The Psychological Impact of HIV on Families, Friends and Partners PHASE, Canadian Psychological Association and Health Canada Module developed by Jennifer Hendrick, Ph.D. QE II Health Sciences Centre Halifax, Nova Scotia

1 You don’t have to be infected to be affected by HIV/AIDS Parents Friends Co-workers Lovers/Partners Children Siblings Other relatives

2 Is it the same as being affected by other chronic illnesses?

3 In some ways... 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.

4 But there are differences with HIV... Stigma Young age Fear of transmission Double disclosures Affected in multiple ways Episodic.

5 A family is whomever a person or persons define as their family.

6 How families cope with illness depends on their... Belief systems Ethnicity Religion Social class Developmental level Relationship to treatment providers.

7 “My adult child is HIV+.” “I always wondered if he was gay but we never talked about it …” “I can’t tell my friends – it’s a small town …” “Am I his mother or his friend?” “A father is not supposed to bury his child …”

8 “I’m an HIV+ parent …”

9 HIV+ parents have many concerns: Future needs of children (guardianship) Living with uncertainty Complicated health issues Complicated family issues Disclosure/fear of discrimination Financial issues Discipline issues Guilt – internally, externally imposed Fear of transmission.

10 “My mother is HIV+ …”

11 Children of HIV+ parents may... Feel helpless, abandoned, sad, scared, angry Lack support Take on “parentified” roles Have problems at school.

12 “My sister has HIV …” “Will I get it too?” “Why does she get all the attention?” “It’s hard to cope with schoolwork.” “I’m so sad.” “I’m so scared.”

13 Issues that Couples Face

14 “My lover has HIV; I don’t.” There are three types of serodiscordant couples.

15 Serodiscordant Couples Those who were together prior to HIV testing; when tested, one was HIV+. One partner seroconverts during the relationship; the other doesn’t. Relationship begins with knowledge that one is HIV+, the other HIV-.

16 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.

17 “We’re both positive …” Concordant couples

18 “… but that doesn’t always make it easier to deal with HIV.” Safer sex is still an issue Financial problems Projection, identification with lover’s health status “What if we’re both sick at the same time?” “Who will die first?”

19 Those affected by HIV need support: >Individual therapy >Couple therapy >Family therapy >Child therapy >Psychoeducation >Connection to community resources (e.g., PFLAG, other support groups) >Bibliotherapy.

20 Therapy with children should: Be integrated with services for other family members Be stable and continuous Take into account the child’s cognitive and emotional developmental levels.

21 Case Studies

22 Case Study: Linda Linda, age 55, has been referred to you by her GP with the following symptoms: insomnia, impaired concentration/ memory, poor appetite, tearfulness. Onset two months ago when her son, age 35, told her he’s HIV+ and gay. Cont’d...

23 Case Study: Linda (cont’d) Linda’s husband, Bob, doesn’t want to talk about it. Bob has forbidden Linda to tell relatives or friends. All Linda knows about HIV is from movies and TV.

24 Questions for Discussion re Case Study 1.What issues or difficulties could be contributing to the client’s symptoms? 2.How would you and your client determine therapeutic goals? 3.How would you intervene or work with the client? 4.What referrals would you suggest or offer?

25 Case Study: Wanda Wanda, age 23, recently tested HIV+ after her 5-month old son was admitted to hospital, diagnosed with AIDS. Her former partner, the baby’s father, an injection drug user, also tested positive. Cont’d...

26 Case Study: Wanda (cont) Wanda’s symptoms include: insomnia, poor memory and concentration, tearfulness, irritability, poor appetite, guilt feelings. She has had several conflicts with the baby’s health care team. She plans to live with her baby at her parents’ until she can find work; they will help but don’t want her to tell anyone in their small town about their HIV.

27 Questions for Discussion re Case Study 1.What issues or difficulties could be contributing to the client’s symptoms? 2.How would you and your client determine therapeutic goals? 3.How would you intervene or work with the client? 4.What referrals would you suggest or offer?

28 Case Study: John and Peter John, age 25, diagnosed HIV+ three years ago, is asymptomatic. John thinks he was infected by his former partner. Peter is HIV-. Lately they’ve been arguing over trivial matters, rarely talking about HIV. John’s having trouble maintaining an erection so he’s been avoiding sex. He wants a referral to Urology.

29 Questions for Discussion re Case Study 1.What issues or difficulties could be contributing to the client’s symptoms? 2.How would you and your client determine therapeutic goals? 3.How would you intervene or work with the client? 4.What referrals would you suggest or offer?

30 Case Study: Jeff and Mary Jeff, age 35, was referred with: tearfulness, irritability, poor concentration and memory, muscle tension, guilt feelings. Jeff tested HIV+ three years ago; very ill until this year. Jeff and Mary married 10 years, have 6- year-old son. Both Mary and their son are HIV- cont’d...

31 Case Study: Jeff and Mary (cont’d) Mary didn’t know that Jeff had been unfaithful (or bisexual). Since he’s been feeling better she’s been really angry, wants to leave him, take their son with her. Jeff can’t work; Mary has job with good benefits.

32 Questions for Discussion re Case Study 1.What issues or difficulties could be contributing to the client’s symptoms? 2.How would you and your client determine therapeutic goals? 3.How would you intervene or work with the client? 4.What referrals would you suggest or offer?