**3. The two pandemics–HIV and COVID-19**

Although there is a significant accomplishment, programs from global to local levels are now confronting a new and unexpected challenge: the coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2. (SARS-CoV-2). The coexistence of the HIV and COVID-19 pandemics has had an indirect impact on people living with HIV by interfering with key services and a direct impact by introducing another possibly lethal risk to the individual's health. Public health measures required to control the spread of SARS-CoV-2 have led to social restrictions and social distancing that have negatively impacted different sectors and also have limited access to routine healthcare. In particular, the COVID-19 pandemic has had a negative impact on HIV testing, linkage to care, and treatment access for those living with or at risk of HIV [9]. Discontinuation of these in association with impeded access to other HIV-related medical services, such as accessibility to pre-exposure prophylaxis (PrEP), HIV testing and treatment of opportunistic infections, and other HIV control methods, has most certainly already resulted in higher HIV incidence, morbidity, and mortality [10]. Disruptions in ART access, resulting in poor virologic control of HIV during the COVID-19 pandemic, suggest that strategies such as giving a multiple moth supply of ART could be helpful [11].

The likelihood of HIV-positive patients contracting CoV-2 infection and vaccination against the novel coronavirus

When the SARS COV-2 pandemic hit, no one knew how HIV-positive patients were exposed to and vulnerable to infection with this new virus, or whether

they will react differently from the general population. With the world's medical research attention focused on SARS CoV-2 infection, there are data that suggests the fact that this second viral infection in HIV-positive individuals with detectable viral load and low CD4 count may have a poor prognosis.

Blanco conducted one of the first research in the UK on the mortality of HIVpositive subjects that were also infected with SARS CoV-2. The compiled data revealed that the mortality rate of immunosuppressed seropositive patients was higher compared to that of the general population [12]. Another study, that has taken gender, age, and comorbidities into account and also the presence of certain addictions, like smoking, concluded that most HIV-positive patients who died had significant associated pathologies and vices (obesity and smoked). The patient cohort was modest, with only 33 participants. According to the study's findings, more information on these concerns is required [13].

Bhaskaran and Tesariero showed that people with HIV and comorbidities have a higher risk of mortality than the general population [14, 15]. "People living with HIV had a higher risk of COVID-19 death than those without HIV after adjusting for age and sex" [14] "PLWDH experienced poorer COVID-related outcomes relative to non-PLWDH (people living with diagnosed HIV), with 1-in-522 PLWDH dying with COVID-19, seemingly driven by higher rates of severe disease requiring hospitalization" [15].

#### **4. The impact of COVID-19 pandemic on adolescences**

The COVID-19 pandemic created disruptions in social contact and health service delivery that negatively affect psychosocial and clinical outcomes [16]. Understanding the effects of the COVID-19 pandemic on adolescents that live with HIV, is crucial for their adherence and compliance to treatment.

Mental health and psychosocial issues usually start throughout adolescence and remain into adulthood if not treated adequately [17], with 10–20% of children and adolescents developing diagnosable mental health conditions [18]. Suicide rates are rising, with young people currently being the demographic category that has increased the risk of suicide in one-third of nations, both developed and developing [17–20]. Depression is one of the top three causes of illness and disability in teenagers, and suicide is the third major cause of death in adolescents between 15 and 19 years. Mental health and psychosocial impairment, apart from morbidity and mortality, has multiple other detrimental implications such as substance abuse, poor reproductive and sexual health, violence, and lower educational achievements.

If untreated, mental health issues that begin before maturity are predicted to cost the health system 10 times more than those that appear later in adult life [21].

Adolescent mental health during the COVID-19 pandemic should not be neglected as adolescents often face disproportionate risks and impacts in this area. Providing responsive psychosocial support and coping strategies for ALHIV (adolescents living with HIV) during this pandemic is critical since the emotional pressures they frequently face may be exacerbated by movement restrictions and isolation, as well as difficulties acquiring food, clothing, housing, and psychosocial support. Peers' contributions to face-to-face and psychosocial and group mental health support have been thoroughly established. Group gatherings are limited or canceled under the existing COVID-19 rules. To maintain communication and support for ALHIV, online and other communications means should be used whenever available.

A multitude of instruments can be used to maintain a balance in the psychological and mental health of ALHIV. It all starts from the household and family

*The HIV Positive Adolescent in a Pandemic Year: A Point of View DOI: http://dx.doi.org/10.5772/intechopen.102480*

members, continues with virtual and interactive online platforms on which ALHIV can have social interaction with peers their age. ALHIV's privacy and confidentiality are crucial, and they should be advised about how and who to contact for extra care if they are feeling ill or mentally upset.

ALHIV are a priority group, and their health and well-being should not be an afterthought within the COVID-19 pandemic response. It is important to ensure that critical services are planned for and delivered during this time.

ALHIV are a key population, and their well-being should not be overlooked as part of the COVID-19 pandemic response. It is crucial that key services are prepared for and supplied throughout this period. While considerable progress has been achieved, ALHIV has had poorer outcomes and is currently falling behind in terms of universal ART coverage. Those accomplishments are at risk of being lost unless we take immediate, aggressive actions to protect their interests and secure their health and survival. We must take action to guarantee that friendly messaging that is targeted to their age group and relevant information on COVID-19 are sent to ALHIV on time. We must ensure that ART is administered with age-appropriate adherence messages given using proven and tested virtual platforms and telecommunications channels. Contraception is part of a comprehensive set of services provided to teenagers who require it during this period. A lot of these services can also be effectively provided by youth-led and directed community-based and nongovernmental groups. These civil society resources may be used while complying with all safety precautions and other infection control methods, particularly at this time, when health care systems are overwhelmed by COVID-19 requirements [22].

#### **5. HIV adolescences in a pandemic year in our clinic**

In the HIV/AIDS Regional Center from Iasi, Romania, over 1440 patients from 5 counties that are in the Moldavian region are closely monitored. Twelve patients are represented by adolescences between 14 and 18 years old. The majority of those (10 cases) are adherent and compliant to treatment. None of the patients is a drug abuser and one patient acquired the infection through vertical transmission.

On March 4th, 2020, "Sf. Parascheva" Clinical Hospital of Infectious Diseases from Iasi, Romania, admitted the first COVID-19 positive patient. From there, step by step the whole hospital became the first line SARS CoV-2 hospital from Iasi, and admitted only SARS CoV-2, infected patients. Alongside this, the main downside for the HIV-positive patients was that they did not have the same condition to be evaluated as before. Of course, the monitoring of these patients was continued with the strict following of the public health measures that were imposed at that time.

Regarding the adolescences that were followed up in our clinic, we observed an increased adherence and compliance to treatment, mainly because it seems that the HIV-infected adolescent acknowledges the fact that good health can shield them from an unknown enemy.

Considering that HIV-positive patients are already a vulnerable group, we observed that in these pandemic times, they experienced higher levels of anxiety, depression, and an increased level of fear regarding their health. On a daily basis, the HIV-positive adolescents had support groups and required interpersonal interaction with their friends (seropositive or seronegative). The public health care measures limited the possibility of all of these support systems. All of the restrictions made the HIV-positive patient to keep closer contact through telemedicine with their physician and most importantly, they required a sustained session, also through telemedicine, with the psychologist.

The red thread of their discussion was focused on their fear, insecurities, and lack of control and the fact that they experienced the feeling of abandonment caused by the absence of interpersonal interaction with their support group.

Fortunately, all of these teenagers come from supportive homes, have had a solid social insertion, and have a fair economic standard. All of them were defining characteristics that contributed to the young patients' commitment and compliance to therapy, as well as the adolescent's immediate psychological support.
