PSYCHOSOCIAL ISSUES IN HIVAIDS Karina K Uldall MD

PSYCHOSOCIAL ISSUES IN HIV/AIDS Karina K. Uldall, MD, MPH Department of Psychiatry University of Washington

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

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

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

Positive Aspects of HIV/AIDS • • • More services and support available Renewed spirituality New, healthier relationships Priorities clarified Conflicts resolved

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

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

Interventions • • Accompaniment Advocacy Assessment Care Coordination Crisis Intervention Engagement Listening • Motivational Interviewing • Patient/Family Education • Problem Solving • Referrals • Skills Building • Support