Introduction

Though a cure for HIV disease remains elusive, medical advances have demonstrated that the virus can be reduced to undetectable levels and disease progression can be significantly slowed. The use of antiretroviral prophylaxis and cesarian section reduces the rate of perinatal transmission of HIV infection, thus increasing the likelihood that a child born to a mother with HIV infection will not be infected. Medical advances, nutritional support, psychosocial support, co-ordination of key services, and attention to quality of life issues have contributed to improved treatment and prevention outcomes for HIV-exposed and HIV-infected children. Children with HIV infection are living well into their teen years and even their 20s. Parents living with HIV who have access to HIV care are able to be primary caregivers for their children for a longer period of time. Although this chapter is primarily oriented to the experience of patients living in the USA, some of the information, particularly the information concerning broader psychological and social concerns should be helpful to patients in other parts of the world.

Psychosocial concerns

Amidst the notable successes in HIV care, there continue to be a number of important psychosocial issues. Among the most critical issues facing children and families living with HIV are the psychosocial developmental needs of children with HIV infection. Children growing into teenagers with HIV face profoundly challenging adolescent psychosocial developmental issues.