IMPORTANCE OF PSYCHOSOCIAL CARE IN HIV

1. IMPORTANCE OF PSYCHOSOCIAL CARE IN HIV Prepared by George Mwongera Clinical Psychologist KNH

2. 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

3. 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.

4. 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 AIDS-related causes

5. 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 multi-disciplinary and comprehensive approach to HIV treatment.”

6. 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

7. 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

9. 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.

10. Young people with HIV need psychosocial support as well as medication.

11. 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

12. 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.

13. 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.

14. 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.

15. The end Thank you