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Keeping the family in focus at an HIV/AIDS pediatric clinic.

Article Excerpt
As the subdiscipline of medical family therapy grows, collaborative partnerships between family therapy programs and HIV/ AIDS clinics represent a promising opportunity to systemically address the medical, intrapersonal, and interpersonal issues that often arise when a family member is coping with the diagnosis and treatment of HIV/AIDS. This article highlights a successful collaboration between Drexel's Couple and Family Therapy Program and a Pediatric and Adolescent HIV/AIDS clinic at St. Christopher's Hospital for Children. The authors describe a brief history of St. Christopher's Pediatric and Adolescent HIV/AIDS clinic and its transition from a more traditional nonfamily therapy model to one that is systemic. An illustrative case example and lessons learned about developing successful collaborations with HIV/ AIDS clinics are presented.

Keywords: collaborative team building, medical family therapy, pediatric HIV/ AIDS

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Collaborations between family therapists and HIV/AIDS physicians and health care professionals are a natural fit. Unlike other physical illnesses like heart disease and cancer, HIV/AIDS is different because many family members can be ill at the same time, there is often social stigma associated with this illness, and families may also be coping with chronic poverty, multiple losses, trauma, and substance abuse (Pequegnat & Bray, 1997). Additionally, there has been a profound effect on low-income African American and Latino families who tend to be disproportionately affected by HIV/AIDS in the United States, highlighting the need for both family centered and culturally sensitive approaches (Mitrani, Prado, Feaster, Robinson-Batista, & Szapocznik, 2003).

HIV/AIDS is a chronic disease requiring long-term medical and psychosocial support to the patients and their families. Most HIV/AIDS clinics include a behavioral component but collaborative and systemic family therapy perspectives have been less common. We describe one HIV/ AIDS pediatric and adolescent clinic's transition from traditional to integrative care with medical and family therapy providers collaboratively identifying the family's strengths and challenges that affect disease management and self-care for patients and their families.

HISTORY OF A PEDIATRIC HIV/AIDS MEDICAL CLINIC: NORTH PHILADELPHIA

Philadelphia is a city with a majority of minorities with 44% African American, 9% Latino/a, and 5% Asian. A quarter of the cities' families live below the federal poverty level. Risk factors for transmission of HIV (multiple partners, unprotected sex, sex with impaired judgment) are present across many populations in the United States, but zip code of residence is the best predictor of acquiring HIV (Pivnick & Villegas, 2000). Minority families in Philadelphia with HIV face the associated comorbidities of substance abuse, domestic violence, low literacy, and mental health issues (Rotheram-Borus, Flannery, Rice, & Lester, 2005).

The Family Program was started at St. Christopher's Hospital for Children (St. Chris) in 1988 in response to the HIV/AIDS epidemic affecting the population of North Philadelphia and the surrounding neighborhoods. It was evident to the founders of...

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