The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 15: Special PopulationsTHE YOUNG AND THE OLD■ The young and the old can have developmental, generational or cultural issues that may keepthem from seeking and remaining in care.26 picasAdolescentsAdolescents feel omnipotent and immortal, have not completely internalized the concepts ofcause and effect, and may mistrust adults in authority. A common adolescent response to adiagnosis of HIV, which is often given by an adult, is to reject the diagnosis, believing that avoidingthe issue is avoiding the illness. For young gay and bisexual men, fear of their sexual orientationbeing revealed because of a diagnosis of HIV might also prevent their seeking care. (SeeChapter 12: The Care of Children and Adolescents.)Young mothers tend to allow their babies’ care to take precedence over their own. If they are indenial that they might die, young mothers may avoid planning for the guardianship of theirchildren. (See Chapter 18: Legal and Financial Issues for discussion of permanency planning.)The following interventions may promote adolescents’ acceptance of care:• Offer to assist them with making decisions about disclosure of their status toparents, children and other family members.• Arrange for peer support by other teens living with HIV if possible; otherwise,link them with other teens via the Internet.• Begin discussions with adolescent mothers about who will care for theirchildren; bring in other team members and agencies to assist them withpermanency planning.Other services that can facilitate a teen mother accepting care for herself include parentingskill classes, respite care, family support and homemaker services. 1 Resources for training staffabout permanency planning are the National Pediatric and Family HIV Resource Center(www.pedhivaids.org) and The Family Center (www.thefamilycenter.org).Older PeopleSenior citizens may not seek care because they fear the stigma of HIV/AIDS as well as becausethey may be dealing with other health problems. The initial discussion of palliative caremight confirm their fears that “nothing more can be done for them.” If they have been receivingcare at a private physician’s office, they may feel uncomfortable in a clinic situation. For oldergay men, who may have lived a “closeted” lifestyle, sharing their sexual orientation with healthcare providers may make them uncomfortable. For example, an older gay man may not be comfortablereceiving palliative care at home because he doesn’t want his providers to know he liveswith his partner.For people with HIV who are older, the following interventions may be useful:• Encourage them to contact the National Association on HIV Over Fifty(NAHOF), an organization for both consumers and providers that has anewsletter (www.hivoverfifty.org/).• For patients who resist receiving palliative care services from an HIVassociatedhospice agency, consider having their primary care cliniciansprovide the palliative care with consultation from a palliative care expert oragency when needed.316U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau