the epidemiology and care of children youth and families living with hiv in canada n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The Epidemiology and Care of Children, Youth and Families Living with HIV in Canada PowerPoint Presentation
Download Presentation
The Epidemiology and Care of Children, Youth and Families Living with HIV in Canada

Loading in 2 Seconds...

play fullscreen
1 / 27

The Epidemiology and Care of Children, Youth and Families Living with HIV in Canada - PowerPoint PPT Presentation


  • 139 Views
  • Uploaded on

The Epidemiology and Care of Children, Youth and Families Living with HIV in Canada. Stanley Read, MD, PhD, FRCPC Division of Infectious Diseases, HIV Family Centered Care Program The Hospital for Sick Children. THE HOSPITAL FOR SICK CHILDREN. Families living with HIV in Canada.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Epidemiology and Care of Children, Youth and Families Living with HIV in Canada' - aviv


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
the epidemiology and care of children youth and families living with hiv in canada

The Epidemiology and Care of Children, Youth and Families Living with HIV in Canada

Stanley Read, MD, PhD, FRCPC

Division of Infectious Diseases,

HIV Family Centered Care Program

The Hospital for Sick Children

THE HOSPITAL FOR SICK CHILDREN

families living with hiv in canada
Families living with HIV in Canada
  • Many are immigrant and refugee families and those without status
  • People from Africa and the Caribbean disproportionately represented
  • Minority and marginalized groups
    • Aboriginals
    • Drug users
    • Mentally challenged
  • Data collected systematically on all known HIV+ pregnant women and their babies (Canadian Perinatal HIV Surveillance Project)
slide3

Vancouver

Edmonton

Calgary

Saskatoon

Winnipeg

Toronto

Ottawa

Hamilton

London

Windsor

Kingston

Sudbury

Montreal

Quebec City

Fredericton

Charlottetown

Halifax

St John’s

Iqualuit

Whitehorse

Yellowknife

slide4

Maternal Ethnicity

Total cohort

prevention of mother to child transmission
PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
  • one of the great achievements in the management of HIV/AIDS
  • optimal ARVs to HIV+ pregnant woman – treat mother and prevent transmission
slide9

Issues:

  • Renewed efforts should be made to avoid “missed opportunities” of prevention, such as:
  • - universal implementation of HIV testing in pregnancy, 3rd trimester testing
  • - improved access to antenatal care in situations of addictions,
  • mental health, recent immigration, poverty
  • - efficient communication of test results
  • - partner testing for pregnant women
  • - emphasize avoidance of breastfeeding, pre-chewed feeding
monitoring program for babies exposed to arvs
Monitoring Program for Babies Exposed to ARVs
  • Evaluation of HIV status and evidence of mitochondrial dysfunction at 1, 2, 3, 6 and 18 months and then annually
  • Developmental assessments at 6 and 18 months and then annually
challenges to developmental assessments
Challenges to Developmental Assessments
  • Many of the children live in an ethnocultural environment reflecting the origin of their parents until they are old enough to go to kindergarten
  • Lack of a control group of children raised in similar situations
slide14

HSC CLINIC POPULATION

  • Approx. 89 HIV+ children and families
  • 67% African and Caribbean
    • 60% - parent(s) born in Africa
    • 15% - parent(s) born in Caribbean
    • 13% - parents born in Canada
    • 1% - Eastern Europe
    • 9% - Asian/South Asian
    • 2% - South and Central America
challenges of daily living
Challenges of daily living
  • Many families living at or below poverty line, stigma and discrimination
  • Taking antiretrovirals is a difficult, lifetime commitment

Many factors involved:

-complex psychosocial and ethnocultural issues, stigma/secrecy, access to health care, lack of education, trust, drug use, mental illness

  • Support systems – very important

-Hospital – multidisciplinary team

-Community – Teresa Group, AIDS Committees, Voices of Positive Women, Women’s Health in Women’s Hands, etc

slide18

5-year survival:

Pre-1996: 70%

1996 and after: 98%

Log-rank p-value = 0.0005

disclosure of hiv to children
Disclosure of HIV to Children
  • How can I tell my children about my HIV?
  • How can I tell my infected child about his or her HIV?
  • Parent’s major concerns:

- Child’s well-being and emotional reaction

- Family’s well-being, fear that children will tell other people about the HIV

-Mothers often fear children will blame them

process of disclosing to children
Process of Disclosing to Children

-Consider cognitive development and ability to keep a secret

-Start with partial disclosure, emphasizing ‘living well’ with their ‘blood infection’

-Use the words “HIV” (full disclosure)

-provide on-going information, hope and support as children grow in understanding

adolescents challenges and rewards
Adolescents: Challenges and Rewards
  • Adolescents with HIV similar to those with any chronic health problem
  • Most have ‘grown up’ with their HIV and the health care team
  • Follow the same patterns: ‘raging hormones’, fluctuations in maturity, attempts at ‘independence’
slide24
Difficult to convince an otherwise well teen that they need to take medication to prevent serious opportunistic infections
  • Group support – sessions facilitated by Teresa Group team
sexual maturation
Sexual Maturation
  • Prepare for sexual exploration – discussions (Adolescent Medicine) around safer sex
  • Encourage openness – non-critical, non-judgmental approach
  • Disclosure to partner before sex
  • Keep an open door for discussions/problems
transition good to go program
Transition – Good-to-Go Program
  • Preparing the adolescent for transition to adult care
  • New responsibilities for self care