Download the other issues - HIV Clinical Resource

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