A qualitative exploration of psychosocial challenges of perinatally HIV-infected adolescents and families in Bangkok, Thailand

Danielle Friedman Nestadt, Sudrak Lakhonpon, Gisselle Pardo, Chutima Saisaengjan, Priya Gopalan, Torsak Bunupuradah, Mary Mc Kernan McKay, Jintanat Ananworanich, Claude Ann Mellins

Research output: Contribution to journalArticlepeer-review


Thailand has the highest HIV prevalence in Asia, with 9600 HIV+ adolescents and thousands of additional younger HIV+ children. Studies from other settings suggest perinatally HIV-infected (PHIV+) adolescents are at high risk for mental health problems and engagement in risk behaviors that threaten individual and public health. Yet, few studies exist in Thailand, and few evidence-based psychosocial interventions have been developed for and studied in this population, despite great need. The current study qualitatively explored psychosocial issues among Thai PHIV+ adolescents to inform development or adaptation of interventions. Thai and US-based researchers and clinicians conducted two focus group discussions with PHIV+ adolescents aged 12–16 and their adult caregivers, and six in-depth key informant interviews with health/social work providers at a large clinic for PHIV+ youth in Bangkok, Thailand. Data were analyzed thematically using framework analysis. Multiple challenges for PHIV+ youth and caregivers were identified. Adherence to antiretroviral treatment was a significant challenge attributed to lack of adult support, side effects, feeling too well to take medicines and avoiding acknowledging sickness. Poor child–caregiver communication and conflict was a key concern, explained in part by cultural expectation of obedience and generation gaps. Concerns about societal stigma and discrimination emerged strongly and influenced delay or avoidance of disclosing HIV status to children and others. Respondents identified positive approaches to addressing these issues and highlighted the need for interventions to improve child–caregiver communication and generate peer and community support for PHIV+ youth. Thai PHIV+ adolescents and families experience significant psychosocial challenges, similar to those seen in other contexts. Cultural adaptation of an existing evidence-based clinic-based family group intervention is recommended to rapidly address these needs.

Original languageEnglish (US)
Pages (from-to)158-169
Number of pages12
JournalVulnerable Children and Youth Studies
Issue number2
StatePublished - Apr 3 2018
Externally publishedYes


  • Perinatal HIV infection
  • Thailand
  • adherence
  • adolescents
  • psychosocial support

ASJC Scopus subject areas

  • Health(social science)
  • Developmental and Educational Psychology
  • Sociology and Political Science


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