PSYCHOSOCIAL PSYCHOSOCIAL ISSUES IN HIV/AIDSISSUES IN HIV/AIDS

Karina K. Uldall, MD, MPHKarina K. Uldall, MD, MPH

Department of PsychiatryDepartment of Psychiatry

University of WashingtonUniversity of Washington

Pre-HAARTPre-HAART

• More rapid, fatal course of disease

• Emphasis on treating opportunistic infections and providing palliative care

• Quality of life affected by various symptoms

Post-HAARTPost-HAART

• More chronic disease course

• Complex treatment regimen with many adverse effects

• Prognostic uncertainty

Population IssuesPopulation 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

Positive Aspects of HIV/AIDSPositive Aspects of HIV/AIDS

• More services and support available

• Renewed spirituality

• New, healthier relationships

• Priorities clarified

• Conflicts resolved

Negative Aspects of HIV/AIDSNegative 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

Cultural IssuesCultural Issues

• Meaning of illness and death

• Family or community role in illness

• Value of autonomy

• Communication patterns

• Mistrust of authority/medical systems

InterventionsInterventions

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

• Motivational Interviewing

• Patient/Family Education

• Problem Solving• Referrals• Skills Building • Support