Download PSYCHOSOCIAL CARE IN HIV

IMPORTANCE OF PSYCHOSOCIAL
CARE IN HIV
Prepared by
George Mwongera
Clinical Psychologist
KNH
Introduction
• Psychosocial support addresses the ongoing
psychological and social problems of HIV infected
individuals, their partners, families and
caregivers.
• HIV infection affects all dimensions of a person’s
life: physical, psychological, social and spiritual.
• Counselling and social support can help people
and their carers cope more effectively with each
stage of the infection and enhances quality of life.
• lack of social support in dealing with these issues
can lead to depression that, in turn, can lead to
poor adherence to treatment
Introduction cont.
• The prevalence of major depression and
demoralization (sometimes called adjustment
disorder)among patients with HIV may be as high
as 50%, with significant overlap between the 2
conditions.
• Psychosocial support programs therefore offers
opportunities for individuals to develop coping
strategies for a challenging medical condition like
HIV
• With adequate support, PLWHA are more likely to
be able to respond adequately to the stress of
being infected and are less likely to develop
serious mental health problems.
How Psychosocial Issues Affect
HIV/AIDS Treatment Outcomes
• Psychosocial influences such as stress, depression
and trauma have been neglected in
biomedical,psychocomatic medicine and
treatment studies involving people infected with
HIV, yet they are now known to have significant
health impacts on such individuals and the
spread of AIDS
• Recent large, long-term studies show that HIV
and AIDS patients with chronic depression and
trauma are about twice as likely to die from AIDSrelated causes
Cont,
• One study of men and women being treated in
infectious disease clinics in the southeastern
United States found that more than 70 percent of
those patients had suffered at least two major
lifetime traumas – about half had been sexually
and/or physically abused.
• Asking about past trauma and current life issues
brings a fuller, truer focus on the patient and
should be a routine practice in any multidisciplinary and comprehensive approach to HIV
treatment.”
Cont,
• Formal systems of mental health care have been
described as being scarce throughout countries
like Kenya, although they are more likely to be
available only in large cities such as Nairobi, due
to the increased availability of resources in urban
areas
• Managing psychosocial distress symptoms has
been systematically and culturally marginalized
and stigmatized, which has been facilitated
further by the limited establishment of more
formal systems of mental health care
Psychosocial Aspects of HIV/AIDS:
Children and Adolescents
• Children and adolescents are an ever-growing
part of the human immunodeficiency virus
(HIV)/AIDS pandemic.
• In 2007, an estimated 2.1 million children
younger than 15 years were living with HIV,
and 290,000 children died from the disease in
2007 alone
psychosocial aspects affecting children
and adolescence
•
Pediatric patients with HIV/AIDS experience many of the stages and
stresses of other pediatric chronic and terminal illnesses.
•
Stigma affects all aspects of caring for children and adolescents infected
and affected by HIV/ AIDS, especially as they face the issue of disclosure of
HIV status.
•
Death and bereavement are important aspects of chronic illness that
must be addressed with children and their families
•
Orphans and young girls are at increased risk of contracting sexually
transmitted infections, including HIV, and of receiving less support and
education than their peers.
•
Adolescents are a unique population with a pivotal role in the future of
the pandemic. They need special care and attention, with an emphasis on
support and education.
Young people with HIV need psychosocial
support as well as medication.
Adolescents
•
Disclosure
Adolescents deal with disclosure issues on multiple levels, from finding out their
own HIV-positive status to deciding to disclose their HIV-positive status to others.
•
Medical Independence
For adolescents living with a chronic illness, transitioning into adulthood includes
an important shift toward medical independence
•
Self-Esteem and Identity
The adolescent years are one of the most important developmental stages prior to
adulthood. If the disease is untreated, the youth may have a delay in physical
development, including pubescent changes.
•
Sexuality
Sexuality is an important topic for adolescents, who are at the age when sexual
exploration begins. A study done in Uganda found that by age 18 years, 64% of
women and 50% of men already reported being sexually experienced. Many youth
are poorly educated about sex and safe sex methods
Cont,
• Illicit Substance Use and Abuse
• Substance use and abuse are common risky
behaviors among today’s youth.
• Screening for substance use among YLH is
important; multiple studies have found an
increased prevalence of substance abuse-related
disorders in this population.
• Increased substance using can also indicate poor
adherence
• Substance use can also have major negative
medical consequences for YLH.
• Substance use also tends to decrease behavioral
inhibitions and increase other risky behaviors.
Way forward
• Psychosocial support should be specifically included in national
guidelines for the management of HIV/AIDS.
• Training on the provision of psychosocial support should be
incorporated into the curriculum for all health care providers.
• Assess what mental health and supportive services are available at
both the governmental and non-governmental level that could be
strengthened or replicated. Assess what additional services are
needed.
• At the community level, groups can be started to provide for the
needs of individual patients and affected family members.
Psychosocial support services that address the specific needs of
vulnerable groups can be especially important (e.g. women,
children, etc.).
• A comprehensive support system linking and coordinating existing
psychosocial services with each other and to health services needs
to be established.
Cont,
• Supervision of health care workers in high prevalence
areas will be key in assisting health workers to cope with
issues related to HIV/AIDS.
• People living with HIV should have access to regular
screening to identify their psychological support needs.
• When concerns are raised in screening, people living with
HIV should have access to more comprehensive
psychological and cognitive assessments, interventions and
rehabilitation by suitably competent professionals.
• People living with HIV should be screened for the presence
of symptoms of depression, anxiety, drug and alcohol
misuse, acute stress disorder, risk of self harm and
cognitive difficulties within the first 3 months of receiving
an HIV diagnosis.
• People living with HIV should have access to a range of
psychological support services appropriate to their needs.
The end
Thank you