PSYCHOSOCIAL

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

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

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

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

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

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

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

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

April 2003