Hi Friends,
On a visit to my local clinic yesterday, something happened. Two things, actually. First, I missed my way around the mazy crops of buildings that formed the hospital. And then, I wound up at a closely knit place that served as a medical support group for HIV patients. Sitting down there in my cashmere sweater, head warmer, slip-on and old school bag, I easily passed as one of them, so I was able to cash in on their conversation. A woman, with a baby in her arms, was telling fellow women about how she had lost heart when she was diagnosed with 'the thing' upon her first pregnancy. She said she lost every sense of existence, lost money easily anytime she was at the market, and even contemplated several unimaginable things. It was her husband, who dissuaded her from her suicidal thoughts, told her not to tell a single soul, not even his mother, as well as encouraged her to take the medicated drugs henceforth. She gloated over the fact that her husband and children were HIV negative. I looked at the woman as dedicatedly as the other women folk were looking at her, and honestly, I couldn't help but catch myself as I marveled at the sheen of her skin, the sparkle in her eyes.
Wikimedia, by USAID, Public Domain Licensed
I told you two things happened. Well, the second was only in relation to the first. While still sitting there, a nurse came in to the waiting area with files and started calling the names of the patients. In due course, she breezed past a name and then a woman rose up to answer. Almost immediately, she picked up another file and called the name out. The name called tallied with the previous name, only varying by the first name. And the answerer? She was a little kid who could barely understand everything going on. Technically, it was obvious that both mother and child were HIV positive. And I don't know if I read too much meaning into the crease on the woman's face, but I thought I saw unhappiness painted all over. This unseemingly unimportant encounter struck a chord in me. And this is what has inspired me to want to address how the management of HIV patients by socio-psychological means.
The Psychological Problems faced by HIV Positive People
If we were to go by a rough estimation, twenty five years ago, HIV was the Hitler of all diseases, and with the deadly ravaging symptoms it unleashed on victims came the accompanying sentiments and prejudices that trailed it closely. Gratuitously, medicine has found a way to manage HIV as well as prolong the lives of infected ones through the development of anti-retroviral drugs. So that, at present, the real menace is not in being diagnosed with HIV, but in the psychological and social menace they are plunged in afterwards. Hence, while an infected person is capable of easily getting past the virus in the body; it is the viruses outside of their bodies that can kill them faster.
Wikipedia, by Thomas Splettstoesser, CC BY SA 3.0 - THE MEDICAL MANAGEMENT OF HIV/AIDS
A person living with HIV is bound to face a wide range of assaults to their psychological well-being and they include the following:
Traumatic reactions upon HIV Diagnosis: It is at the point of diagnosis that the psychological problems confronting a patient begins. Upon receiving the news of their infection, HIV patients are prone to various reactions, the best among them being fear, shock, utter disbelief, denial and guilt. Generally, these feelings arise from their preconceived notions as to what HIV is, and their impending mortal death. Even in several parts of the world, many still believe that a person, once diagnosed with the viral infection, is bound to waste away slowly and painfully with no hopes for living out the future they erstwhile had in mind. This exaggerated myth has confined many HIV patients diagnosed in these countries to the throes of guilt?
And yes, there are the other things. While the confidentiality of a patient is duly adhered to, these patients are expected to confide in and trust the information to certain individuals, like their sexual partners with whom they have had unprotected sex with and those prone to sharing objects with them. However, the psychological demoralisation that comes with the diagnosis and the fear of social acceptance cripple most of them into not telling. And this, one must admit, is a dangerous card to play which only ends up mounting their feelings of guilt.
Anxiety and depression: The anxiety and depression in a HIV patient mostly comes from the utter and drastic change of lifestyle they are subjected to. This is especially with recourse to the need to abstain from the work they do or the circle of friends they keep. Or even their sexual relationships. The anxiety and depression may be somatic or physical in nature, so that it causes an increase in heart rate, sweating, nausea, sleep difficulties, loss of libido, anorexia etc. It might as well be cognitive manifesting as reduced concentration, feeling of worthlessness, failure. And there is the affective symptoms where a patient experiences loss of control, restlessness, reduced activity levels, lack of energy and irritability.
Burnout: This generally occurs more in younger patients, with a high number of dependants and an awkward environmental setting. This burnout refers to a lethal combination of emotional exhaustion, depersonalisation, and a feeling of unaccomplishment. It often comes with treatment related stress, especially when the patient's condition is fully blown into AIDS.
Side Effects: Gracious as the HAART medication is, in helping HIV patients live a better life, it has its own side effects which prompt the patients into psychological menaces. These effects might be short term (diarrhoea, nausea) or long time (neuropathy, lipodystrophy). The side effects may also be physical in nature, as the affected persons may end up adding more flesh to their body parts. The feeling of despair and depression occasioned by these side effects might cause them to stop using the drug or complying with medical instructions. And this, in the long run, hampered their health.
Neuropsychological Implications: Patients in their advanced phases have gone on to exhibit defects in their central nervous systems like sub cortical dementia, decline in visio-specisl ability, and the deficiency of their immunes have led to secondary implications like toxoplasmosis, progressive multi- focal leuconencephalopathy and lymphoma. Also, family and friends have been plunged into several stages of distress. The lack of financial aids and social support may advance this despair.
So what do our psychotherapists think are the therapeutic solutions to these psychological crises?
Meeting the Psychological Needs of People Living with HIV
Wikimedia by Gary van der Merwe, CC BY SA 3. 0
Informational Assessment and Mental Health Counseling: Before establishing the diagnosis of a patient, a pre-counseling session is often advisedly carried out. This is to empower those awaiting diagnosis in preventing further transmissions through a proper knowledge of sex and drug using behaviors. Also, the distress of the patient upon receiving a positive affirmation of the infection is reduced. In essence, the pre abs post counseling sessions are meant to act as support pillars for the concerned individuals as well as help the society.
Also, it has been tagged important to assess the patient's current psychological state after diagnosis. This is to help psychological doctors and experts prioritise the psychological needs of patients upon diagnosis. While a couple of the patients will need to have their mythological doubts cleared first, some other might need bolstering with regards to talks on possible financial freedom or relationship possibilities. Even without any previous clinical affective disorders, distresses occur. Hence, those with a history of psychological conditions will need to get more concentrated attention.
Counseling intervention for HIV patients may come in form of individual treatments that address the individualised problems of patients or group treatments in form of support groups where a specific situations such as drug compliance are touched.
Cognitive Behavioural Psychological Model: The psychological needs of HIV patients are addressed via the adherence to the cognitive behavioural model. This includes having relaxation training and breathing exercises, engaging in thought stopping, activity scheduling, positive reframing, reality resting, and the development of long and short term plans. For instance, in Hong Kong, several small groups of HIV infected people meet weekly in 2-3 months to engage in exercises, discuss about health behavior changes, stress responses and positive coping techniques. And this has been thought to improve the quality of lives of members.
Spirituality: Many HIV infected people upon diagnosis seek solace and meaning in religious meetings and a deep, soul-searching delve into the concepts of God. And surprisingly, psychotherapists think this proves a positive channel to expel the guilt and feelings of condemnation or punishment the patients have exacted on themselves. Also, spirituality can help HIV infected people cultivate forgiveness and develop hope that can positively change their attitudes and mindset. However, in the process of seeking spiritual comfort, patients can be exposed to new emotional traumas and a a spitting rejection of their beings. In such a case, the affected patient should be withdrawn from whatever is causing the retrogressive trauma.
Social Support: More than anything else,reintegrating HIV infected people into the normal scheme of things is the most important phase of their management. And it is the hardest part. This is because of the stigma attached to HIV and the self inflicted trauma that comes from seeing the viral infection as a form of judgemental retributio. In combating this, the family and friends of patients are to be re-educated as to their role in the individual's life. They are not to directly attack the individual neither should they shy away from the obvious. Rather, they should talk about the condition, gloss over its negativites and dwell more on the positivites.
Also, thoughts about death and dying inherent in the patient need to be detoxified with constant reference to the medical breakthroughs that is bound to increase the lifespan of the patient. Not for once should family and friends allow these suicidal thoughts to dwell alone in the patient and fester within them.
More so, health workers have been advised to investigate on the social needs of the patient and address it. Be it the need for a vocational trade, the need for a more receptive environment or for a specialised support group, like in the case of pregnant HIV patients or children who were infected with the virus by their mothers.
Palliative Care: The possibility of getting to the final stages of AIDS and facing death is inevitable. In the event of this, measures should be taken to relieve the suffering of patients. And for psychotherapists, the best way to do this is to make the patients feel in charge of their situation till the end. They should be made the final call with regard to crucial decisions that need to be taken. No decision on drug stoppage or chemotherapy or what have you should be taken on behalf of the patient. And while it is important to keep the patients within the confines of a hospital, vit is more important to expose them to the love and care of their families and friends.
I should stop here already. But I do hope that you have picked one or two tips, and that, in the event of being close to a HIV infected person, you would know just how to affect them socially and psychologically, and put a smile on their faces.