Why the need for psychological support:

In order to deal with a range of psychological challenges associated with testing positive:

1. Anticipatory losses/mourning

2.  Increased risk for the worsening of the quality of life

3.  Fear of physical decline and death

4.  Coping with uncertainty.

5.  Keeping up with the rapidly changing treatment developments and outlook.

6.  Coping with the stigmas associated with the contracting of HIV/AIDS.

7.  Coping with reactions of those in family/community/nationhood, who has fears related to HIV being infectious and potentially fatal.

Issues facing persons with HIV/AIDS

 ¨      Testing HIV positive

Emotional responses to testing HIV-positive include:

1. Shock
2. Disbelief
3. Panic
4. Fear:

·        Of rejection by loved ones and community

·        Of being stigmatised (e.g. Homophobia)

·        Pain associated with medical aspects of the disease

·        Death and dying.
 

5. Guilt- persons who have contracted the infection due to "preventable" causes will likely feel guilt and blame themselves for having contracted the disease
6. Anger
7. Despair
8. Hopelessness
9. numbness
10. Sense of possible abandonment
11. Proneness to self-loathing
12. Isolation

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Patients need to integrate this new information into their existing identity. This involves:

1.  Questioning assumptions about many aspects of their life

2.  Rethinking priorities and goals

3.  Acquiring new skills that may be necessary to accomplish reformulated goals.

4.  Coming to terms with a sense of guilt that they "should have known better."

Ways to provide support in this process include:

1.  A supportive, non-judgmental stance.

2.  Empathy.

3.  Assuring the person that s/he is not alone.

4.  Referrals to a mental health professional, as support group, a local community-based organisation and online resources e.g.- online support groups.

¨      Disclosure of HIV Status (Individual vs. public rights)

Ø      Who should the information be disclosed to.

Ø      When is the right time to disclose to:

1. Sexual partner (s)

2.  Family (of origin and procreation)

3. Workplace

4. Friends

Ø      Who has the right to disclose. Should disclosure be done by a third party, for instance:

1.  Medical doctor

2.  Mental Health person- Confidentiality issues pertaining to when there is a duty to warn.

3.  Co-worker who was taken into confidence of the person.

4.  Supervisor/management who were informed for purposes of accommodation.

Note: Since research has not shown that co-workers are at risk, by working with a person who is HIV positive, the laws in a lot of communities do not recognise termination of employment based on a person having the disease. By extension, it is seen as the person's right to disclose.  

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Ways to provide support:

1. Active listening, empathy and feedback.
2. Referrals to a mental health professional, as support group, a local community-based organisation and online resources e.g.- online support groups.

¨      Making Treatment Decisions

1. This process is hindered when patients do not feel comfortable to ask questions and seek opinions of professionals, because the doctor is the "expert" and attempting to get involved is perceived as the patient wanting to be the doctor themselves or inappropriate. Such fears are sometimes supported by the doctor themselves, who are not open to the patient being a part of the collaborative process for care.

2. However, patients who take a strong interest in their medical care and participate actively in treatment decisions are more likely to adhere to their treatment plan and medication schedules.

3. Many patients are uncertain, ambivalent and anxious about starting therapy.
   

Ways to provide support:

1. Encourage patients to educate themselves about the appropriate options by giving referral to informational sources.
2. Give the patient permission to express their opinions, concerns, disagreements, or doubts about ongoing or proposed treatments.
3. Give the person facts about the options, and then time to decide.

¨      Adherence to Combination Antiretroviral Therapy

 Problems associated with it are:

1. A demanding dosing schedule
2. Common adverse side effects
3. The threat of the relatively rapid development of resistance.

Ways to provide support include:

 Medical/Mental Health Professionals/ Family Members

1. Although the goal is to facilitate adherence to the treatment, providers need to adopt a non-judgemental stance which recognises (normalises), that medication is missed from time to time.
   Such a stance encourages patients to be open about problems they have with adherence.
2. Identify what are the blocks to adherence.
3. Problem-solve around strategies that will deal with these blocks.
4. Implement and evaluate such.

  ¨      Maintaining a Healthy Lifestyle

 This is a very important way in which the person may be able to see himself/herself as influencing the course of HIV disease, the quality of life and psychological well-being. These behaviours include:

1. Good nutrition
2. Exercise
3. Control of recreational drinking/smoking.
4. Alterations in sexual risk behaviour.

Taking charge by making improvements in these areas can enhance patients' feelings of well-being and mastery of their lives.

¨      Sex and Relationships

Usually, when someone is initially diagnosed with HIV infection or AIDS, there is a significant decline in sexual interest and activity. The process of re-engaging in sexual activity and romantic relationships can be difficult because of:

1. Anxiety over disclosure
2. Fear of rejection from potential partners.
3. Fear of inflecting others.
4. Difficulties in negotiating safer sex.

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Over time, however, most people will want to resume sexual activity. The following should be taken into consideration:

1. Disclose condition to ALL potential sexual partners.
2. Couple should explore their feelings and thoughts re. Resuming sexual activity.
3. Talk to the doctor about ways to minimise risks of spreading the infection e.g. condom usage, one vs. multiple sexual partners.
4. Talk to the doctor about potential for spreading the disease to a baby, in the case of a heterosexual, child-bearing age couple.
5. Both partners should be fully aware of all risks and be comfortable with their planned course of action before re-starting sexual relations.

¨      Assessing psychiatric states

During specific times in the course of HIV disease, patients are particularly vulnerable to acute distress, such as when first notified.

Psychiatric distress is common among HIV-positive patients:

1. Depression - the most common psychiatric disorder observed among HIV-positive patients.
2. Substance use disorders.
3. Cognitive impairment (neuropsychiatric) .

Impact :

1. Increase in stress and psychiatric problems can slow down the immune system and tends to place more strain on it.
2. It can contribute to diminished health outcomes e.g. by affecting the effectiveness of the combination treatment.
3. Lead to increased substance use
4. Poor treatment adherence due to impairment in judgement and greater difficulty in putting in a structure by which to care for self.
5. Increase in risky sexual behaviour
6. Increase in other maladaptive behaviours.
   

Ways to provide support:

Family Members

1. Educate yourself on symptoms of common psychiatric disorders.
2. Observe where symptoms are shown, or anything that constitutes strange behaviour.
3. Talk with the patient.
4. Bring it to the attention of your doctor or mental health professional.
   

Medical/Mental  Health professional

1. Rule out for symptoms being the result of the course of the disease.
2. Refer patient for specialist evaluation and treatment of psychiatric disorders.

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