Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment

Abstract

Mexico is the third Latin American country with the most children and adolescents living with human immunodeficiency virus (ALHIV). There is a lack of information on the characteristics of this population. We aimed to describe the social and mental health characteristics of Mexican ALHIV. A census was conducted of all adolescent patients with HIV at a pediatric hospital (n = 47; mean age 14.39, S.D. = 3.65) and their caregivers. We collected data on socio-demographic characteristics, family, intelligence, mental health, adverse life events, substance use, treatment, knowledge of Antiretroviral Treatment (ART) and HIV, and biomarkers. Most cases were transmitted vertically and self-reported ART adherence was above 90%. Some obstacles to adherence were medicine discomfort, believing that they did not need it, and forgetfulness. The vulnerabilities were intellectual disability, adverse life events, possible mental health problems, and little knowledge of their illness and treatment. These findings suggest the importance of interventions to improve the perception and knowledge of HIV and ART to increase ART adherence.

Keywords

adherence adolescents ART HIV LMIC mental health

Introduction

Adolescents from low- and middle-income countries (LMIC) are disproportionately affected by the global human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic compared to other age groups (Benton et al., 2019; Hudelson and Cluver, 2015). Of all children and adolescents living with HIV worldwide, 60% live in Latin America and the Caribbean (LAC). Mexico is the third country in LAC, with the most children and adolescents living with HIV, after Brazil and Haiti (Fondo de las Naciones Unidas para la Infancia, 2018, 2019). In 2021, 504 new cases of adolescents living with HIV (ALHIV) were registered in Mexico (Centro Nacional para la Prevención y el Control del VIH y el SIDA, 2021).

Fortunately, access to antiretroviral treatment (ART) has increased in LMIC, which allows children with HIV infection to reach adolescence (Lowenthal et al., 2014; Teasdale et al., 2021). ART adherence is vital for the survival and healthy living of ALHIV (Benton et al., 2019; Hudelson and Cluver, 2015). Inadequate ART adherence is the main cause of increased deaths due to AIDS (Lowenthal et al., 2014; UNICEF, 2021). In Mexico, there is no well-documented estimate of ART adherence among ALHIV. Nevertheless, it is calculated that 50% of ALHIV aged between 15 and 19 years abandon medical attention (Alaniz, 2014).

ALHIV face unique challenges in ART adherence. Often, they are informed about their serological status during adolescence (Vreeman et al., 2013), the developmental period of disinhibition (Hudelson and Cluver, 2015), increased risk-taking behavior such as substance abuse (Abiodun et al., 2022; Arnett, 2004; Dako-Gyeke et al., 2020; Vreeman et al., 2017), and a reduction in parental support and monitoring (Abiodun et al., 2022; Arnett, 2004; Dako-Gyeke et al., 2020; Vreeman et al., 2017).

Other obstacles to ART adherence among ALHIV are adverse life events (e.g. death of parents due to AIDS, suicide risk; Dako-Gyeke et al., 2020; Lall et al., 2015) and mental health problems like depression and anxiety (Dessauvagie et al., 2020; Too et al., 2021). Previous research has found a bidirectional association between depression and ART adherence (Benton et al., 2019) and a relationship between anxiety and notification of diagnosis, which in turn involves stigma and fear of rejection (Chandwani et al., 2012; Gray et al., 2017).

Behavioral problems are frequent among ALHIV, which directly affect ART adherence and increase the odds of omitting doses (Kacanek et al., 2015). Moreover, although less than 20% of ALHIV use any drug (Teasdale et al., 2021), almost all of them have tried alcohol at least once (Abiodun et al., 2022). The risk of tobacco and cannabis consumption among ALHIV can increase in the presence of depressive symptoms (Benton et al., 2019; Chandwani et al., 2012), and both comorbidities (substance abuse and depression) are associated with a higher risk of virologic failure (Agwu and Fairlie, 2013).

Given that HIV is a chronic illness, ALHIV face challenges such as fatigue from taking up to six pills a day (Abiodun et al., 2022). Additionally, they must attend several medical appointments, often during school hours, and spend much of their families’ financial resources (Abiodun et al., 2022; Dako-Gyeke et al., 2020). Other barriers include forgetfulness, being far from home, avoiding side effects, experiencing emotional discomfort, believing it is unnecessary, feeling “they’re all right,” and “being busy with other things” (Chandwani et al., 2012).

In contrast, some factors that increase ART adherence and prevent HIV transmission are family characteristics, such as maintaining a close relationship with caregivers (Da Costa et al., 2020; Teasdale et al., 2021). Strategies like use of reminders, taking pills before leaving home, keeping medicine in the same place, and being informed of the importance of treatment (Abiodun et al., 2022; Ammon et al., 2018; Reif et al., 2020; Vreeman et al., 2013) can counter certain obstacles to ART adherence.

To our knowledge, only a few studies have been published on the characteristics of ALHIV in Latin America (Lee et al., 2018; Santos-Cruz et al., 2011), and none have been published in Mexico. Hence, the objective of this study was to describe the sociodemographic, family, clinical, cognitive, mental health, ART adherence, and biomarker characteristics of a Mexican sample of ALHIV.

Method

Design

This is a cross-sectional descriptive study.

Participants

Our sample included 41 of the 47 adolescents at the HIV clinic of a public care hospital in Mexico City in November 2020, and their primary caregivers. Their ages ranged from 11 to 19 (mean = 14.39; S.D. = 2.65), and 53.7% were female. The remaining six adolescents could not be contacted.

Measures

We administered semi-structured interviews and psychometric questionnaires. The variables were grouped into the following five sections:

Socio-demographic and family characteristics

Adolescents were asked about their age, sex, sexual orientation, school enrollment, labor activity, place of residence, travel time to the hospital, family structure (nuclear/mono-parental/extend/re-configured/living with someone who is not their parents/living in an institution), and quality of relationship with the main caregiver (close/neutral/distance/conflictive). The main caregiver was asked about the adolescent’s type of orphanhood (mother/father/both/none) and the cause of the parent’s death.

Treatment and clinical characteristics

We searched adolescents’ clinical records for their date of diagnosis, duration of ART use, number of hospitalizations related to HIV complications, serostatus disclosure, route of HIV transmission (vertical/horizontal), number of ART pills taken per day, and type of treatment regime. They were asked about their strategies for adherence to ART, reasons for stopping when they did so (emotional discomfort/forgetting to do it/does not believe they need it/ART-related discomfort), and treatment fatigue (no past week fatigue/fatigued for 3 months/fatigued a year or more). We used the Questionnaire of Basic Knowledge about HIV and ART (QBK-HIV-ART; Neria, 2016) which assesses five categories: HIV infection, ART, adherence, reinfection, and food intake that interfere with ART functioning. A higher score indicates greater knowledge of HIV and TAR, and the test has content validity using the expert judgment method (intraclass correlation coefficient = 0.86) in a Mexican population with similar characteristics (Neria, 2016).

Mental health, adverse events, and intelligence

We searched the adolescents’ clinical records for their clinical evaluation of intelligence which we dichotomized into average intelligence versus below-average intelligence.

To assess emotional and behavioral problems, we administered the validated Mexican version of the Youth Self Report (YSR) (α = 0.949), which is composed of 112 three-point Likert-type statements. The instrument is categorized into internalizing problems (anxious/depressed, withdrawn/depressed, and somatic complaints), externalizing problems (delinquent and aggressive behavior), mixed problems (social, thought, and attention problems), and positive qualities (Barcelata-Eguiarte and Márquez-Caraveo, 2019).

We also asked the adolescents about adverse life events and mental health problems throughout their lives based on a list of the most frequently reported disorders in the literature (Benjet et al., 2009a, 2009b, 2009c; Mutumba and Harper, 2015). We also inquired whether they were currently receiving psychiatric treatment.

Substance use risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST V3.0) which assesses lifetime and past 3-month risks and problems associated with the use of substances, providing a risk classification (low, moderate, or high) for each substance. The Mexican version explains 51% of the variance and has an alpha reliability coefficient of 0.087 (Tiburcio Sainz et al., 2016).

ART adherence

Adolescents and their caregivers were asked about the frequency of failing to adhere to their ART (never/in the last week/the last 3 months/in the last year or more) and the exact number of omitted pills or pills taken out of schedule in the last week. The percentage of adherence by self-report and reported by the caregiver was calculated using the following formula: (number of pills prescribed per week – number of pills omitted per week)/number of pills prescribed per week) × 100.

Biomarkers of treatment response

We consulted the participants’ clinical records for their most recent reports of biomarkers, which were taken between 1 and 13 months prior. These biomarkers include the count of CD4+ T cells (CD4, cells per cubic millimeter (counts/mm³)); plasma HIV ARN levels (viral load, detectable/undetectable/virological failure), and the number of times they have experienced virological failure in their lives. We defined virological failure as a viral load ⩾200 cp/mL beginning 6 months after ART initiation (Centro Nacional para la Prevención y el Control del VIH y el SIDA, 2019).

Scenery

HIV clinic which belongs to the infectiology service in a tertiary level pediatric public care hospital. Patients are cared for by affiliated doctors and residents in appointments with an approximate periodicity of 3 months. In the institute they are also channeled to other areas of specialized attention that they require.

Procedure

Once the study protocol was approved by the Research and Ethics Committees, we contacted every adolescent patient in the HIV ward. Recruitment occurred by approaching them during their appointment at one of the hospital services and/or by phone call or text messages, offering them face-to-face or remote appointments. When patients did not have the financial resources to go to the hospital, they were compensated for transportation and food for that day. Up to five attempts were made to contact adolescents and their caregivers before excluding them from the study.

Once contacted, we explained the study’s objective, invited them to participate, and obtained informed consent and assent from the caregiver and adolescent, respectively. The adolescents’ interview lasted 45 minutes, and the caregivers’ 20 minutes; they were interviewed separately to maintain confidentiality.

The standard care at the HIV clinic is to notify patients of their diagnosis around 12 years of age. Therefore, serostatus disclosure was first verified in the clinical records, and participants who did not know their diagnosis were not asked questions regarding HIV. Patients with mental health problems were offered psychiatric and psychological support.

Statistical analysis

Absolute and relative frequencies were obtained for nominal and ordinal variables, and arithmetic mean, median, and standard deviation for interval variables. All analyses were performed using SPSS version 24.

Results

The sociodemographic and family characteristics of the participants are presented in Table 1. Extended family configuration was the most frequent (36.6%), and almost a quarter (24.3%) did not live with their mother or father. Almost half (48.7%) were orphaned by one or both parents; all mothers’ deaths and half of fathers’ deaths were due to HIV complications. Only 61% attended school, and 29.3% worked. Almost a fifth (19.5%) traveled from out-of-state to receive treatment. The mean time of travel of all participants from home to the hospital was 2 hours and 43 minutes, and a mode of 2 hours.

Table 1.

Socio-demographic and family characteristics of the sample (N = 41).

	M	SD		n	%
Age	14.39	2.65	Parental death
Time of travel from home to the hospital (months)	163.80	114.97	No parental death	17	41.5
	n	%	Mother died	11	26.8
Sex			Father died	6	14.6
Female	19	46.3	Mother alive, father unknown	4	9.8
Male	22	53.7	Both parents died	3	7.3
Sexual orientation			Father’s cause of death^a
Heterosexual	34	82.9	HIV complications	4	44.4
Homosexual	2	4.9	Murder	2	22.2
Other (bisexual or not defined)	5	12.2	Accident	2	22.2
Place of residence			Unknown	1	11.1
Local (Mexico City or Mexico State)	33	80.5	Kinship with the main caregiver
Out-of-state	8	19.5	Mother	22	53.7
Attends school	25	61.0	Father	2	4.9
Has labor activity	12	29.3	Other biological relative	15	36.6
Family configuration			Other unrelated people (stepfather, nanny)	2	4.9
Nuclear	3	7.3	Quality of relationship with the main caregiver
Mono-parental	12	29.2	Close relationship	22	53.7
Extended or re-configured	15	36.6	Neutral relationship	9	22.0
Lives with someone other than mother or father (uncle, stepfather, grandparents, partner)	10	24.3	Distant relationship	7	17.1
Lives in an institution	1	2.4	Troubled relationship	3	7.3
Mother died because of HIV^a complications	14	100

M: arithmetic mean; SD: standard deviation; F: frequency; % = relative frequency or percentage.

The percentage represents the percentage of those orphaned by mother/father.

As for clinical and treatment characteristics (see Table 2), almost all participants (90.2%) acquired HIV vertically, which is why they were diagnosed in the first months or years of life and had been on ART for approximately 11.85 years (S.D. = 3.58). Only 61% of participants knew their diagnosis. The most common ART regimen was taking doses twice a day (53.7%). Treatment fatigue was reported by almost half of the participants (43.9%) who reported fatigue for a year or more. Some reasons why adolescents reported having stopped taking ART were discomfort associated with taking ART (e.g. unpleasant taste, difficulty swallowing pills, and side effects) (14.6%), not believing they needed it (19.5%), and forgetting to take it (80.5%). It is worth noting that a little less than half of them stopped owing to emotional discomfort (48.8%).

Table 2.

Clinical characteristics and antiretroviral treatment adherence (N = 41).

	M	SD		n	%
Time since diagnosis and time taking ART (months)	142.17	43.07	Caregivers report on adolescents’ ART adherence fails^a
Number of ART pills taken every day	3.61	2.2	Never or currently without failing	15	36.6
Antiretroviral treatment adherence			In the last week	1	2.4
% Of adherence (all treatment pills−omitted pills)/all treatment pills) × 100^a	94.32	12.87	In the last month	1	2.4
	94.32	12.87	In the last year or more than a year	23	56.1
% Of adherence (all treatment pills−omitted pills reported by caregiver)/all treatment pills) × 100^b	94.06	14.04	No data	1	2.4
	94.06	14.04	Follows ART adherence strategies^a
Adherence response measured by biomarkers			Keeping medication in the same place	37	90.2
CD4+ T cell count	675.78	242.16	Taking medication before leaving the house or taking it with them	28	68.3
Virological failures in their history of living with HIV	6.02	7.2		28	68.3
	n	%	Cellphone reminders	11	26.8
CD4+ T cell count ⩽500^c counts/mm³	11	26.8	Keeping a journal of adherence	1	2.4
Viral load			Reasons to stop taking ART medication^a
Indetectable (<40 cp/mL)	36	87.8	Emotional discomfort	20	48.8
Detectable (⩾40 cp/mL)	1	2.4	Forgetting to do it	33	80.4
Virological failure (⩾200 cp/mL)	4	9.8	Doesn’t believe they need it	8	19.5
Treatment regime (times of taking medication a day)			ART-related discomfort (bad taste, difficulty swallowing pills, side effects)	6	14.6
Once	16	39.0		6	14.6
Twice	22	53.7	Treatment fatigue
Three or more	3	7.3	Does not report fatigue	17	41.5
Patient’s HIV via of transmission			Fatigued for a week	4	9.8
Vertical/perinatal	37	90.2	Fatigued for 3 months	2	4.9
Horizontal/behavioral	4	9.8	Fatigued for a year or more	18	43.9
Self-report of ART adherence fails			Number of hospitalizations due to HIV complications
Never or currently without failing	15	36.6	None	24	58.5
In the last week	1	2.4	One or two	12	29.2
In the last 3 months	1	2.4	Three or four	0	0
In the last year or more than a year	19	46.3	Five or more	5	12.2
No data	0	0	Is notified about HIV diagnosis	25	61

M: arithmetic mean; SD: standard deviation; n: absolute frequency; %: relative frequency or percentage.

The variable had two missing data. Given the sample size, we did not provide input data.

The variable had one missing data. Given the sample size, we did not provide input data.

CD4 cells count below 500 is considered below the normal range (U.S. Department of Health and Human Services, 2020).

As for adherence to ART (see Table 2), participants were polarized toward two extremes: those who had never failed to adhere to their ART or who had not failed recently (36.6%), and those who had failed in the last year or more than a year prior (46.4%). The percentage of self-reported adherence (94.32%) was almost the same as that reported by the caregiver (94.06%). Both in the self-report and the caregiver’s report, low values of doses omitted or taken out of hours were observed with means of 0.58–1.59.

Regarding treatment response (see Table 2) the mean CD4 cell count was 675.78 counts/mm³ (S.D. = 242.167), and 26.8% of adolescents had less than 500 counts/mm³ which is below the normal range for a healthy or undetectable person (U.S. Department of Health and Human Services, 2020). While 87.8% had an undetectable viral load, their clinical history showed that there were individual participants who had reached up to 29 virological failures during their treatment.

About the questionnaire on basic knowledge of HIV and ART. Only participants who were aware of their diagnosis responded to the questionnaire (n = 25 see Supplemental Online Materials). The most correct answers were about the role of ART in preventing the progression of the infection to AIDS; however, only 60% answered this item correctly. Only 20%–48% answered correctly the questions regarding CD4 cells, the stage of AIDS, what it is to be undetectable, and why it is important to use condoms. Less than 10% of ALHIV knew the main objective of ART, the definition of treatment adherence, and the foods that interfere with it. The median number of correct answers was 2 (out of 10 possible), with a semi-interquartile range of 1.

Regarding adverse life events, intelligence, and mental health characteristics (Table 3), 78% of participants reported experiencing adverse life events or mental health problems throughout their lives. The most frequent events were bullying (56.1%), suicidal ideation (31.7%), having been a victim of a violent crime (29.2%), and having hurt themselves intentionally (24.4%). However, only 12.2% of the patients received psychiatric treatment. Moreover, 46.3% had below-average intelligence and most had never used tobacco, alcohol, cannabis, or cocaine. However, the substance with the highest risk score (moderate risk) was tobacco (9.8%), followed by alcohol (low risk) (7.4%). The YSR classified most adolescents as having normal symptomatology. There were two dimensions in which only slightly more than 10% of adolescents were at a clinical level: withdrawn/depressed, and social problems. In addition, 19.5% presented a subclinical level for the following dimensions: withdrawn/depression, attention problems, and aggressive behavior.

Table 3.

Mental health, adverse life events, and cognitive characteristics (N = 41).

	n	%
Adverse life events
Mental health problems	32	78.0
Victim of bullying	23	56.1
Suicide ideation or death wish	13	31.7
Victim of violent crime	12	29.2
Intentional self-harm	10	24.4
Been in a serious accident	4	9.8
Sexual harassment or abuse	4	9.8
Earthquake distress	3	7.3
Been arrested by police	2	4.9
Suicide plan or attempt	2	4.9
Currently in psychiatric treatment	5	12.2
Intelligence (WISC-IV)
Below average	19	46.3
Average or above	22	53.7
Substance use risk (ASSIST V 3.0)
Tobacco
Never used it	29	70.7
Low risk	8	19.5
Moderate risk	4	9.8
Alcohol
Never used it	24	58.5
Low risk	14	34.1
Moderate risk	3	7.4
Cannabis
Never used it	39	95.1
Low risk	1	2.4
Moderate risk	1	2.4
Cocaine
Never used it	39	95.1
Low risk	2	4.9
Moderate risk	0	0
Youth self report
Complementary evaluation (Qualities)
Normal	39	95
Sub-clinical	2	4.9
Clinical	0	0
Internalized problems
Anxious/depressive
Normal	34	82.9
Sub-clinical	4	9.8
Clinical	3	7.3
Withdrawn/depressive
Normal	27	65.9
Sub-clinical	8	19.5
Clinical	6	14.6
Somatic complaints
Normal	30	73.2
Sub-clinical	7	17.1
Clinical	4	9.8
Mixed problems
Social problems
Normal	31	75.6
Sub-clinical	5	12.2
Clinical	5	12.2
Thought problems
Normal	34	85.4
Sub-clinical	4	7.3
Clinical	3	7.3
Attention problems
Normal	30	73.2
Sub-clinical	8	19.5
Clinical	3	7.3
Externalized problems
Rule breaking
Normal	36	87.8
Sub-clinical	5	12.2
Clinical	0	0.0
Aggressive behavior
Normal	32	78
Sub-clinical	8	19.5
Clinical	1	2.4

M: arithmetic mean; SD: standard deviation; n: absolute frequency; %: relative frequency or percentage.

Discussion

A description of the characteristics of ALHIV in unexplored cultural contexts is necessary to understand the factors related to ART adherence in those populations and thus contribute to the development of more effective HIV care models and interventions to improve adherence. Therefore, the present study explored the sociodemographic, family, clinical, cognitive, mental health, adherence, and biomarker characteristics of Mexican ALHIV receiving treatment in a tertiary hospital.

We found that the low percentage of school attendance in this sample was similar to that reported in previous studies from LMICs, and working was much higher in our study, even though these previous studies were composed of older adolescents (Abiodun et al., 2022; Chandwani et al., 2012; Dessauvagie et al., 2020; Lall et al., 2015; Teasdale et al., 2021; Too et al., 2021). This finding may be because almost half of the ALHIV in our study had some type of intellectual limitation, which could make it difficult for them to remain in school. Learning disabilities and lower intelligence have been reported, especially in adolescents who acquired HIV perinatally (Koenig et al., 2011). On the other hand, working may be high because these ALHIV need to contribute financially to their families, an issue also reported previously for ALHIV from LMICs (e.g. Abiodun et al., 2022; Dako-Gyeke et al., 2020; Louthrenoo et al., 2014; Martinez et al., 2014; Teasdale et al., 2021).

Most ALHIV have a mother, father, or another biological family member as their main caregiver, and they report having a close or neutral relationship with them, which could be a protective factor for adherence. Previous studies have found that when the caregiver-patient relationship is closer, caregivers tend to be more involved in patients’ treatment, enhancing adherence (Adejumo et al., 2015; Donenberg et al., 2006; Orth and Van Wyk, 2021; Teasdale et al., 2021). Likewise, only 7.3% were orphaned by both parents, and evidence suggests that missing both parents is a higher risk of ART nonadherence than other family configurations (Kikuchi et al., 2012). This finding was consistent with the adherence observed in this study. For future studies, a valuable contribution would be to identify how this relationship favors adherence to ART in AVVIH.

Despite the overall past week adherence reported, both by ALHIV and their caregivers, was optimal according to the standards of Nabukeera-Barungi et al. (2007) and the World Health Organization (Organización Mundial de la Salud, 2004), most reported having failed adherence at some time in the previous year or more than a year prior. It is important to consider that most adherence reports were obtained on the day of their medical appointment, and it is possible that patients were stricter on taking their medication correctly in the days immediately prior to their appointment. The biomarkers were consistent with self-reported adherence. However, the percentage of adolescents who presented less than 500 counts/mm³ of CD4 cells and virological failure history suggests that ART adherence may fluctuate as a function of changing barriers and facilitators as youth develop (Adejumo et al., 2015; Ammon et al., 2018).

One crucial barrier to treatment adherence is travel time to the hospital, which can impact other aspects of their lives, such as school performance (Dako-Gyeke et al., 2020), family finances, and other everyday activities (Maskew et al., 2016). The average travel time to the hospital was much higher than that reported in other studies from LMICs (e.g. Abiodun et al., 2022). This difference could be explained by the difficulties of mobilization and transport faced in a megacity such as Mexico City and the centralization of health services in Mexico (Lambdin et al., 2013; Zachariah et al., 2006).

Almost all participants acquired HIV vertically, which is why they had been on ART since their first years of life. This result could explain why 60% of the patients reported treatment fatigue. This is a well-known barrier to adherence (Orth and Van Wyk, 2021), mainly among vertically infected HIV patients (Fields et al., 2017; Merzel et al., 2008; Spiegel and Futterman, 2009) and older adolescents, independent of when they started taking ART. This suggests that treatment fatigue may be more related to developmental stage than the length of time with ART (Claborn et al., 2015; Yang et al., 2018).

Besides treatment fatigue, participants reported that some adherence barriers were physical and emotional discomfort, forgetfulness, and belief that they did not need medication. This finding is consistent with the results of previous studies from LMICs (Abiodun et al., 2022; Abubakar et al., 2016; Chandwani et al., 2012). Not believing in the necessity of treatment could be explained because some of them have not been notified about their diagnosis and because of a lack of basic knowledge of HIV and ART, as suggested by Teasdale et al. (2021). The lack of basic knowledge about HIV and ART may be partially explained by cognitive limitations.

In contrast, the main treatment facilitators were keeping the medication in the same place and taking it before leaving their house or taking it with them, as has been reported in other descriptive studies and intervention protocols for ALHIV (Abiodun et al., 2022; Ammon et al., 2018; Reif et al., 2020; Vreeman et al., 2013). On the other hand, the medication as such can also act as a facilitator or barrier. For example, in another study with this sample it was identified that a type of treatment was associated with abandoning it due to adverse effects.

Besides the factors that can be directly associated with ART adherence, we found other factors that could indirectly affect adherence, such as mental health issues and substance use (Betancourt et al., 2014; Dessauvagie et al., 2020; Mellins et al., 2011; Too et al., 2021; Vreeman et al., 2017). Most participants reported having lived adverse life events or mental health problems, and the most frequently reported were experiencing bullying, and suicidal ideation.

It is important to address bullying, as the psychological discomfort derived from these events (and their frequency) is related to a lack of adherence to ART as well as to the worsening of internalized symptoms and behavioral problems (Ashaba et al., 2018; Boyes et al., 2014; Casale et al., 2021; Dessauvagie et al., 2020). Whether bullying was related to HIV status was not evaluated in this study but would be important for future research into stigma and discrimination.

Even though the participants reported several adverse life events, most of them scored within the normal range of the YSR. This finding indicates that HIV diagnosis is not a determining factor for developing mental health problems and highlights the capacity for resilience in these vulnerable youth. The YSR dimensions that suggested greater, but still primarily subclinical, levels of symptomology were withdrawn/depressed, somatic complaints, social problems, attention problems, and aggressive behavior, in concordance with the literature (Brown et al., 2015; Chandwani et al., 2012; Lam et al., 2007; Naar-King et al., 2006; Pao et al., 2000; Scharko, 2006; Shubber et al., 2016). Therefore, preventive interventions should be focused on these areas.

We found that most participants had never tried any kind of drug. The only substance for which we detected moderate risk was tobacco and for low risk was alcohol. This is consistent with the YSR scores in the normal range that we found for rule breaking, suggesting that our participants showed a low degree of engagement in risky behavior, possibly due to some protective factors, such as family support (Brittain et al., 2019; Conner et al., 2013; Teasdale et al., 2021).

Conclusion

To our knowledge, this is the first report on the characteristics of ALHIV in Mexico, which is relevant because Mexico is the third country in Latin America with the most children and adolescents living with HIV (Fondo de las Naciones Unidas para la Infancia, 2018). However, our study is not representative of all ALHIV in Mexico, as it was conducted in a census of patients at a specific public children’s hospital in Mexico City, although this hospital receives youth from various regions of the country. Another limitation identified in this study was that other support networks outside the family were not investigated, as well as their influence on adherence. We invite future studies to deepen this topic.

Despite this limitation, these findings contribute valuable knowledge of the characteristics and needs of these youth and suggest variables to be explored in future research (e.g. stigma, discrimination, resilience, and how intellectual deficits might influence illness knowledge and treatment adherence). Additionally, these findings suggest strategies that can be implemented to improve adherence and meet the specific needs of these patients. The main difficulties were transportation and travel time to the hospital, lack of knowledge about the disease, behavioral barriers to ART adherence, bullying, suicidal ideation, and below-average intelligence.

Supplemental Material

sj-docx-1-hpq-10.1177_13591053231207474 – Supplemental material for Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment

Supplemental material, sj-docx-1-hpq-10.1177_13591053231207474 for Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment by Cointa Arroyo-Jiménez, Corina Benjet, Rebeca Robles, Nancy Patricia Caballero-Suárez, Carmen Lizette Gálvez-Hernández, Javier Ordoñez-Ortega, Marco Tulio Suárez-Maldonado and Luis Xochihua in Journal of Health Psychology

Supplemental Material

sj-docx-4-hpq-10.1177_13591053231207474 – Supplemental material for Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment

Supplemental material, sj-docx-4-hpq-10.1177_13591053231207474 for Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment by Cointa Arroyo-Jiménez, Corina Benjet, Rebeca Robles, Nancy Patricia Caballero-Suárez, Carmen Lizette Gálvez-Hernández, Javier Ordoñez-Ortega, Marco Tulio Suárez-Maldonado and Luis Xochihua in Journal of Health Psychology

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Supplemental material, sj-spv-6-hpq-10.1177_13591053231207474 for Social and mental health characteristics of adolescents living with HIV in Mexico: Implications for adherence to antiretroviral treatment by Cointa Arroyo-Jiménez, Corina Benjet, Rebeca Robles, Nancy Patricia Caballero-Suárez, Carmen Lizette Gálvez-Hernández, Javier Ordoñez-Ortega, Marco Tulio Suárez-Maldonado and Luis Xochihua in Journal of Health Psychology

Footnotes

Acknowledgements

We are thankful for the tremendous support provided by the HIV ward of the Infectious Disease Service staff from the Instituto Nacional de Pediatría as well as the adolescents and caregivers who gave us their full support during the investigation to make this study possible. This study was possible thanks to financial supported by the Quality Postgraduate Programs of the National Council of Humanities Sciences and Technologies (CONAHCyT) (Scholarship No. 814111; CVU No. 363878).

Author contributions

Conceptualization: C.A., C.B., and R.R.; Methodology: C.A., C.B., and R.R.; Formal analysis: C.A., and C.B.; Investigation: C.A. and C.B.; Writing—Original Draft: C.A., C.B., and R.R.; Writing—Review & Editing: N.C., L.G., J.O., and M.S.; Resources: J.O.; Supervision: C.B.

Data sharing statement

The current article is accompanied by the relevant raw data generated during and/or analysed during the study, including files detailing the analyses and either the complete database or other relevant raw data. These files are available in the Figshare repository and accessible as Supplemental Material via the Sage Journals platform. Ethics approval, participant permissions, and all other relevant approvals were granted for this data sharing.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was possible thanks to financial supported by the Quality Postgraduate Programs of the National Council of Humanities Sciences and Technologies (CONAHCyT) (Scholarship No. 814111; CVU No. 363878).

Ethics approval

The Research and Ethics Committees of the Instituto Nacional de Pediatría [National Institute of Pediatrics] in Mexico City approved the study (#2020/061).

Informed consent

Written informed consent was obtained from each participant.

ORCID iDs

Cointa Arroyo-Jiménez

Nancy Patricia Caballero-Suárez

Carmen Lizette Gálvez-Hernández

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