What is HIV?
HIV is ‘Human Immunodeficiency Virus’. It’s a degenerative disorder that attacks the immune system. It is recognised as a chronic treatable illness, rather than a terminal condition (Boisse, Gill & Power, 2008). Someone who is HIV positive, however, can be ill for many years without showing symptoms. When various particular illnesses happen due to the HIV virus, a person can develop AIDS (Acquired Immune Deficiency Syndrome). The use of Highly Active Antiretroviral Therapy (HAART) medication in conjunction with HIV-1 viral load monitoring has become standardised clinical care for HIV-infected individuals.
You cannot ‘catch’ AIDS. If a person has HIV, however, and doesn’t show symptoms, doesn’t know and therefore hasn’t had a diagnosis or treatment, the virus can be transmitted via the following bodily fluids: semen, blood, vaginal fluids and breast milk. Infection occurs only when these fluids from a HIV positive person enter the blood stream of another. Typically, the main route of HIV transmission is via unprotected sex. It can also be transmitted via sharing needles and syringes, mother to child and, very rarely, via blood transfusion.
HIV/AIDs trauma and change
At the time of first being diagnosed with HIV, people talk about incredible shock, panic, fear, guilt, disbelief, anger, hopeless and numbness. For some individuals, their response can include symptoms similar to Post-Traumatic Stress Disorder (PTSD). Those who later develop AIDS (‘sero-conversion’) after HIV talk about it being a physically and emotionally traumatic period.
For individuals living with HIV/AIDs, there are consequential changes to the way they see themselves and their world – with periods of assumptions about life, it’s meaning, the relationship within it, their priorities and goals. There can be associated guilt and self-blame – the whys, should haves and what ifs. Individuals who were diagnosed in the 80’s can often share a collective trauma – when the virus was first considered terminal, their families could reject them or prepare their funerals. The future was uncertain. Many individuals of this time remember burying their friends.
Psychological well-being and maintaining quality of life are important issues – considering what is within or outside your control and how best to look after yourself. This includes examining (and if need be changing) nutrition, exercise and drug and alcohol use.
Psychological issues for people living with HIV/AIDs (PLWHA)
There is a considerable overlap between having a HIV infection and being at risk of psychological difficulties. Many HIV-positive individuals will have a co-existing mental illness (or number of illnesses).
Depression is the most common psychological difficulty experienced by HIV-positive individuals, followed by anxiety disorders. At any one time, 22-50% of people with HIV will have depression and/or anxiety (Perkins et al., 1995). Rates of depression amongst HIV infected individuals are at least twice that of the general population (e.g. Ferrando & Freyberg, 2008) and are moderated by how compromised the person is by their HIV.
The symptoms of depression and HIV not only overlap but can play off one another – these include lethargy and mood and motivation changes. A loss of interest or enjoyment in life (a stand-alone symptom of depression) is commonly worsened by being acutely sick, or having a chronic physical illness. Those who are medically will also experience a higher severity of symptoms (Clark, Cook & Snow, 1998). For example, feeling hopeless is common, severe and pervasive.
A number of cognitive (thought) changes are also shared between HIV and Major Depression (including poor concentration, forgetfulness and difficulty with decision making). Finally, the side effect profiles of HAART medications (such as fatigue, headache and changes to appetite) can also mimic depression. Assessing when and how depressive symptoms develop (e.g. how close the link between them and beginning antiviral therapy) are important questions to ask in getting the best help.
The issues faced in depression also affect how likely a person with HIV adheres to their medication. Continuing to monitor your neuropsychological, emotional and physical health profile is important. HAART medications, for example, can help with preventing some of the brain changes that come with HIV (Cysique et al, 2009; Kaul, 2009; Cohen et al, 2001).
Drug use (recreational or otherwise) can also be an issue before a HIV diagnosis, or can be an initial way of avoiding the trauma of diagnosis – living hedonistically (given life is uncertain) can be at first an (apparent) way of coping. Over time, however, this drug use can significantly impact upon a person’s ability to work, socialise and maintain relationships. Pot, speed, ice, coke and/or pills puts an HIV-positive person at risk of exposure to new infections, changes in physical and emotional well-being and non-adherence to medication. When the frequency, amount, and context of the substance use are problematic (in their degree of impact on a person’s health, in any way), therapy is available.
Therapy for HIV-related psychological issues
Cognitive Behavioural Therapy interventions (which emphasise coping strategies and active behaviours) have been found to be very helpful, particularly in reducing depressive symptoms (Ferrando & Freuberg, 2008). Acceptance and Commitment Therapy (ACT) has also been considered significantly helpful for those living with HIV/AIDs. Given the illness is unchangeable, ACT explores ways of living consistently with values and self-identity. Mindfulness and defusion strategies are also helpful ways of managing anxiety and uncertainty. Finally, the relationship with your therapist is paramount. Some individuals have reported feeling invalidated by treatments that saw their psychological issues ‘under the umbrella’ of living with HIV, rather than as stand-alone issues (warranting attention) in their own right.
Where to go from here?
If you would like to find out more about our therapies for those living with HIV/AIDS, or to book an appointment with our Clinical Psychologist who provides treatment for HIV-related psychological issues, please email or call us on 02 9438 2511.