Contact with social service agencies

Introduction/overview Though a cure for HIV disease remains elusive, in many patients virus in the blood can be reduced to undectable 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, coordination 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 beyond. 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 salient psychosocial issues. Prominent among these are the following. Children growing into teenagers with HIV are facing adolescent developmental challenges. The developmental problems faced by children and families have changed, producing new challenges in parenting and planning for the future. As children grow older, issues such as disclosure, development of intimacy, career and school choices, and the usual tasks of adolescence may offer overwhelming challenges for parents and require support from health and mental health professionals.