HIV infection, sexual abuse and social support in Jamaican adolescents referred to a psychiatric service.

BACKGROUND Children and adolescents with HIV/AIDS often have psychological/psychiatric issues that require specialist intervention. We explored whether HIV infection acquired through sexual abuse led to particularly negative psychiatric outcomes and whether good social support is a protective factor in the development of undesirable psychiatric sequelae. METHODS This study consists of a case series of five persons referred from the Paediatric Infectious Diseases Clinic to the Child Psychiatry Clinic, both at the University Hospital of the West Indies (UHWI) in Jamaica, during July 1 to November 30, 2005. The patients were clinically assessed and diagnosed by a psychiatrist using the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM IV) criteria. Cases were compared according to gender, age, likely route of HIV infection, level offamily/social support and nature of psychiatric outcome. RESULTS Adolescents who acquired HIV infection through sexual abuse reported more intense feelings of sadness and suicidal ideations. Those with good social support reported less intense feelings of sadness with no suicidal ideations and were more optimistic about their future regardless of the route of acquisition. Two of three adolescents who acquired HIV infection through sexual abuse and one of two who was perinatally infected required ongoing supportive psychotherapy to augment their social support, the characteristic most associated with favourable outcome. CONCLUSION Both sexual abuse and HIV/AIDS are likely to have negative psychological consequences in children and adolescents. This psychological impact may be intensified when HIV infection results from sexual assault as opposed to other methods of transmission. The findings support the practice of providing HIV prophylaxis to all sexual assault victims of known or suspected HIV-positive perpetrators and of encouraging utilization of existing social support networks.