Exploring Psychological Interventions for HIV Sinéad Rooney PhD Student, School of Psychology Queen’s University Belfast

Overview Implications of acceptance to HIV diagnosis Reviewing challenges to HIV Acceptance and Commitment Therapy (ACT) Promotion of timely access to psychological support

Acceptance verses Non-Acceptance of Diagnosis Denial of status and active avoidance accounting for periodic and delayed entry to HIV care (Knockle-Parker, Amico & Henderson, 2011) Psychological care impaired through exposure to stigma- related experiences (Vanable, Carey, Blaire & Littlewood, 2006) Acceptance promotes medication adherence (Vervoort, Grypdonck, de Grauwe, Hoepelman, & Borleffs, 2009) Self-managment of HIV cited as an important goal for patients (Webel, Dolansky, Henry & Salata, 2012)

Current Study To gain understanding of the Challenges experienced by PLWH Focus Group Design Qualitative Methodology Initial Focus Group: Explore Challenges Second Focus Group: Introduce Strategies

Current Study Exploring challenges among support groups ▫Men’s, Women’s and First Steps Groups ▫Diagnosed between 4months- 26years ▫Age range Analysis using Thematic Analysis (TA) to identify common themes across all groups Themes identified: ▫Stigmatised Identity ▫Fear of Rejection ▫Attributional Styles ▫Self and Social Perspectives

Stigmatised Identity Perceived HIV Risk “I was a married woman and I split up with my husband and five years after that I met a man that was nice and we didn’t have dirty sex, we made love. And HIV was, you know, what I got from that.” (Gillian, FSG, p.2) “…I’m not this kind of one night girl…” (Gillian, FSG, p.7)

Stigmatised Identity Confronting Stereotypes “Yeah ‘cause I always used to say to myself like I was never the type to sleep about, never have one night stands…Any relationship that I’ve had or anybody that I’ve met, I’ve ended up in a relationship for 2 years or more…I don’t sleep about like that there and then I’m like why me?...I’m not a dirty tramp.” (Hazel, FSG, p.18)

Experienced Stigma Reaffirming negative beliefs “…I told the dentist…he called me and said ‘I’m sorry we are going to have to see you last’…” (Debbie, WG, p.11) “…once the midwife found out I was HIV positive she asked me to use the bathroom on my own. She even wrote a notice ‘Out of Order’…” (Clara, WG, p.3)

Consequences Social Isolation “I don’t have friends…the people I know are people from here.” (Debbie, WG, p.11) Adverse mental health outcomes “…I wanted to kill myself not that long ago.” (Gillian, FSG, p.23) Sexual Avoidance “…I could get into a relationship, I explain to the person my diagnosis then they run…the rejection yes and that trauma I don’t need…” (Betty, WG, p.16) Barrier to progress “…at the start I should have came but I don’t know why I just, I just wanted to block it all out like…” (Hazel, FSG, p.16)

Acceptance and Commitment Therapy (ACT) ACT aims to alter a client’s relationship with their negative thought processes with a view to enhancing psychological flexibility within the values of the individual. ACT asks its clients to take a new perspective on their own personal thinking habits (Hayes, Strosahl & Wilson, 2012)

Future Directions Application of the principles of the model on a one-to-one basis Analysis of the impact of ACT for HIV Review experiences for participants

Considerations for New Diagnoses Implementation of timely psychological support Awareness of the individual value-base Initiating early adjustment and acceptance can have important and long-term health and psychological benefits

“It’s not all doom and gloom and darkness and stigma, and you know, life is a lot of what you make of it…I’ve found that you have to make the most of your negatives and do what you can to, you know, help yourself really.” (Mitchell, MG, p.20) Sinéad Rooney School of Psychology