PSYCHOSOCIAL ISSUES IN HIV/AIDS

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PSYCHOSOCIAL ISSUES IN HIV/AIDS

• Karina K. Uldall, MD, MPH
• Department of Psychiatry
• University of Washington

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Pre-HAART

• More rapid, fatal course of disease
• Emphasis on treating opportunistic infections and
  providing palliative care
• Quality of life affected by various symptoms

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Post-HAART

• More chronic disease course
• Complex treatment regimen with many adverse
  effects
• Prognostic uncertainty

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Population Issues

• Disproportionate impact on marginalized groups
• Less access to and engagement with care system
• Co-morbidities such as hepatitis, mental illness,
  substance use
• Complex psychosocial issues result

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Positive Aspects of HIV/AIDS

• More services and support available
• Renewed spirituality
• New, healthier relationships
• Priorities clarified
• Conflicts resolved

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Negative Aspects of HIV/AIDS

• Stigma/Discrimination
• Estrangement from family/community
• Fear of contagion
• Fear of death

• Feeling like a burden
• Loss of dignity
• Guilt
• Grief over multiple losses

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Cultural Issues

• Meaning of illness and death
• Family or community role in illness
• Value of autonomy
• Communication patterns
• Mistrust of authority/medical systems

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Interventions

• Accompaniment
• Advocacy
• Assessment
• Care Coordination
• Crisis Intervention
• Engagement
• Listening

• Motivational Interviewing
• Patient/Family Education
• Problem Solving
• Referrals
• Skills Building
• Support