Psychosocial Issues in the Era of New AIDS Treatments from the Perspective of Persons Living with HIV

Abstract

In the past, HIV disease meant an almost invariably downward health course. New highly active antiretroviral therapy (HAART) regimens have improved the health outlook for many persons living with HIV/AIDS but may create new psychological and coping challenges. In this study, open-ended, in-depth interviews were undertaken with an ethnically diverse sample of 44 purposively selected men and women with HIV disease who were on HAART regimens. The interviews were transcribed and qualitatively coded to identify major themes. While patients responding well to the regimens held optimistic views for their future, some who continued to have detectable viral load exhibited depression and feelings of hopelessness. Many patients reported stress associated with the demands of adhering to complex HAART regimens. Other common themes emerging in the interviews involved concerns about employment, romantic and non-romantic relationship formation, sexual behavior and serostatus disclosure, whether to plan families, and experiences of AIDS-related discrimination. There continue to be critical roles for psychological services in the care of persons living with HIV.

Keywords

antiretroviral treatment HAART HIV/AIDS psychosocial adjustment

Get full access to this article

View all access options for this article.

References

Carpenter, C. C. , Fischl, M. A. , Hammer, S. M. , Hirsch, M. S. , Jacobsen, D. M. , Katzenstein, D. A. , Montaner, J. S. G. , Richman, D. D. , Saag, M. S. , Schooley, R. T. , Thompson, M. A. , Vella, S. , Yeni, P. G. , & Volberding, P. A. (1998). Antiretroviral therapy for HIV infection in 1998: Updated recommendations of the International AIDS Society-USA panel. Journal of the American Medical Association, 280, 78–86.

Catz, S. L. , Kelly, J. A. , Bogart, L. M. , Benotsch, E. G. , & McAuliffe, T. L. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.

Deeks, S. G. , Loftus, R. , Cohen, P. , Chin, S. , & Grant, R. (1997). Incidence and predictors of virological failure of indinavir and/or ritonavir in an urban health clinic [Abstract LB-02]. In Program and Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, Ontario, September.

Glaser, B. G. , & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research(pp. 62–65). Chicago, IL: Aldine.

Kalichman, S. C. , & Ramachandran, B. (1999). Mental health implications of new HIV treatments. In D. G. Ostrow & S. C. Kalichman (Eds.), Psychosocial and public health implications of new HIV therapies(pp. 137–150). Boston, MA: Plenum.

Kelly, J. A. , Otto-Salaj, L. L. , Sikkema, K. J. , Pinkerton, S. D. , & Bloom, F. R. (1998). Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV primary prevention. Health Psychology, 17, 310–319.

King, G. , Keohane, R. O. , & Verba, S. (1994). Designing social inquiry: Scientific inference in qualitative research. Princeton, NJ: Princeton University Press.

Luborsky, L. , & Crits-Christoph, P. (1990). Understanding transference: The core conflictual relations theme method. New York: Basic Books.

Rabkin, J. G. , & Ferrando, S. (1997). A ‘second life’ agenda: Psychiatric research issues raised by protease inhibitor treatments for people with the human deficiency virus or the acquired immunodeficiency syndrome. Archives of General Psychiatry, 54, 1049–1053.

10.

Shontz, F. C. (1965). Research methods in personality. New York: Appleton-Century-Crofts.

11.

Siegel, K. , Schrimshaw, E. W. , & Dean, L. (1999). Symptom interpretation and medication adherence among late middle-age and older HIV-infected adults. Journal of Health Psychology, 4, 247–257.

12.

Singh, N. , Squier, C. , Sivek, C. , Wagener, M. , Hong Nguyen, M. , & Yu, V. L. (1996). Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 8, 261–269.

13.

Stone, V. E. , Clarke, J. , Lovell, J. , Steger, K. A. , Hirschhorn, L. R. , Boswell, S. , Monroe, A. D. , Stein, M. D. , Tyree, T. J. , & Mayer, K. H. (1998). HIV/AIDS patients' perspectives on adhering to regimens containing protease inhibitors. Journal of General Internal Medicine, 13, 586–593.