Not the purview of the paediatrician
Coming to recognize HIV-positive youth as sexually interested and active imposes a struggle for both health and mental health providers in paediatrics:
A 12-year-old denied any interest in sex when talking to her doctor. The team was taken by surprise when they received a call from the school saying the 12-year-old was found having oral sex with a peer. Perhaps due to their own discomfort or disbelief that children should be sexually active, providers may overlook or deny signs that suggest children are developing into adolescents. There develops a partnership in disbelief that protects both parties from having to talk about something uncomfortable.
When professionals are involved in providing care for young children, often from birth, they become connected to the child and the progress that they make as they grow and achieve normal developmental milestones. They have long-term relationships with these children and their families, become comfortable and, in many ways, feel a bit like a�?familya��. What component of professional training prepares the health and social work team for children growing up and becoming sexually active? Making the transition to seeing them in this light, especially when their engagement in sexual activity starts young, can be challenging.
Many professionals did not enter into taking care of children with HIV by plan. Older clinicians trained before HIV was even a known entity or component of training in paediatric infectious diseases. Those who trained in the 1980s and early 1990s did so at a time when HIV in children was seen as a terminal illness. For this professional cohort, the relationships children would develop in later life were not the primary focus. Switching gears and growing to understand who these children are and will be as young adults represents a paradigm shift both for those focused on a�?paediatric carea�� and those who have had decades of experience with HIV-positive children. Providers do not necessarily easily change their way of thinking about those with whom they work.
Children and young people who are HIV-positive: the journey forward
Studies show children with perinatal HIV infections who are ageing into adolescence are typically healthy and may have no outward symptoms of the disease. The majority are on several medications (ibid.) and must confront the difficulties of adherence to a complex medical regimen. They tend to be a heterogeneous group in terms of drug history and sexual history; despite their health Care Mall in Canada condition, they are like their HIV-negative counterparts in that they are vulnerable to risky behaviour. The normal challenges of adolescence a�� sexuality, experimentation and independence a�� must all be addressed within the context of HIV.