1. April 2003 PSYCHOSOCIAL ISSUES IN HIV/AIDS Karina K. Uldall, MD, MPH Department of Psychiatry University of Washington

2. April 2003 Pre-HAART More rapid, fatal course of disease Emphasis on treating opportunistic infections and providing palliative care Quality of life affected by various symptoms

3. April 2003 Post-HAART More chronic disease course Complex treatment regimen with many adverse effects Prognostic uncertainty

4. April 2003 Population Issues Disproportionate impact on marginalized groups Less access to and engagement with care system Co-morbidities such as hepatitis, mental illness, substance use Complex psychosocial issues result

5. April 2003 Positive Aspects of HIV/AIDS More services and support available Renewed spirituality New, healthier relationships Priorities clarified Conflicts resolved

6. April 2003 Negative Aspects of HIV/AIDS Stigma/Discrimination Estrangement from family/community Fear of contagion Fear of death Feeling like a burden Loss of dignity Guilt Grief over multiple losses

7. April 2003 Cultural Issues Meaning of illness and death Family or community role in illness Value of autonomy Communication patterns Mistrust of authority/medical systems

8. April 2003 Interventions Accompaniment Advocacy Assessment Care Coordination Crisis Intervention Engagement Listening Motivational Interviewing Patient/Family Education Problem Solving Referrals Skills Building Support