Psychological responses to an HIV positive result
Many reactions to an HIV positive diagnosis are part of the normal and expected range of responses to news of a chronic, potentially life-threatening, medical condition. Many patients adjust extremely well with minimal intervention.
Some will exhibit prolonged periods of distress, hostility or other behaviours which are difficult to manage in a clinical setting. It should be noted that serious psychological maladjustment may indicate pre-existing morbidity and will require psychological/psychiatric assessment and treatment. Depressed patients should always be assessed for suicidal ideation.Effective management requires allowing time for the shock of the news to sink in; there may be a period of emotional “ventilation”, including overt distress. The counsellor should provide an assurance of strict confidentiality and rehearse, over time, the solutions to practical problems such as who to tell, what needs to be said, discussion around safer sex practices and adherence to drug therapies. Clear information about medical and counselling follow-up should be given. Counselling may be of help for the patient's partner and other family members.
Counselling can also be offered to the patient and their partner together. This should only take place with the patient's explicit consent, but it may be important for the following reasons listed in Box 13.7.
Partners and family members sometimes have greater difficulty in coming to terms with the knowledge of HIV infection than the patients do themselves. Individual counselling support is often required to manage this, particularly role changes within the relationship, and other adjustment issues that may lead to difficulties. This is part of a holistic approach to the patient's overall health care.
In many cases the need for follow-up counselling may be episodic and this seems appropriate given the long-term nature of HIV infection and the different challenges a patient may be faced with. The number of counselling sessions required during any of these periods largely depends on the individual presentation of the patient and the clinical judgement of the counsellor.