1. April 2003April 2003
PSYCHOSOCIALPSYCHOSOCIAL
ISSUES IN HIV/AIDSISSUES IN HIV/AIDS
Karina K. Uldall, MD, MPHKarina K. Uldall, MD, MPH
Department of PsychiatryDepartment of Psychiatry
University of WashingtonUniversity of Washington

2. April 2003April 2003
Pre-HAARTPre-HAART
• More rapid, fatal course of disease
• Emphasis on treating opportunistic
infections and providing palliative care
• Quality of life affected by various
symptoms

3. April 2003April 2003
Post-HAARTPost-HAART
• More chronic disease course
• Complex treatment regimen with many
adverse effects
• Prognostic uncertainty

4. April 2003April 2003
Population IssuesPopulation Issues
• Disproportionate impact on marginalized
groups
• Less access to and engagement with care
system
• Co-morbidities such as hepatitis, mental
illness, substance use
• Complex psychosocial issues result

5. April 2003April 2003
Positive Aspects of HIV/AIDSPositive Aspects of HIV/AIDS
• More services and support available
• Renewed spirituality
• New, healthier relationships
• Priorities clarified
• Conflicts resolved

6. April 2003April 2003
Negative Aspects of HIV/AIDSNegative Aspects of HIV/AIDS
• Stigma/Discrimination
• Estrangement from
family/community
• Fear of contagion
• Fear of death
• Feeling like a burden
• Loss of dignity
• Guilt
• Grief over multiple
losses

7. April 2003April 2003
Cultural IssuesCultural Issues
• Meaning of illness and death
• Family or community role in illness
• Value of autonomy
• Communication patterns
• Mistrust of authority/medical systems

8. April 2003April 2003
InterventionsInterventions
• Accompaniment
• Advocacy
• Assessment
• Care Coordination
• Crisis Intervention
• Engagement
• Listening
• Motivational
Interviewing
• Patient/Family
Education
• Problem Solving
• Referrals
• Skills Building
• Support