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The Board of Trustees voted to approve policy guidelines dealing with HIV in children and adolescents at the Board's meeting last month in Washington, D.C.
Despite progress in reducing the rate of new HIV infections, there is still a worldwide epidemic, said Marshall Forstein, M.D., chair of the APA Commission on AIDS.
"You will all be hearing a great deal in the media about how this epidemic is winding down," but this is true only in the United States, Canada, and Western Europe, he cautioned. Even in the U.S., there is great danger that complacency will cause a resurgence of new HIV infections. For example, 11 programs in the U.S. that treat HIV-infected patients are scheduled to close this August as a series of federal Center for Mental Health Services demonstration grants come to an end, he observed.
The potential public health costs of a failure to remain vigilant in fighting AIDS are tremendous, said Forstein. "The psychosocial implications of this go way beyond AIDS as a single disease."
There is a new "mythology" among gay men that it is safe to have unprotected sex with an HIV-positive partner if that partner is on anti-retroviral drugs, said Forstein. In a recent survey, 30 percent of a sample of gay men reported having unprotected sex, he added.
There is a substantial risk of new, drug-resistant strains of HIV developing as a result of nonadherence to the complex medication regimen required to treat AIDS, explained Forstein. Unfortunately, the complexity of many of the combined drug therapies makes nonadherence to dosing schedules commonplace, he noted.
While specific to children and adolescents, the two policy guidelines impress upon psychiatrists their responsibility to be knowledgeable about the "medical, psycho-social, ethical, and legal aspects of HIV infection." They further place responsibility for HIV-related education on psychiatry training programs.
Confidentiality is critical with HIV, and HIV testing should not be routine, but rather ordered only on a case-by-case basis, the guidelines observe. Psychiatrists must be aware of the legal, emotional, and developmental issues related to disclosure of HIV infection.
"Developmentally appropriate, culturally sensitive" HIV prevention strategies are essential, and psychiatrists "have a responsibility to incorporate messages and attitudes into psychiatric practice that promote the reduction of HIV-risk behavior," they note.
The recommendations specific to adolescents and HIV focus more on sexual and other risk behaviors. It is critical to assess levels of sexual behavior and alcohol or other drug use, the guidelines note. Goals should include a reduction in substance use and unprotected sex.
Teens who are pregnant or whose behavior puts them at risk for contracting HIV should be encouraged to undergo HIV testing and counseling. Psychiatrists must ensure that teens understand the implications of an HIV test and guide them to appropriate resources. Where appropriate, psychiatrists should support teens regarding "the complex issues surrounding disclosure of HIV infection and with notifying sexual and/or drug injection partners."
HIV infection, "in and of itself, must not be a source of restriction in attendance at school, participation in group activities, or hospitalization," the guidelines stress.