HIV / AIDS

Human immunodeficiency virus (HIV) is a serious, incurable health condition. HIV causes the immune system to gradually fail and ultimately leads to AIDS (acquired immunodeficiency syndrome), which can leave individuals susceptible to tumors, cancers, and opportunistic infections. As of June 2016, over 1 million people in the United States have HIV. Approximately 1 in 8 of these individuals remain unaware of their HIV status. 

There is not yet a cure for HIV, and the condition is ultimately fatal. Thus, a diagnosis of HIV or AIDS is often likely to have a negative impact on the mental and emotional well-being of those diagnosed. The support of a therapist may be helpful while waiting for test results or coming to terms with a diagnosis of HIV or AIDS. 

• How Is HIV Contracted?
• Medical Treatment for HIV and AIDS
• Coping with HIV and AIDS through Therapy 
• Support Groups and Group Therapy for HIV and AIDS
• Therapy for Families Affected by HIV and AIDS
• Case Example

How Is HIV Contracted?

HIV is transmitted through bodily fluids such as blood, vaginal fluid, semen, pre-ejaculate, and breast milk. It is not spread through saliva or casual contact. The virus is most often spread between people through the use of contaminated needles, during unprotected sex with an individual who has the virus, and through breast milk. It can also be transmitted during blood transfusions of HIV-infected blood or from mother to baby during childbirth, when the mother carries the virus. HIV cannot survive outside the body for long, however, and the virus is not often spread in other ways.

With precautions it is possible to reduce transmission risk, and it is also often possible to help reduce the risk that AIDS will develop from HIV. Transmission risk can be reduced in a number of ways, such as getting tested and being aware of one's HIV status, using condoms consistently and correctly, treating sexually transmitted infections (which can increase transmission risk if left untreated), and reducing the sharing of needles.

Medical Treatment for HIV and AIDS

HIV and AIDS cannot yet be cured, but treatment is available. Antiretroviral treatments, also known as post-exposure prophylaxis, reduce the viral load, controlling the infection and decreasing the risk of AIDS developing. In 2013, 37% of those living with HIV were able to receive treatment in the form of antiretroviral medications.

Antiretroviral treatment has also been shown to reduce the risk of HIV transmission from an individual who is infected by up to 96%. These antiretroviral treatments may also reduce the viral load to undetectable levels, making the virus almost nonexistent in the body (although it is still present). An individual with undetectable levels of the virus is far less likely to transmit it. This form of treatment as prevention began to be used in the mid-1990s, when it was shown to be effective at reducing the risk of transmission from mothers who were HIV-positive during pregnancy, delivery, or while breastfeeding.

Pre-exposure prophylaxis (PrEP) is a medical treatment that has been recently approved to help prevent HIV infection in those who are at substantial risk for contracting the virus: those in serodiscordant relationships (relationships in which one partner is infected with HIV and one is not), those who do not use condoms consistently with partners of unknown HIV status, gay or bisexual men who have recently been diagnosed with a sexually transmitted infection or who have unprotected sex, and those who share needles. This form of treatment is not 100% effective at preventing the virus from being transmitted, but research suggests that when PrEP is taken consistently and correctly, it may be up to 96% effective at preventing an uninfected person from contracting HIV.

With antiretroviral therapy, HIV often does not progress to AIDS, and those who take medication might still have a life span near that of a person without HIV. Without treatment, HIV often remains latent in the body for up to 10 years before progressing to AIDS. Once the virus has progressed to AIDS, however, life expectancy is typically about three years without treatment.

Coping with HIV and AIDS through Therapy

A diagnosis of HIV or AIDS may often be difficult to cope with. Although treatment has been shown to be very effective for HIV, and those receiving treatment for the condition can expect to live longer and experience a higher quality of life than they might have in years past, the virus may still have a significant effect on mental health. People diagnosed with HIV or AIDS may often experience depression and anxiety, grief for the perceived loss of the life they thought they would have, anger toward the person who transmitted the virus, and stress due to the financial demands of treatment and any lifestyle changes that may be required. It may also be difficult for individuals infected with the virus to navigate the additional challenges a diagnosis of HIV or AIDS can have on romantic relationships.

In therapy, an individual can explore ways to cope with these issues. Some mental health professionals may have particular training in treating people who have a life-threatening or chronic illness, and these therapists and counselors may be particularly suited to treat those who have been diagnosed with HIV or AIDS. Family counseling might also be beneficial to those who wish to inform their family of their diagnosis, explain what it means, and help family members adapt to the news. Couples counseling may be helpful to people in serodiscordant relationships (relationships where one partner has HIV and one does not). Individual or group therapy can also help an individual living with HIV to come to terms with the illness and cope with the challenges it adds to life.

HIV progression may also lead to cognitive impairment, as the virus can affect the brain. Dementia, delirium, and psychosis are some of the conditions that can result, and should any of these conditions develop, a combination of therapy and psychiatric medications may be effective treatment.

Some of those affected by HIV might find it difficult to cope with their illness and maintain a healthy routine. Relaxation methods such as meditation, eating well, making enough time for sleep, exercising, and enjoying hobbies that facilitate relaxation are all ways that might help some cope with their illness more easily. Being able to mentally cope with the challenges of a chronic illness may also help one have an easier time fighting off physical effects.

Because AIDS, which can develop from HIV, is a life-threatening illness, people infected with HIV may also wish to seek end-of-life counseling, especially as the disease reaches final stages. In therapy, individuals can discuss medically necessary issues with a therapist, make plans for the future for any family members or children who might need care, and come to terms with the eventual end of their life. In this manner, they are able to exercise control over the aspects of life that they still are able to control, as control over the body diminishes.

Support Groups and Group Therapy for HIV and AIDS

Some people with HIV or AIDS benefit from group therapy and/or support groups where they can connect and share with other people who are also infected as well as those who are not infected but may have a loved one who is. In this type of therapy, people may have the chance to network with other people who have experienced life with HIV/AIDS, to receive support that may be helpful when facing the challenges associated with an HIV or AIDS diagnosis, and to seek reassurance that life is still possible. Support groups often focus on developing healthy coping strategies and providing a community for people with HIV or AIDS.

Therapy for Families Affected by HIV and AIDS

HIV can be passed easily between intimate partners, especially between those who are unsure of their HIV status. It can also be passed from mother to child during pregnancy, childbirth, and breastfeeding. While any chronic illness might have a significant effect on the family and friends of the person who is ill, HIV can be particularly difficult for family and friends to cope with. A person who is infected might depend on an intimate partner or family member for care but might also be reluctant to disclose the illness to family members for fear of stigmatization, which may limit support. Parents may be reluctant to tell children who have been infected with the virus or to discuss safe sexual practices with a teen, though these can prevent further transmission.

Those with HIV are also often fairly young compared to other individuals coping with a chronic illness, which may be another factor that is difficult for families and loved ones to face. In a relationship where both partners are HIV-positive and one is dying of AIDS, the healthier partner may also experience survivor's guilt while fearing the eventual progression of the virus in his or her own body.

In these situations, therapy can be helpful. A couple might see a therapist individually, together, or both, and a family therapist might be beneficial to all family members. A therapist can help a family come up with the best way to notify a child or other family member of HIV status. Therapists may also often be able to provide information and resources about the condition.

Case Example

• Coping with an HIV diagnosis: Peter, 38, enters therapy shortly after being diagnosed with HIV. He reports symptoms of depression, an inability to concentrate on his work, trouble going about his daily routines, and fear that his life is rapidly slipping away. He tells the therapist that he worries constantly about developing AIDS, although he has started antiretroviral therapy and has been determined to be in good health by his doctor. The therapist asks Peter about his family and friends, and he reports that he has not told his brother or sister, both of whom Peter is fairly close to, and that he has not told his father and does not wish to, since his mother passed away only three years earlier from complications of multiple sclerosis. His friends have tried to comfort him, Peter reports, but he admits that he had difficulty accepting their affection and sympathy and lashed out at them instead, which has caused him to feel more isolated, as he worries that he has entirely lost their support after pushing them away. In therapy, he begins to explore ways to discuss his diagnosis with his friends and family. The therapist reminds him that mental health is just as important as physical health and encourages him to reach out to his friends and accept their support. Peter begins to develop mechanisms to cope with his anxiety, and he begins to feel more hopeful about his future after several sessions with the therapist. He is able to talk to his siblings and reconnect with his friends, and though he is aware that his life is changed, he begins to realize, with the help of his therapist, that he still has a great deal of control.

References:

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2. HIV in the United States: At a glance. (2016, July 11). Retrieved from http://www.cdc.gov/hiv/statistics/overview/ataglance.html
3. HIV treatment as prevention. (2015, June 1). Retrieved from http://www.avert.org/hiv-treatment-as-prevention.htm.
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5. Shernoff, M. (1996). Counseling end stage clients with AIDS. Retrieved from http://www.thebody.com/content/art2451.html.
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7. Teaching tip sheet: Multiple loss and AIDS-related bereavement. (n.d.). Retrieved from http://www.apa.org/pi/aids/resources/education/bereavement.aspx.