AFISE Are Romanian HIV+ youth gambling with death?

Are Romanian HIV+ youth gambling with death? Background While the Romanian COE was able to achieve very low mortality rates in the previous years, (less than 1%) there are some puzzling situations regarding lack of adherence and patients’ limited cooperation with the care team, which lead to their death; we consider that these situations require better analysis from a psychosocial perspective. Objectives This presentation aims to share experiences, identify possible common factors in the profiles of the target group and raise further questions that might become relevant for other BIPAI centers delivering youth services in terms of psychosocial services design. Design/ methods The Baylor Romania psychosocial team has retrospectively analyzed a sum of case studies comprised of all patients that died in 2008 as well as cases that are currently in our care and have a very high probability of death due to ill health. We have also analyzed some cases that accepted the therapy on their own initiative after years of refusal of care. Finally, we tried to identify some common factors, dilemmas and issues that might be relevant for psychosocial programs design. Results There are two categories of patients: • those that were chronically ill, hospitalized and have lost hope and trust in medication and medical care, • those who were immunologically ill for long time, but kept a good life quality and died “unexpectedly “ in spite of all warnings and efforts to be brought back into care. While the family support is important, it seems that other factors are stronger, such as: personality type, cognitions and beliefs. The issues that arose in connection with the delivery of psychosocial services refer to: intensity and nature of support, timing and type of warnings regarding illness related dangers, ways of dealing with professionals’ feelings of helplessness. Conclusions It seems that medical success (ie achieving good clinical result) can be tricky when working with adolescents and young people. They tend to develop cognitions that link their good health to other factors than the ARVs such as luck or invincibility. Also, there is a peer pressure among adolescent patients themselves, especially in regard to therapy and it’s effects. Therefore, we recommend shaping psychosocial support upon personality type and identifying patterns of social networking within the patients groups in order to identify role models that might be copied; also, we consider that other BIPAI centers need to think about best ways of supporting “success” cases, in a manner that will develop and keep their trust in the health professionals and ARVs. Authors: L. Vlahopol A. M. Schweitzer A. Caraveteanu