1

Psychosocial Issues Faced by PLHIV

HAIVNHarvard Medical School AIDS

Initiative in Vietnam

2

Learning Objectives

By the end of this session, participants will be able to:Describe the psychosocial issues faced by PLHIVExplain HIV-related stigma and discrimination issuesIdentify strategies to address psychosocial issues in PLHIV

3

Question: What are the Main

Psychological and Social Issues Faced by PLHIV?

4

Overview of Psychosocial Effects of HIV

Psychosocial effects may begin as early as initial diagnosis and evolve throughout person’s illness

Common effects may be:• Economic• Medical• Emotional• Social

5

Types of Psychosocial Effects

Category Effect

Medical • uncertainties about disease progression, life expectancy, risk of treatment failure, side effects

• mental health problems

Economic • job loss due to discrimination, being too ill to work• savings lost due to money needed for treatment

Emotional • low self esteem• fear of death• loss of beloved, loneliness• guilt, fear of abandonment

Social • isolation from family and community due to stigma and rejection

• fear of disclosure

6

Discussion: Patient Reactions

What reactions might patients have to HIV?

As doctors, what reactions have you witnessed when someone is first

diagnosed with HIV or AIDS?

7

Mental Health and PLHIV

8

Mental Health and HIV

Mental health problems are common in PLHIV• Depression• Anxiety• Substance Abuse and Addiction

Although common, these conditions frequently go undiagnosed and untreated.

9

Mental Health and HIV: Depression

Depression is common among PLHIV in Vietnam

Depression can manifest as:• Depressed mood• Poor appetite, irritability, sleep

disturbances• Difficulty concentrating• Suicidal thoughts

Source: Esposito et al (2009)

10

Stigma and Discrimination

11

Stigma and Discrimination (1)

Stigma is the most significant negative psychosocial impact of HIV/AIDS

People with HIV frequently experience discrimination

Healthcare providers must consider this when addressing psychosocial needs

12

Stigma and Discrimination (2)

HIV related stigma: Is experienced

differently by PLHIV, family members and community

Occurs when HIV diagnosis is not kept confidential or PLHIV are treated differently

Gaudine, A., et al., Perspectives of HIV-related stigma in a community in Vietnam: A qualitative study. Int. J. Nurs. Stud. (2009), doi:10.1016/j.ijnurstu.2009.06.004

13

What are Some of the Effects of Stigma and

Discrimination on PLHIV?

14

Effects of Stigma and Discrimination

Prevent accessibility to HIV testing, prevention, care and treatment services

Affect psychological well being Associated with depression Prevent PLHIV from disclosing HIV-

status to partners, family, and friends Cause PLHIV to hide HIV status for fear

of being denied services

15

What Can We Do in the Healthcare Setting to

Address Stigma, Discrimination, and Other Psychosocial

Effects Faced by PLHIV?

16

Fighting Against Stigma and Discrimination

Make sure all providers understand risk for occupational HIV infection• Educate health workers about the risks

and methods of HIV transmission Implement universal precautions Treat PLHIV the same as others Do not label public spaces “HIV

wards” as this discloses HIV status

17

Addressing Psychosocial Issues (1)

Identify patient’s emotional state Identify patient’s own resources Assess patient’s support system Encourage HIV disclosure and

develop a disclosure plan Refer patients to local network of

social and medical services

18

Addressing Psychosocial Issues (2)

Encourage positive thinking:• view self as “living with HIV” rather than

“dying from HIV” Encourage positive living Provide holistic care via family

centered approach

19

Key Points

Psychosocial issues of PLHIV are complex

Stigma and discrimination worsen the psychological state of PLHIV

Providers need to be aware of these psychosocial complexities in order to optimize patient treatment, and refer for counseling as needed

20

Thank you!

Questions?