Adressing Psychosocial Issues Among PLHIVs

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Addressing psychosocial issues

among PLWHIVSalmiah Md Sharif


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Outlines

Evolution of HIV care

Psychosocial issues and its impact to

individual and family

How to help PLHIV to address this issues.


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Evolution of HIV Care

Disease CareAcute

Reactive

Focus on dx/rx

Customized care

SpiritualMD role central

Health Care

Chronic

Proactive

Focus on behavior

Standardized care

Practical

Pt role central

Kathleen Clanon, MD 2007

1980 2010


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Evolution of HIV Care

PRE HAART: short

Term care

HAART: Long Term Care

RX of OI

Palliative care

Treatment Adherence / side-efects CoInfection / Comorbidity

Reproductive health / parenthood

Social Relationship

Employment / education

HIV CARE LINKAGESTIGMA &

DISCRIMINACY


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STIGMA, DISCRMINATION AND HIV

Stigma : attitude (labeling) Discrimination: act (harassment,

scapegoating

Self - stigma , social stigma People with HIV/AIDS are stigmatized

and discriminated against for manyreasons : HIV = bad lifestyles disease

HIV = incurable = death sentences

HIV = transmissible public fear


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Stigma

Fear ofdisclosure

Fear of loss

Fear of

harassment Fear of

rejection

Fear ofdisfigurement

Health behaviour

Preventivemeasures

Condomuse

Breastfeeding

Delay inseekingtreatment

Poor

treatmentadherence

Substanceuse

No socialsupport

outcomes

Poor QOL

Poorprognosis

Psychosocial

issues notresolved

Spread ofinfection

IMPACT OF STIGMA ON PLWHIV

HCP should aware of stigma

a/w HIV and protect patients

confidentiality and potray

Emphaty and non judgemental

Attitude.


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Psychological aspects of HIV

In order to provide holistic andcomprehensive care of HIV, HCP need tounderstand :

Psychological response of individual to diagnosisdisclosure

Impact of HIV on individual

Impact of HIV on families

Psychological issues associated with progressionof the disease

Reproductive health needs

Issues related to treatment


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Developmental stages of HIV disease in adulthood(Ross, Tebble, and Viliunas, 1977)

Reaction Psychological process

Stages 1 and 2:

Shock, denial, anger

Guilt, powerlessness, anger

Stage 3: Withdrawal Recognition of stigma, isolation

Stage 4: Bargaining

4a: Coming out to significant others

4b: Looking for otherHIV positives

4c: Special status

4d: Altruistic behavior

Testing others reactions and

bargaining, stress displacement, need

to be loved

Sharing, recognition, trust, positive

reinforcement, social support

Turning alienation into a unique

advantage, difference becomes special,

needed by others

Group commitment and cohesiveness,

feeling of community

Stage 5: Acceptance Integrated HIV status into self-identity,

balance between altruism and self,

coming to terms with condition


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Psychosocial effects of HIV on the

individual HIV threatens a persons life, goals,

expectance and significant relationships.

Requires enormous psychosocial

adjustments.

To battle HIV successfully, PLWHV must

have some level of acceptance of the

disease, so that they can seek counseling,social support and medical care.


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Individual Reactions to Disclosure of HIV Disease

The level of distress; depend on thefollowing:

Mode of acquiring the infection

Personality characteristics and lifestyle

Degree of support system available

Knowledge of and experience with AIDS-

related issues Accessibility to HAART (highly active

antiretroviral therapy)


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Psychosocial reaction of diagnosis

disclosure Psychosocial reactions :

anxiety

Depression

guilt

social isolation The nature and quality of disclosure are

critical to preventing emotional trauma. If the disclosure is blunt and aggressive

(ineffective pre test counselling), it canbecome a traumatic event that will affect thelong-term psychological balance


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Reactions to stress and trauma

Normal (fear, anger denial, depression, withdrawal)

Neurotic (exaggerated reactions)

Panic / anxiety

extreme avoidance behaviors

impairment of ability to love and work

Psychotic; most common is depressive disorders.

Psychosomatic


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Psychological Issues through Progression of

HIV/AIDS

Early stage : being persecuted by the virus. Later stage: physical and psychological

anxiety, fear of death

As the disease progresses, control (orpower) issues emerge as patients faceincreasing loss of physical control.

Self-efficacy and active involvement in their

health can increase peoples sense of being incontrol and reduce their risk of feelinghelpless.


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Psychosocial effects of HIV on the

family You dont have to be infected to be affectedby

HIV/AIDS:

Parent

partner

Sibling Children

relatives


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Psychosocial impact on the family

Stigma

Fear of transmission

Double disclosures Dealing with loss

Fear of illness and death

Feeling helpless, sad, angry

Financial worries Relationship conflicts

Uncertainty about the future

Dealing with the medical system.


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How families cope with illness

depends on their ...

Belief systems

Ethnicity Religion

Social class

Relationship to treatment providers.


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Serodiscordant couples face

many challenges:

Safer sex

Survivor guilt

Envy of the healthy

Lack of empathy

Fear of abandonment

Fear of transmission

Fear of illness/death

Trust/betrayal.


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Concordant couple

Safer sex is still an issue

Financial problems Projection, identification with lovers

health status

What if were both sick at the sametime?

Who will die first?


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Reproductive health issues

Sexual relationships

prevention of transmission and re-infection,

negotiation of safer sex ; condom use

disclosure of HIV status,

dealing with sexual dysfunction

Contraception

Prevent unplanned pregnancy

Desire for parenthood

Pre and post conception counseling


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What happened if we do not addrress

reproductive health issues

Review PMTCT reports in Selangor 39.1% of cases are a known case, about

40% of them booked late, even 29.3% of

them came at delivery.( ?? Achieve 0vertical transmission by 2015)

70% are married, about 48% of known

HIV status of partner was serodiscordant( issue of condom use and disease

transmission)


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Issues related to living with chronic

illness when to start treatment Treatment adherence

Fear of sideeffects especially lipodystropy

Treatment fatigue Treatment failure

survivor guilt

Employment

finance and benefits.

education


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Psychosocial Decision needs for

PLHIVStigma

Discrimination

Isolation

PLHIV

Whether or

not todisclose

Having or

nottreatment

Sexual/parenthood


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Behavioral mediation of psychosocial factors and HIV

disease progression : (Psycosomatic Medicine 70:

569-574 (2008)

Psychosocial Factors

Depression

Stress

Coping

Social support

HIV progresion

CD4 decline

AIDS

AIDS related death

Behavioral Mechanism Treatment non adherent

Substance use

Sexual risk behaviour

Lack of exercise


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Factors influencing the quality of life in patients

with HIV in Malaysia

C. I. Hasanah A. R. Zaliha Maheran : 2010

A cross sectional study, 271 PLHIV, outpatient Hospital Kota Baharu

To detemine factors influence QOL

PLHIVMalay version of the Functional Assessment of HIV Infection

(FAHI) and Malay Hospital Anxiety

Depression Scale (HADS).


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Factors influencing the quality of life in patients

with HIV in Malaysia

C. I. Hasanah A. R. Zaliha Maheran : 2010

Overall FAHI scores : better in nonmalays,employed, CD4 > 200, no psychologicaldisturbances.

Poor social wellbeing in Heterosexual vs IDU;

non- closure and, mental illness (38% possibleanxiety, depression or both)

Anxiety and depression impaired overall QOL

Psychological and social well-beings were more

affected than physical well-being in out-patients. Recommended that PLHIV should received better

psycho-education and psychological intervention.


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Psychosocial intervention

Psychosocialsupport

Counseling

education

Psychotherapy Cognitive

behaviour

therapy

Stress

management Pre & post

conception care

Medications

Positive behaviour

Good

adherence

Full use ofhealth care

service

High condom

use Positive living

Good mental

health

Good outcome Prevent spread

Delay disease

Good QOL


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How to help PLHIV .

Self awareness ? Judgemental

Reduce stigma and discrimination

Update knowledge

Strengthened communication skills

Widened network

Provide good delivery system


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How to help them .

Be able to recognize patients emotionalreactions .

Help them overcome denial

Help them improve self-esteem Assist them to recognize the unpleasant

reality of the disease while keeping hopeand goals in life,


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How to help them ..

Identify patients need and help them meet the needs

The needs could be

Information of the disease and treatment options.

legal support

Access to services

developing practical skills to improve adherence

disclose diagnosis to other parties,


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How to help them

Give support to patients through; Counselling

Education

Practical support and assistance Psychotherapy and psychiatric support
http://www.improvingchroniccare.org/index.php?p=Chronic+Care+Model&s=124


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http://www.improvingchroniccare.org/index.php?p=Chronic+Care+Model&s=124


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Health care delivery

Patient involvement and self- care

Shared care ; patients preferences are

considered

Pt has adequate and accurate information

Decision support aids / intervention

Information on risk and benefits of each

alternatives.


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Take home message

Psychological and social factors influence theability to cope with HIV/AIDS more than theseverity of the disease.

Stigma and discrimination are critical factors

to be considered. HIV has profound psychosocial effects on

the HIV-infected person, the family, thecommunity

Our duty to assist PLHIV addresspsychosocial issues by empowering them tomake informed decision.

Documents

Adressing Psychosocial Issues Among PLHIVs