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The Importance of Counselling Support for Individuals Living with HIV

An overview of HIV

The human immunodeficiency virus (HIV) is a virus that targets the immune system and weakens a human’s ability to defend against various forms of infection, disease, and cancers (1.) Typically, a healthy human immune system that is well functioning has the capacity to defend against differing types of infection and disease, however, individuals living with HIV have a significantly low functioning immune system, resulting in increased physical health comorbidities. HIV is a non-curable virus and works by destroying and impairing the function of immune cells, which can result in an individual becoming immunodeficient; this is the most advanced stage of HIV infection defined as acquired immunodeficiency syndrome (AIDS) (1). Aids is characterised by the acquisition of various forms of cancer, infections, and other diseases, and has severe complications for the health of an individual (1). Historically, HIV has had significant health consequences for the global population, and since the start of the AIDS epidemic the virus has claimed approximately 40.1 million lives so far (1). HIV continues to be a major global public health issue, particularly in third world countries such as Sub-Saharan Africa where preventative health care and treatment is less accessible. Despite HIV being a non-curable disease, advances in medical treatments have enabled people living with HIV to manage the disease effectively and live relatively normal and long lives. The introduction of antiretroviral (ARV) drugs has improved the quality of life for humans living with HIV and reduced the prevalence of AIDS. Current antiretroviral therapy (ART) does not cure HIV infection, but rather works by suppressing viral replication and allows an individual’s immune system to strengthen and regain the capacity to defend against infections and some forms of cancers (1). Therefore, people are living longer as HIV is now considered a chronic illness that can be managed with antiretroviral treatments. The stigma around HIV however remains, which can make living with HIV incredibly distressing.

Health complications overview

Antiretroviral treatment offers hope for individuals living with HIV as the disease was once untreatable. The literature continues to highlight the significant psychological impacts that a positive HIV diagnosis has on an individual, including increased susceptibility to mental illness such as depression and anxiety, exposure to stigma, poor self-esteem and feelings of shame and guilt (3). People living with HIV also experience a wide range of biological health implications because of the disease, with the research indicating that a positive HIV diagnosis often correlates with poor physical health outcomes such as major physical illnesses, increased hospitalisations, physical pain, and other comorbid health conditions (4). Consequentially, because of the debilitating physical and psychological implications of living with HIV, individuals often experience an array of negative social health consequences such as social isolation, withdrawal, discrimination, and difficulties forming positive relationships (3). People living with HIV benefit significantly from counselling, psychological intervention, social support, healthcare engagement, education, and sexual health prevention strategies.

Psychological health implications of HIV

Being diagnosed with HIV can be highly stressful and produce severe anxiety for many. People living with HIV often experience increased feelings of shame and guilt and are more likely to be negatively impacted by social discrimination and stigma (11). People living with HIV are at a higher risk of experiencing a mental health disorder. Many studies have discovered a high prevalence rate of depression in older people living with HIV, with one research study by Heckman and colleagues finding that 29% of HIV-positive adults aged 45 years and above experienced moderate to severe depression, and 31% experienced mild depression (12). Another study by The AIDS Community Research Initiative also supported Heckman’s findings and discovered that in a sample of nearly 1000 participants, 52% had a diagnosis of depression (13). Alongside depression, the literature also shows that people living with HIV are likely to experience anxiety related to difficult life decisions arising from their diagnosis (3). Some of these decisions include fear of disclosure to others, adhering to long term treatment and decisions in relation to sexual relationships and parenthood (3). The experience of being diagnosed with HIV can increase a person’s vulnerability to experiencing poor mental health, particularly in the early days of receiving a diagnosis, with one study finding that some participants described feeling sad, depressed, crying and in some cases suicidal when being diagnosed for the first time (11). Research by McDonald and associates found that depression was a highly significant health issue for most HIV positive participants in the ageing with HIV qualitative study, with more than half of the participants interviewed disclosing that they suffered from clinically diagnosed depression (4). The research clearly highlights the significant psychological health impacts that HIV can have, which can drastically affect the quality of life for people living with a diagnosis of HIV. People living with HIV have been found to experience higher rates of social discrimination and stigma, and often internalize this stigma; the result of internalised stigma has been shown to manifest as feelings of shame, guilt, anger, fear, and self-loathing, which increases likelihood of poor mental health outcomes (14). People living with HIV must feel they have a safe space to discuss their diagnosis openly and with no judgement or shame, as this will only exacerbate poor psychological health, so it is important that people living with HIV are able to access supportive counselling or psychological intervention. Ensuring that people living with HIV are provided with social support and connection is vital to reduce feelings of isolation or loneliness, which may stem from internalised stigma and shame.

Social health implications of living with HIV

A diagnosis of HIV can have an array of impacts on an individual’s social health and wellbeing. People living with HIV require extensive social support and connections to manage the many psychosocial complications associated with the disease, however, some individuals have difficulty accessing appropriate social support for HIV-related issues as this requires the individual to disclose their HIV status (15). Many people living with HIV often do not access the relevant social and community supports due to fear of/lived experience of stigmatisation, discrimination, and negative responses from society. People living with HIV often experience difficulties in their sexual relationships and intimate partnerships, including difficulties surrounding parenthood and the consequences of passing on HIV to their children (16). Research has found that for people living with HIV, attempting to continue a normal sex life is the most difficult social implication of the disease, and that fear of spreading the virus to others is a concern for many (16). Consequentially, this can cause people living with HIV to experience higher rates of social isolation, withdrawal, and loss of interest in sexual relationships due to living with the disease. In their research study, McDonald and associates found that the experience of social stigma and rejection deterred people living with HIV from engaging socially and making new friendships or social connections (4). Moreover, participants within the study often avoided intimate relationships due to the perceived difficulties and challenges associated with sexual relationships, including the fear of infecting a partner and the fear of rejection from a potential partner (4). Evidently, there are many barriers to accessing social connections and support for people living with HIV, often associated with concealment of HIV, fear of transmission of HIV, stigma, discrimination, and rejection (5). People living with HIV can still have healthy relationships and sex lives with the appropriate prevention measures such as condom use and adhering to antiretroviral treatment regimes.

Counselling for people living with HIV

It is evident that people living with HIV will experience a diverse and complex range of biopsychosocial implications of the disease and may benefit from counselling support. Slomka and Colleagues found that for people living with HIV, coping with the disease was much easier when a therapeutic relationship was developed through effective professional–patient communication (17). Therefore, a strong therapeutic alliance and person-centred approach established in therapy may be helpful. Due to the increased risk of psychological health comorbidities, it is important that people living with HIV are provided with effective psychological intervention and mental health support if the individual is experiencing a mental health disorder. Furthermore, people living with HIV must be provided with sexual health education and safe HIV preventative practices. Educating people living with HIV about safe sex practices such as condom use allows them to maintain healthy relationships and sex lives, thus reducing the social health impacts of HIV. Living with HIV can cause significant social withdrawal and isolation for many, so it is therefore important to ensure people living with HIV continue to have strong social supports and relationships and are provided with various community resources to stay connected.

Author: Abbey Sawyer Sexologist, MAAPi, PostGradDipPsych, BPsychSci, BCrim.

Abbey is a Sexologist who is near completion of her Master of Science in Medicine degree, specialising in psychosexual therapy. Abbey is passionate about the interlink between psychological health and sexuality, and enjoys supporting people of all ages, genders, and cultural backgrounds to enrich their sexual lives and improve their mental health.

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References

  1. World Health Organisation. HIV fact sheet [Internet]. 2022 [cited 2022Sep28]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids
  2. UNICEF East Asia and Pacific Regional Office. Tools for HIV Counselling in the AsiaPacific [Internet]. 2009. Thailand. Available from: https://www.fhi360.org/sites/default/files/media/documents/Tools%20for%20HIV%20Counselling%20for%20the%20Asia-Pacific_0.pdf
  3. Bravo P, Edwards A, Rollnick S, Elwyn, G. Tough decisions faced by people living with HIV: A literature review of psychosocial problems. Aids Review. 2010;12:76-88.
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