romantic relationships and sexual activities of the first generation of youth living with HIV since birth

Abstract HIV-infected children, now maturing into adolescence and adulthood, must cope not only with adolescent developmental issues, but also with a chronic, socially stigmatised and sexually transmittable illness. Little research on this first generation of survivors has focused on romantic involvement and sexuality. This study, which employs a mixed-method embedded strategy (qualitative supported by quantitative), describes the perspectives of youth living with HIV since birth concerning: (1) romantic involvement and sexuality; and (2) risk management including the risk of HIV transmission and partner serostatus disclosure. Eighteen adolescents aged 13–22 from Montreal, Canada, participated in individual semi-structured interviews and completed self-report questionnaires. Most youths participated in non-penetrative sexual activities. Ten participants reported having had vaginal and three anal intercourses, at an average age of 14 for girls and 15 for boys. All sexually active youth reported having used a condom at least once. Of those who reported that their first sexual relationship was protected, over half had taken risks in subsequent relationships (e.g., unprotected sex, multiple partners, etc.). Interviews conducted with sexually inactive youths illustrate the interrelatedness of romantic involvement, sexual initiation and potential serostatus disclosure. Involvement in a sexual relationship would not be conceivable unless the partner was informed of their serostatus. For sexually active participants, risk management implies HIV transmission and partner disclosure. These youths have emotional issues regarding disclosure in romantic relationships and few risked potential rejection by disclosing. Condom use acts as a reminder of the infection and a barrier to intimacy. The narratives illustrate how risk perception changes and becomes relative with time and experience, especially when the viral load is undetectable and when past experience has convinced the adolescent that his/her partner might not become infected. Findings reinforce the need to prioritise sexual health issues for young people with perinatally acquired HIV.

Sexual inactivity and sexual satisfaction among women living with HIV in Canada in the context of growing social, legal and public health surveillance

Women represent nearly one‐quarter of the 71,300 people living with HIV in Canada. Within a context of widespread HIV‐related stigma and discrimination and on‐going risks to HIV disclosure, little is known about the influence of growing social, legal and public health surveillance of HIV on sexual activity and satisfaction of women living with HIV (WLWH).

Dyadic Dynamics in Young Couples Reporting Dating Violence An Actor–Partner Interdependence Model

This study uses a combination of observational methods and dyadic data analysis to understand how boyfriends’ and girlfriends’ perpetration of dating violence (DV) may shape their own and their partners’ problem-solving communication behaviors. A sample of 39 young heterosexual couples aged between 15 and 20 years (mean age = 17.8 years) completed a set of questionnaires and were observed during a 45-min dyadic interaction, which was coded using the Interactional Dimension Coding System (IDCS). Results suggest that neither boyfriends’ nor girlfriends’ own perpetration of DV was related to their display of positive and negative communication behaviors. However, estimates revealed significant partner effects, suggesting that negative communication behaviors displayed by girls and boys and positive communication behavior displayed by girls were associated to their partner’s DV but not to their own. Such results confirm the need to shift our focus from an individual perspective to examining dyadic influences and processes involved in the couple system and the bidirectionality of violent relationships.

The Importance of Meanings of Antiretroviral Treatment and Care Providers for Adherence and Transitioning to Adult Services Among Youth With Perinatally Acquired HIV Infection

The transition from pediatric to adult services for youth with perinatally acquired HIV (PaHIV) is a critical period. A successful transition is key to ensuring patient treatment adherence as adults. Eighteen youths with PaHIV, aged 13–22, participated in two individual, semistructured interviews conducted 3 years apart. Results indicate that a key factor appearing to help youth in overcoming barriers to adherence and facilitating coping strategies is the way they perceive their medication: youth with positive perceptions are more likely to overcome the barriers than are those with negative perceptions, such as emphasis on the side effects and stigma associated with the medication. Positive relationships with health professionals allowed youth to face transitioning challenges. Interventions targeting PaHIV should focus on these issues.

A Meta-Analysis of Risk and Protective Factors for Dating Violence Victimization: The Role of Family and Peer Interpersonal Context:

Dating violence (DV) is a widespread social issue that has numerous deleterious repercussions on youths’ health. Family and peer risk factors for DV have been widely studied, but with inconsistent methodologies, which complicates global comprehension of the phenomenon. Protective factors, although understudied, constitutes a promising line of research for prevention. To date, there is no comprehensive quantitative review attempting to summarize knowledge on both family and peer factors that increase or decrease the risk for adolescents and emerging adults DV victimization. The current meta-analysis draws on 87 studies with a total sample of 278,712 adolescents and young adults to examine effect sizes of the association between various family and peer correlates of DV victimization. Results suggest small, significant effect sizes for all the family (various forms of child maltreatment, parental support, and parental monitoring) and peer factors (peer victimization, sexual harassment, affiliation with deviant peers, and supportive/prosocial peers) in the prediction of DV. With few exceptions, forms of DV (psychological, physical, and sexual), gender, and age did not moderate the strength of these associations. In addition, no difference was found between the magnitude of family and peer factors’ effect sizes, suggesting that these determinants are equally important in predicting DV. The current results provide future directions for examining relations between risk and protective factors for DV and indicate that both peers and family should be part of the development of efficient prevention options.

The EVVA Cohort Study: Anal and Cervical Type-Specific Human Papillomavirus Prevalence, Persistence, and Cytologic Findings in Women Living With HIV

Background The risk of anal cancer due to high-risk human papillomavirus (HR-HPV) is higher in women living with human immunodeficiency virus (HIV) than in the general population. We present findings of cervical and anal HPV and cytologic tests at baseline in the EVVA cohort study and HPV persistence data 6 months after baseline. Methods Semiannual visits included questionnaires, chart reviews, cervical/anal cytologic and cervical/anal HPV testing for 2 years. Genotyping for 36 HPV genotypes was performed using the Roche Linear Array HPV genotyping test. Results A total of 151 women living with HIV were recruited. At baseline, 75% had anal HPV, 51% had anal HR-HPV, 50% had cervical HPV, and 29% had cervical HR-HPV. Anal HPV-16 and HPV-51 were more frequent in women born in Canada (31% and 29%, respectively, compared with ≤16% for other women). Most anal HR-HPV types detected at 6 months (57%-93%) were persistent from baseline. Findings of anal cytologic tests were abnormal for 37% of women. Conclusions Anal HPV is highly prevalent in women living with HIV, and type distribution varies by place of birth. High-resolution anoscopy was indicated in more than one third of results. As anal cancer is potentially preventable, these important findings need to be considered when selecting the best approach for anal cancer screening programs.

Barriers to health-care and psychological distress among mothers living with HIV in Quebec (Canada)

Health-care providers play a major role in providing good quality care and in preventing psychological distress among mothers living with HIV (MLHIV). The objectives of this study are to explore the impact of health-care services and satisfaction with care providers on psychological distress in MLHIV. One hundred MLHIV were recruited from community and clinical settings in the province of Quebec (Canada). Prevalence estimation of clinical psychological distress and univariate and multivariable logistic regression models were performed to predict clinical psychological distress. Forty-five percent of the participants reported clinical psychological distress. In the multivariable regression, the following variables were significantly associated with psychological distress while controlling for sociodemographic variables: resilience, quality of communication with the care providers, resources, and HIV disclosure concerns. The multivariate results support the key role of personal, structural, and medical resources in understanding psychological distress among MLHIV. Interventions that can support the psychological health of MLHIV are discussed.

Transition to adult clinics in youth living with HIV since birth

Background For youth living with HIV, transition from childhood to adulthood is also a transition from child to adult HIV health care clinics. Related studies show the more youth are spending time in pediatric services the more difficult the transition is likely to be. It appears many factors can facilitate or cause difficulties in the transition process; including individual factors and environmental factors. In this study we explore the transition process from child to adult HIV health care clinics through personal experiences of young adults infected by perinatal transmission.

Decision-making about motherhood among women living with HIV in Canada: a negotiation of multidimensional risks

Abstract Little research in Canada has examined the perspectives of women living with HIV on decision-making across the stages of motherhood. In 2004–2005, semi-structured interviews were conducted with 42 African, Caucasian and Haitian HIV-positive women recruited in Montreal. All were or wished to be biological mothers. Transcripts underwent thematic analysis organised by three culturally informed models of motherhood described by the participants, which influenced decision-making and perceived risks. For women who saw motherhood as ‘self-fulfilment and completeness’, vertical HIV transmission was a primary concern. It threatened their identity as a ‘good mother’, which also meant adhering to antiretrovirals. For women who viewed motherhood as a ‘social realisation’ (all African or Haitian), fears of compromised fertility dominated. Not becoming pregnant threatened their social status and presumed health within their community. Antiretrovirals were abandoned after delivery, fearing they would reveal their HIV status. For women endorsing a ‘personal growth’ model of motherhood (all Caucasian), threats to personal health were paramount. Pregnancy meant purifying body and soul. Antiretrovirals, seen as pollutants, were stopped after delivery. These findings can inform current research and sensitise health providers to the complex biological, psychological, social and spiritual risks that HIV-positive women negotiate in motherhood-related decision-making, towards more patient-centred care.

Talking about sex in HIV-affected families: perspectives of HIV-infected mothers and their children from a mixed-methods study

ABSTRACT Sexual education in HIV-affected families could be impeded by secrecy surrounding HIV status. This paper aims to (1) examine the prevalence of mother–child communication about sexuality, (2) evaluate the impact on sexual education of disclosing the mother’s HIV-positive status to her children and (3) explore the willingness of mothers living with HIV (MLWH) to talk about sexuality with their children. A mixed-methods design (combination of quantitative and qualitative methods) was used. A total of 109 MLWH (average age: 40.7 years) and 71 of their children (average age: 16.3 years) completed a face-to-face questionnaire. Descriptive analyses and 2×2 Fisher’s exact tests were conducted to compare the occurrence of communication about nine sexual topics from the children’s and mother’s standpoint according to the children’s awareness of their mother’s HIV status or lack thereof. A subsample of 11 MLWH also took part in a semistructured interview. Interviews were analyzed using thematic content analysis. Sexually transmitted infections (STIs), puberty and dating were the three most frequently discussed subjects between MLWH and their children. Children’s awareness of their mother’s HIV status was significantly associated (p < .05) with mother–child communication about all nine subjects from the standpoint of MLWH. Children’s awareness of their mother’s HIV status was significantly associated (p < .05) with mother–child communication about contraception, condom use and STIs from the children’s standpoint. Qualitative analyses indicated that while talk about sexuality was common, MLWH raised several barriers to sexual education, including a lack of knowledge about sexuality. The results highlight the importance of targeting parental attitudes and knowledge about sexuality. Interventions should consider the mother’s willingness to disclose their HIV status and be oriented with respect to their choice.