title: Spirituality in HIV-infected adolescents and their families: FAmily CEntered (FACE) Advance Care Planning and medication adherence.
abstract: OBJECTIVE
  To explore the effect of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence among human immunodeficiency virus (HIV) positive adolescents and their surrogate decision-makers.
  
  
  METHODS
  A sample of HIV-positive adolescents (n = 40) and their surrogates, aged ≥ 21 years, (n = 40), was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents' spirituality and their belief that HIV is a punishment from God were assessed at baseline and 3 months after the intervention, using the Functional Assessment of Chronic Illness Therapy-Spiritual Well Being Scale, Expanded, Version 4.
  
  
  RESULTS
  Control adolescents increased faith and meaning/purpose more than FACE adolescents (p = .02). At baseline, more behaviorally infected adolescents (16%) believed that HIV was a punishment from God as compared with those who were infected perinatally (8%). Adolescents endorsing that HIV was a punishment scored lower on spirituality (p = .05) and adherence to Highly Active Antiretroviral Therapy (HAART) (p = .04). Surrogates were more spiritual than adolescents (p ≤ .0001).
  
  
  CONCLUSIONS
  Providing family support in a friendly, facilitated environment enhanced spirituality among adolescents. Facilitated family conversations had an especially positive effect on medication adherence and spiritual beliefs among behaviorally infected adolescents.
authors.affiliation: Children's National Medical Center, Division of Adolescent and Young Adult Medicine, and George Washington School of Medicine and Health Sciences, Washington, District of Columbia 20010-2970, USA. mlyon@cnmc.org
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Lyon
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Garvie
authors.forename: Ellin
authors.initials: E
authors.lastname: Kao
authors.forename: Linda
authors.initials: L
authors.lastname: Briggs
authors.forename: Jianping
authors.initials: J
authors.lastname: He
authors.forename: Robert
authors.initials: R
authors.lastname: Malow
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: D'Angelo
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
mesh_terms: D000293:Adolescent; D032722:Advance Care Planning; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence; D011678:Punishment / Q000523:psychology; D012068:Religion and Medicine; D029181:Spirituality; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents