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THE OTHER ISSUES BEYOND PSYCHIATRIC DISEASE AND SUBSTANCE USE IN THE MANAGEMENT OF PATIENTS FEAR • OF THE UNKNOWN – What will happen to me? – What will life be like? • OF DISCLOSURE – Rejection because of HIV status – Rejection because of behavior that led to infection • OF LOSS OF CONTROL HEALTH BELIEFS • If you need to take medication you are sick – I don’t feel sick and therefore… – If I’m taking medicine I must be sick and this symptom is potentially deadly • Medications are toxic • Taking medicines weakens your system • With certain conditions or with some medications, you should not take HIV medicines. • The medicines killed my friend LIFE CRISES • Life is crisis after crisis, hard to plan • Living between two countries or two states or two homes • Homelessness or sheltered in system • Relationship crises - parents, children, partners • Jail and court system • Economic EFFECTS OF OTHER ILLNESS • • • • • • • Hepatitis B, C and cirrhosis ESRD GERD Diarrhea Neuropathy Elevated lipids Diabetes SECONDARY GAIN • Medication-seeking and selling: Needed meds, un-needed meds, pain and psych meds • Access to benefits and entitlements • Identity as someone with HIV - a “victim” • Symptoms as access to caring and support LACK OF SKILLS • • • • • Reading and writing Following a schedule Advocating for oneself Language Knowledge of how the body works and some basic biology POWER DYNAMICS IN DR-PT RELATIONSHIP • Pleasing the doctor • Inability to participate in decisions about “ own care - passivity • Refusal or avoidance only method of having control • “Fixing it” is the responsibility of the doctor • The chasm between the lives of the provider and the patient is enormous • Assumptions re race, sex, sexuality, age SELF WORTH ISSUES • I deserve what happens to me • What does it matter? • I always mess up everything and let everyone down For more HIV-related resources, please visit www.hivguidelines.org