Looking Toward the Future: Understanding the Social Implications of HIV in Adolescence

Academic Blog by: Zoe Finer

In an ideal, more equitable world, children would fall asleep at night feeling hopeful and excited about waking up the next morning. Head hitting the pillow, young people would think about goals for their future and dream of where they see themselves further down the line. Unfortunately, in reality, the ability to have hope and goals for one's future has become a privilege that excludes many. For some youth, especially youth living with HIV (YLWH), the struggle of surviving day-to-day life takes precedence over thinking about the future. However, for many of these adolescents, the day-to-day struggle is not consumed by their physical health but by negative social conditions, stigma, and marginalization.

Identifying the problem

HIV is not the death sentence that it was in the 1980s and early 90s. Today, YLWH have better health because because of antiretroviral therapy. However, as HIV transitions to be a chronic disease rather than a fatal one, YLWH face concerning social and structural factors which may negatively impact health. For those that identify with already marginalized communities, living with HIV can contribute to even more health disparities. For example, populations of YLWH in the US are concentrated among minority populations living in poor, inner city neighborhoods. Additionally, YLWH experience higher rates of discrimination, homelessness, history of incarceration, and psychological distress. These negative factors are prime examples of the ways in which YLWH are socially vulnerable. Essentially, for many of these youth, living with HIV only scratches the surface of the challenges they face. The mixture of these unfortunate social and structural factors leads to an experience of social stress that encompasses social oppression, marginalization, and HIV stigma for YLWH. For this population, living with these adversities may negatively impact future orientation and lead to increased substance abuse

Living with HIV Impacts the Future Orientation of Youth

Future orientation is how people see themselves in the future, including expectations and goals. Those with high future orientation can clearly envision themselves going to college, landing a job, working their way up the ladder; finding love, or buying a dog—the future is theirs to shape. Lin (2014) and colleagues demonstrated that life experiences involving stigma severely and negatively influence future orientation of YLWH. Moreover, this study shows that YLWH report lower future orientation than their unaffected counterparts. It is hard to envision a future for oneself when the present is a constant struggle. Additionally, there is evidence linking low future orientation with engagement of risky behaviors such as substance abuse and sexual behaviors.

Other studies, conversely, have demonstrated that emerging adults with HIV cite goals similar to their unaffected counterparts such as school, work, relationships and family. The differences for these youth however, lies in that that they also view their HIV status and social networks as obstacles to achieving their future goals (Bruce et al. 2012). Living with HIV impacts future life goals for emerging adults. The future orientation of YLWH is inhibited by a reality that is overwhelmed by chronic physical and psychosocial stressors. How could it not be? But for YLWH, the problem goes far beyond the inability to see themselves in the future. These circumstances lead to YLWH being at an increased risk for substance use compared to their peers. The unique social vulnerabilities YLWH face, coupled with their increased risk for substance use, imply that tailored interventions are needed to meet the specific needs of YLWH.

Call to Action: Identifying Future Directions...

Proposed interventions to protect from engagement in risk behaviors such as substance abuse should include having a multi-leveled approach that addresses factors across social contexts. Moreover, these interventions should seek to remedy substance abuse through improving YLWH's lived social experience. Additionally, these interventions should focus on building the future orientation of YLWH. In order for YLWH to build their future orientations, the social and structural factors that inhibit this line of thinking must be addressed. Public health approaches to creating interventions need to consider the social conditions that limit YLWH from the privilege of hoping for a future.