Amsterdam 2015
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| Abstract #2154 - Evidence and interventions | ||||
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Session: 30.6: Evidence and interventions (Oral poster discussion) on Thursday @ 13.30-14.30 in Poster room 1 Chaired by Tamsen Rochat, Sibylle Nider/i> Authors: Presenting Author: Dr Lisa Langhaug - REPSSI, Zimbabwe |
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| Additional Authors: | ||||
| Aim: Current research emphasizes lasting implications (lower self-esteem, increased psychological and behavioral problems) when young people are not properly supported to process their grief following close family deaths. Early disruptions in primary relationships can also lead to difficulty forming close relationships later in life. Issues: Current interventions to support processing grief use Western models geared towards a single primary loss (one parent or a sibling). However, in sub-Saharan Africa (SSA), HIV+ adolescents experience multiple deaths of one or both parents, siblings, other family caregivers, and friends. These deaths are often accompanied by other serious losses including household mobility, separation from siblings, loss of belongings, and disrupted school attendance. These sequential losses frequently begin in early childhood and are interwoven throughout the child’s life. Data from HIV+ adolescents in Zimbabwe highlights that even in supportive groups, discussions about their grief over these losses are lacking. | ||||
| Method / Issue: Project: Formative research was conducted in Zimbabwe with 10 HIV+ adolescents to better contextualise their grief. Aged 18–20, they had all experienced the death of one or both parents and others close to them. | ||||
| Results / Comments: They acknowledged important non-death losses listed above. Over eight sessions, we explored how they understood their grief, their current emotional and behavioural responses and coping strategies (both positive and negative.) Particular attention was given to their multiple and varied losses. Emerging key themes: i) limited experience in recognising their losses ii) confusion and lack of control over poorly understood feelings iii) recurrent feelings of hopelessness, depression, fear, sadness, and guilt iv) feeling isolated and reticent about sharing, believing their feelings were unusual v) shame around ongoing connections felt towards their deceased. Upon conclusion, members reported relief in learning of shared experiences, the ability to link their feelings with specific experiences and employ constructive coping strategies to address them. Several members spontaneously reported decreased anger they’d felt towards deceased parents and their HIV status, giving them relief and greater emotional control. Information garnered here facilitated adaption of existing materials on grief for HIV+ adolescents in SSA. Materials support their ability to identify and label their feelings validates their normalcy in relation to their significant loss(es) provides a platform for expression highlights commonality of their experiences and develops coping strategies for ongoing challenging life circumstances. This 6-session intervention will be implemented in existing community-based adolescent HIV+ support groups and evaluated among 400 HIV+ adolescents using a wait-listed study design. Trained peer educators who lead support group activities will deliver the intervention. | ||||
| Discussion: Lessons Learned: This formative research highlights the importance of contextualising existing high quality grief interventions to respond to the complex realities of many HIV+ adolescents in SSA prioritsing their multiple deaths and ongoing losses. Key practical adaptations for resource constrained settings include i) minimal use of craft materials (no resources, minimal privacy at home to store crafts) ii) limit activities that rely on writing skills iii) acknowledge restrictive space for holding support groups. Finally, further research is needed to uncover the relationship between unaddressed grief and difficulties maintaining adherence in this HIV+ population. | ||||
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