In Spain AIDS cases have declined substantially, but not the rate of new HIV infections, which are higher than the EU average. Current figures show that two thirds of those infected with HIV are young men who have sex with men (MSM). Nearly 40% of new diagnoses are for foreigners. But mother to child transmission (MTCT) has become relatively rare (only 0.3% in 2011), so much so that this group of subjects is in noticeable decline.  Today they are the living testimony of a most tragic stage in the history of the disease: a pioneering and unique group, with a long association with the infection.

In this paper we present some of the first conclusions of an ethnographic study of processes of social exclusion experienced and conceptualized by Spanish adolescents vertically HIV-infected. Since the mid-1990s, Highly Active Antiretroviral Therapy (HAART) has been implemented in countries with advanced public health systems, with the result that children infected at birth manage to survive, reach adolescence, and gain intimate and inescapable awareness of the disease and its social significance. Consequently, for these young people some of the problems usually associated with adolescence are amplified or exacerbated by qualities specifically related to the side-effects of their medication, to their generally low self-esteem and to their fear of social rejection.  Initial observations of these phenomena stimulated the research reported here, whose main objective is eventually to discover and represent any cultural model or models and behavioral strategies that adolescents living with HIV might share.  We seek to address these goals by examining autobiographical narratives collected through semi-structured interviews. Through their interpretations we hope to assess the nature and degree of social exclusion they suffer, given the powerful stigma associated with HIV/AIDS in Spain.  We also seek to discover the strategies and tactics that they employ to avoid or attenuate these outcomes. Specifically, we will describe a form of auto-exclusion we found to describe a number of the HIV positive youth with whom we worked.

In the course of our interviews we sought to understand these facts and circumstances but, above all, the focus has been on how these youth experienced and conceptualized their disease and how they have acted to reduce their exposure to social rejection. Unlike the cases of young people infected by unsafe sex, knowledge of diagnosis does not substantially and immediately alter the medical aspects of the lifestyle of an adolescent who contracted HIV at birth, but only learned of it subsequently.  These patients are not only accustomed to the routines of the hospital and medication regimens, their early experiences have been marked deeply by the disease and its treatment.   Yet, at the critical moment of transition to adolescence, they abruptly encounter the full impact of the social significance of HIV.  

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