1. 1 Psychosocial Issues Faced by PLHIV HAIVN Harvard Medical School AIDS Initiative in Vietnam

2. 2 Learning Objectives By the end of this session, participants will be able to: Describe the psychosocial issues faced by PLHIV Explain HIV-related stigma and discrimination issues Identify strategies to address psychosocial issues in PLHIV

3. 3 Question: What are the Main Psychological and Social Issues Faced by PLHIV?

4. 4 Overview of Psychosocial Effects of HIV Psychosocial effects may begin as early as initial diagnosis and evolve throughout person’s illness Common effects may be: Economic Medical Emotional Social

5. 5 Types of Psychosocial Effects Category Effect Medical uncertainties about disease progression, life expectancy, risk of treatment failure, side effects mental health problems Economic job loss due to discrimination, being too ill to work savings lost due to money needed for treatment Emotional low self esteem fear of death loss of beloved, loneliness guilt, fear of abandonment Social isolation from family and community due to stigma and rejection fear of disclosure

6. 6 Discussion: Patient Reactions What reactions might patients have to HIV? As doctors, what reactions have you witnessed when someone is first diagnosed with HIV or AIDS?

7. 7 Mental Health and PLHIV

8. 8 Mental Health and HIV Mental health problems are common in PLHIV Depression Anxiety Substance Abuse and Addiction Although common, these conditions frequently go undiagnosed and untreated.

9. 9 Mental Health and HIV: Depression Depression is common among PLHIV in Vietnam Depression can manifest as: Depressed mood Poor appetite, irritability, sleep disturbances Difficulty concentrating Suicidal thoughts Source: Esposito et al (2009)

10. 10 Stigma and Discrimination

11. 11 Stigma and Discrimination (1) Stigma is the most significant negative psychosocial impact of HIV/AIDS People with HIV frequently experience discrimination Healthcare providers must consider this when addressing psychosocial needs

12. 12 Stigma and Discrimination (2) HIV related stigma: Is experienced differently by PLHIV, family members and community Occurs when HIV diagnosis is not kept confidential or PLHIV are treated differently Gaudine, A., et al., Perspectives of HIV-related stigma in a community in Vietnam: A qualitative study. Int. J. Nurs. Stud. (2009), doi:10.1016/j.ijnurstu.2009.06.004

13. 13 What are Some of the Effects of Stigma and Discrimination on PLHIV?

14. 14 Effects of Stigma and Discrimination Prevent accessibility to HIV testing, prevention, care and treatment services Affect psychological well being Associated with depression Prevent PLHIV from disclosing HIV- status to partners, family, and friends Cause PLHIV to hide HIV status for fear of being denied services

15. 15 What Can We Do in the Healthcare Setting to Address Stigma, Discrimination, and Other Psychosocial Effects Faced by PLHIV?

16. 16 Fighting Against Stigma and Discrimination Make sure all providers understand risk for occupational HIV infection Educate health workers about the risks and methods of HIV transmission Implement universal precautions Treat PLHIV the same as others Do not label public spaces “HIV wards” as this discloses HIV status

17. 17 Addressing Psychosocial Issues (1) Identify patient’s emotional state Identify patient’s own resources Assess patient’s support system Encourage HIV disclosure and develop a disclosure plan Refer patients to local network of social and medical services

18. 18 Addressing Psychosocial Issues (2) Encourage positive thinking: view self as “living with HIV” rather than “dying from HIV” Encourage positive living Provide holistic care via family centered approach

19. 19 Key Points Psychosocial issues of PLHIV are complex Stigma and discrimination worsen the psychological state of PLHIV Providers need to be aware of these psychosocial complexities in order to optimize patient treatment, and refer for counseling as needed

20. 20 Thank you! Questions?