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  Table of Contents  
Year : 2022  |  Volume : 43  |  Issue : 1  |  Page : 35-38

“Bouncing back to life: A perspective of living arrangement among adolescents with HIV''

1 Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
2 Department of Pediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India

Date of Submission07-Dec-2017
Date of Decision22-Dec-2019
Date of Acceptance24-Mar-2020
Date of Web Publication07-Jun-2022

Correspondence Address:
Dr. Janardhana Navaneetham
Department of Psychiatric Social Work, NIMHANS, Bengaluru - 560 029, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijstd.IJSTD_112_17

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Background: Most research on adolescent focuses on the risk associated with the illness. Very little research has been carried out on adolescents who have been diagnosed with HIV since birth. With recent advances with ART treatment, life span of these children has increased, and there are lots of protective factors in the environment influencing the resilience. The present study has focused on the resilience among the adolescence with respect to the living arrangement, i.e., in institutionalized care and extended family. Methodology: The current study follows an exploratory research design with the aim of comparing resilience among adolescents living in the institutional setup and those living with their families–parents and extended families. Adolescents receiving ART treatment from a tertiary care hospital constitute universe and were selected purposively for the study. Resilience was measured using Child and Youth Resilience Measure. Results: The results indicated that 70% of the female and majority of them belong to Hindu religion. For majority, the mode of transmission is mother to child. There is no statistically significant difference between the resilience with respect to the living arrangement. However, respondents are resilient. Conclusion: This study has given a space for resilience for different groups of adolescents with respect to the living arrangement.

Keywords: Adolescents, HIV/AIDS, living arrangement, resilience

How to cite this article:
Rajan S, Navaneetham J, Sanjeeva G N. “Bouncing back to life: A perspective of living arrangement among adolescents with HIV''. Indian J Sex Transm Dis 2022;43:35-8

How to cite this URL:
Rajan S, Navaneetham J, Sanjeeva G N. “Bouncing back to life: A perspective of living arrangement among adolescents with HIV''. Indian J Sex Transm Dis [serial online] 2022 [cited 2023 Dec 11];43:35-8. Available from:

   Introduction Top

The life expectancy of children with prenatally acquired HIV has increased over the period of time and they are entering adolescence and adulthood.[1] Adolescence is a period where one develops knowledge and learns to manage emotions and relationship, and it is a foundation to assume adult roles.[2] Specifically, for the adolescent who are born with HIV, it is a turbulent period due to different reasons such as traumatic periods in life, loss of parents, multiple caregivers (institutionalization), prolonged health problems, and hospitalization. Hence, they require specific kind of assistance compared to other adolescents. Their needs are complex in terms of developmental tasks which include physical and sexual maturity. Maturation also brings the need to understand relationship and peer pressure. Economic and psychosocial distresses are one among the pressures for institutionalized adolescents which can heighten the risky behaviors. Hence, without the protective factor of having parents, adolescents are more vulnerable.[3]

Adolescent living with HIV has increased risk of being victims, exploitation, and neglect. Death of a parent during childhood has a profound and potentially lasting impact on a child's psychosocial well-being.[4] There is a difference in the process of grief when children with HIV loss their parents including stigma, disruption of care, and financial hardship institutionalization.[5] Research findings suggested that children in long-term residential are at high risk of impaired cognitive, behavioral, emotional, and social development.[1] The social and psychological needs of the adolescent in the institutional care are unmet due to the structure and capacity of the institute.[6] Furthermore, the institutional care facilities attract the children from poverty-stricken environments and render them more vulnerable to physical and sexual abuse and promote stigma and discrimination.[7] Hence, adolescents born with HIV/AIDS either residing with extended caregiver or institute have their own difficulties. Hence, there is a need to evaluate the protective factor for them to foster and promote resilience. This helps one to positively deal with the worst or traumatic circumstances. To date, there is very little coordination across research on resilience in adolescents with HIV/AIDS.

The present study operationalizes resilience as the attainment of desirable social and emotional adjustment, despite risks due to HIV[8],[9] explained that a supportive environment with reciprocity in individuals' need enhances environment and conflicted relationship decreases the level of resilience. Positive aspects of the interpersonal relationship, social support and reciprocity, should lead to resilience and the negative aspect of social support, conflict, should decrease the level of resilience.

This article introduces the concept of resilience among the adolescents born with HIV in institutional care and the one who is residing with the secondary caregiver.

   Methodology Top

The study aims to explore the resilience among adolescents living with HIV and then compare the resilience among the adolescents born with HIV, in an institutional care and with the extended family. The study sample included adolescents from the age group of 13–18 years, from both the genders, and who were receiving ART treatment from the Indira Gandhi Institute of Child Health Hospital, Bengaluru. The exclusion criteria were the adolescents who were residing with both the parents. The study was carried out during January 2016–February 2016. The study was approved by the institute ethics board and followed the ethical guidelines. Informed written permission was obtained from IGICH and NIMHANS and written consent was obtained from the caregivers, respondents, or legal guardians.


The following two tools were used for gathering data from participants.

  1. Sociodemographic data sheet: Prepared by the researcher, which includes age, sex, domicile, and education
  2. Child and youth resilience measure [Table 1]: Self-report instrument. Items are rated on a 5-point scale from 1 = does not describe me at all to 5 = describes me a lot. Higher scores indicate higher levels of resilience.
Table 1: Child and Youth Resilience Measure

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Data analysis

Quantitative data were coded and analyzed using the Statistical package for the social sciences (SPSS) Version 22.00 (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). Frequency distributions, percentage analysis, mean, and standard deviation were the descriptive statistics that were used. Independent t-test and Mann Whitney U-test were used to find significant differences between the means of variables.

   Results Top

[Table 2] represents the sociodemographic details of the respondents. A total of 60 adolescents participated in the study [Table 2]. They were aged 13–18 years, and majority of them follows Hindu religion. [Table 2] also gives us the overview about the mode of transmission in the respondents that is from mother to child. Regarding the knowledge about the illness and Anti Retroviral T herapy, 47 have knowledge of HIV/AIDS and 59 have knowledge about the ART.
Table 2: Sociodemographic data

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[Table 3] represents the living arrangement of the respondents where 30 of them are in residential care and the rest are residing with the extended family members.
Table 3: Living arrangement

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[Table 4] represents a statistically significant difference which was observed between the respondents who are residing in institution and with the secondary caregiver in terms of the subdomain spirituality.
Table 4: Comparison of means of resilience and domains

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   Discussion Top

The present study evaluated the difference between the resilience among the two groups of the respondents. However, it can be inferred from the results that majority of the respondents are either institutionalized or staying with extended caregivers. (Brief et al., 2004)[10] pointed out that many children are usually incorporated into the extended families that act as a safety net. However, the shrinking number of caregivers and the considerable strain on families mean that children are much more vulnerable to economic and social hardships such as malnutrition, poverty, child labor, homelessness, and reduced access to education and health care.[10] Thus, the results of the present study also indicate that due to the reduced number of caregivers, the adolescents are receiving institutional care.

In general, the study revealed partial knowledge about HIV/AIDS among adolescents. Most of the research findings in India and abroad have pointed out that people between 15 and 24 years have adequate knowledge about HIV/AIDS,[11] and people still harbor several misconceptions about this infection.[12] In the present study, of 60 respondents, 59 have knowledge about ART, whereas 47 respondents have knowledge about HIV/AIDS.

Around 98% of the adolescents in the research group have prenatally acquired HIV/AIDS. Adolescents with perinatally acquired HIV have been prescribed antiretroviral therapy from an early age; they are likely to have some resistant strains of HIV.[13] Mother-to-child transmission accounts for the majority (80%–90%) of pediatric HIV-1 infections around the world.[14]

One objective of the present study was to compare resilience in adolescent who are residing with extended caregiver and institutional care. The mean score of resilience for both the groups is 112 and 107, respectively. It does not indicate any significance difference. Both the groups share commonality status of prenatally acquired HIV. The results support the existing literature available on resilience among the children born with HIV/AIDS.[15]

Research on exposure to adversities in childhood and range of developmental and social adaptation difficulties in childhood and adulthood are well established.[16] It also indicates the risk for social adaptation difficulties in parallel with focus in identifying resources that facilitate the occurrence of positive outcomes and avoidance of negative outcomes in the face of adversity.[17] Resources in the individual, family, and community-organizational domains facilitate positive outcomes by either promoting effective adaptation processes or by reducing the child's exposure to adversities.[18] This is in converse with the finding by Hong et al., 2011[19] that reveals that double orphans in community-based group homes have better psychosocial well-being as compared to their counterparts in orphanages and kinship care. The reason is community-based homes provide support preserving the family style.

The only difference was in terms of spirituality where mean was 11.50 and 14 for the respondents residing with the family and institution, respectively. Even though the difference was very small, it shows that the institutionalized adolescents have more spirituality as compared to their counterparts residing with the extended family. Activities in institutions are more structured than in home when it comes to spirituality. It is a key factor for fostering resilience as it encompasses existing and shared inner strengths, as well as interpersonal and problem-solving skills, such as hope and morality.[20]

Limitation and Implication

There are limitations of the current study that should be noted. It can also be considered as guidelines for the future research. First, the number of respondents who participated in the study was limited; the results cannot be generalized to a larger population. Second, the relation between the duration of stay in the institutional care has not been into consideration while measuring resilience. Third, the data regarding when orphan hood was established are not elicited which is also one factor in determining resilience. Further research on qualitative exploration about resilience among adolescent with HIV/AIDS will capture the richness of the data regarding the positive experiences in a traumatic environment. Another limitation of the study is that the impact of malnutrition, poverty, child labor, homelessness, and reduced access to education and health care on resilience in the two groups was not analyzed.

The findings of the study also have some important implication for HIV education among the adolescents. Culturally, appropriate education strategies are needed that should also include other family members.

   Conclusion Top

This study concluded that one's capacity to bounce back toward life lies in the situational protective factors which can be at individual, family, or community level. Adolescents with chronic illness conditions like living with HIV, do have acceptance of their illness, are bouncing back in their life, coping with the day-to-day demands, and meeting the expectation. It is required to consider their resilience level and help them with appropriate psychosocial interventions so that they can bounce back when ever their chronic condition limits their functioning.

Financial support and sponsorship

University Grants Commission (1380/(NET-DEC.2013).

Conflicts of interest

There are no conflicts of interest.

   References Top

Brady MT, Oleske JM, Williams PL, Elgie C, Mofenson LM, Dankner WM, et al. Declines in mortality rates and changes in causes of death in HIV-1-infected children during the HAART era. J Acquir Immune Defic Syndr 2010;53:86-94.  Back to cited text no. 1
Naswa S, Marfatia YS. Adolescent HIV/AIDS: Issues and challenges. Indian J Sex Transm Dis AIDS 2010;31:1-0.  Back to cited text no. 2
Ruland, C.D., et al., Adolescents: Orphaned and Vulnerable in the Time of HIV/AIDS. 2005: Family Health International, YouthNet Program Washington, DC.2005;18-25.  Back to cited text no. 3
Dowdney L. Annotation: Childhood bereavement following parental death. J Child Psychol Psychiatry Allied Discip 2000;41:819-30.  Back to cited text no. 4
Belsey MA, Sherr L. The definition of true orphan prevalence: Trends, contexts and implications for policies and programmes. Vulnerable Child Youth Stud 2011;6:185-200.  Back to cited text no. 5
Dunn A, Jareg A, Webb DW. A last resort: The growing concern about children in residential care: Save the children. London 2003.  Back to cited text no. 6
Meintjes H, Moses S, Berry L, Mampane M. Home Truths: The Phenomenon of Residential Care for Children in a Time of AIDS. South Africa 2007.  Back to cited text no. 7
Rutter M. Resilience in the face of adversity. Br J Psychiatry 1985;147:598-611.  Back to cited text no. 8
Flach FF. Resilience: Discovering a new strength at times of stress. California Fawcett Columbine; 1988.  Back to cited text no. 9
Brief DJ, Bollinger AR, Vielhauer MJ, Berger-Greenstein JA, Morgan EE, Brady SM, et al. Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes. AIDS Care 2004;16 Suppl 1:S97-120.  Back to cited text no. 10
Wadgave HV. Knowledge of HIV/AIDS transmission among the adolescent girls in slum areas. Indian J Sex Transm Dis AIDS 2011;32:139-41.  Back to cited text no. 11
McManus A, Dhar L. Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education: (A cross sectional survey of urban adolescent school girls in South Delhi, India). BMC Womens Health 2008;8:12.  Back to cited text no. 12
Mullen PD, Ramirez G, Strouse D, Hedges LV, Sogolow E. Meta-analysis of the Effects of Behavioral HIV Prevention Interventions on the Sexual Risk Behavior of Sexually Experienced Adolescents in Controlled Studies in the United States: Centre for Reviews and Dissemination (UK); 2002.  Back to cited text no. 13
Pienaar A, Swanepoel Z, Rensburg HV, Heunis C. A qualitative exploration of resilience in pre-adolescent AIDS orphans living in a residential care facility. SAHARA-J 2011;8:128-37.  Back to cited text no. 14
Wang B, Li X, Barnett D, Zhao G, Zhao J, Stanton B. Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: A structural equation modeling analysis. Soc Sci Med 2012;74:1435-43.  Back to cited text no. 15
Winslow EB, Sandler IN, Wolchik SA. Building Resilience in All Children Handbook of Resilience in Children.Boston, MA: Springer; 2005. p. 337-56.  Back to cited text no. 16
Wyman PA, Cowen EL, Work WC, Hoyt-Meyers L, Magnus KB, Fagen DB. Caregiving and developmental factors differentiating young at-risk urban children showing resilient versus stress-affected outcomes: A replication and extension. Child Dev 1999;70:645-59.  Back to cited text no. 17
Sandler I. Quality and ecology of adversity as common mechanisms of risk and resilience. Am J Community Psychol 2001;29:19-61.  Back to cited text no. 18
Hong Y, Li X, Fang X, Zhao G, Zhao J, Zhao Q, et al. Care arrangements of AIDS orphans and their relationship with children's psychosocial well-being in rural China. Health Policy Plan 2011;26:115-23.  Back to cited text no. 19
Greene R. Human behavior theory: A resilience orientation resiliency: An integrated approach to practice, policy, and research. Washington; 2002. p. 29-62.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3], [Table 4]


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