I came to write this post due to my current position in a Jamaican NGO that has a primary focus on helping adolescent youth with HIV. Not too long ago, I had little more than a passing understanding of the issues underpinning Sexual and Reproductive Health (SRH) as a whole, much less the specifics of HIV/AIDS. This began to change at the beginning of this year when I found myself in a position focused on adolescent SRH, which gave me an introduction to the field. What has been the most jarring for my perceptions on HIV/AIDS however, is my current experience on internship in Jamaica. Few things can prepare one for hearing impassioned speeches from girls who suffered sexual abuse from a relative, or who are fearful of being expelled from their community should it be known they are HIV positive. What also became apparent to me is how psychosocial approaches can help with these issues. From someone who did not even know what the term psychosocial meant, seeing the impact this approach has had on so many of these girls in coping with the consequences of HIV/AIDS, rapidly imparted on me the importance of conveying the effectiveness of these approaches.
With that preamble contextualizing this blog post from my perspective, we can now delve into an oft forgotten component of HIV/AIDS treatment, these are the psychosocial elements. Despite the understandable focus on addressing biological manifestations of HIV/AIDS, for people living with this illness, psychosocial approaches are critical in living a happy and healthy life. Before getting into the minutia of psychosocial approaches, it is prudent to conduct what is admittedly, an exceedingly brief, scan of some of the current HIV/AIDS trends.
Justifiably there is significant attention paid to prevention efforts, ancillary contact I had with HIV/AIDS prior to more recent positions was largely centred on this. Noteworthy new ideas and technologies have emerged in this respect however that have begun to bear fruit. Voluntary Medical Male Circumcision (VMMC) is one of these. VMMC is estimated to reduce HIV acquisition to heterosexual men by between 51-60%, according to several Randomized Controlled Trials (Rennie, Perry, Corneli, Chilungo, & Umar, 2015). This has caused VMMC to become a major focus, with a five year joint strategic action framework headed up by many heavy hitters including the WHO, UNAIDS, the Bill and Melinda Gates Foundation, PEPFAR and the World Bank (World Health Organization, 2012). Similarly, Pre Exposure Prophylaxis (PReP) and Post Exposure Prophylaxis (PEP) have also burst onto the HIV/AIDS scene. PReP is used for high-risk individuals to prevent contraction of the virus, while PEP is used within 72 hours of a potential HIV causing event to decrease the likelihood of contraction. This has shown to be very effective with daily PrEP reducing the risk of getting HIV by over 90% (Centers for Disease Control and Prevention, n.d.). It almost goes without saying that condoms are still an integral part of HIV prevention efforts in addition to increasing testing so individuals know that their HIV status, among other methods.
As far as the treatment side is concerned, there are unquestionably pushes towards facilitating improved Anti-Retroviral Treatment (ART). It seems however, that this is often where it stops. Perusing some major donor priorities quickly reveals an impetus for improving treatment retention by simplifying the delivery of ART and increasing viral load testing (Bill and Melinda Gates Foundation, n.d.). Improving standard methods of biomedical treatment is vital in coping with HIV/AIDS. But for the many people living with HIV/AIDS, the issues they grapple with only start there. Community ostracization, fear of disclosure to partners, and emotional travails are all crucial hurdles that need to be overcome. Without surmounting these challenges, HIV positive populations cannot live full and productive lives. The work to tackle these problems is labour-intensive, and much less alluring than new ART medications or cutting-edge prevention techniques, but just as critical in HIV responses.
A more holistic approach that tackles some of these aforementioned issues requires professional counseling and support groups, as well as community engagement and employment training. These are the psychosocial approaches, which broadly refers to addressing the interplay of societal factors with psychological well-being. Utilizing these methods is required since prevention alone is not sufficient for the 36.7 million people already living with HIV (UNAIDS, 2016). Better testing and improved ART delivery is only the start for those who have HIV/AIDS. Even as far as effective ART is concerned, many people living with HIV/AIDS struggle to come to terms with their ailment and need significant support in order to adhere to ART regimens. My own experience in viewing a support group meeting exposed me to an adolescent girl who explained how she had left the group for a while, and subsequently stopped following her ART regimen. It was then that she realized the pivotal role the support group had in her own ART adherence. In addition, people with HIV/AIDS need help to cope with the ramifications of an HIV positive diagnosis, and in learning to be comfortable and happy with themselves. A study revealed that internalized stigma was in fact present in the majority of a sample of people with HIV/AIDS. Key variables which increased internalized stigma were being less likely to have attended an HIV support group, the presence of families who were not accepting of their status and knowing fewer people with HIV (Lee, Kochman, & Sikkema, 2002). All of which are things which can be ameliorated with effective psychosocial approaches.
Persons with HIV can be vulnerable to abusive relationships, community rejection and under/unemployment. Much of this has a psychological underpinning as has been described and requires counseling, support groups, mentors etc. to cope. A salient example of the basic psychological issues people with HIV/AIDS face came from a colleague, who described an experience where in the course of a workshop he hugged an HIV positive woman and she started crying as a result. When he inquired as to what he had done, she explained that she was simply racked with emotion because she had not been hugged in years as a result of her status. Addressing these issues requires the undergirding of a psychosocial approach to HIV/AIDS. Focusing on employment specifically, evidence on a sample of HIV/AIDS patients showed significantly improved quality of life with greater employment (Blalock, Mcdaniel, & Farber, 2002). This is especially pertinent considering that there is some evidence that HIV/AIDS is associated with higher unemployment at poverty rates (Carter, 2008)
This provides just a smattering of the issues, and solutions, that are steeped in the psychosocial elements of dealing with HIV/AIDS. There has been understandable excitement about new methods of prevention and treatment with respect to HIV/AIDS. It is important however not to let a parochial focus simply on biomedical approaches neglect the long and hard psychosocial work, which is a nearly ubiquitous need for people living with HIV, to exercise their full potential. To do so would be to imperil the significant strides that are being made in prevailing over HIV/AIDS. I can say from my very limited personal experience in Jamaica, these psychosocial approaches do work and must be an element of the HIV/AIDS response.
James Jarvis is a Monitoring and Evaluation Specialist with Eve for Life in Kingston, Jamaica.
Bill and Melinda Gates Foundation. (n.d.). What We Do HIV Strategy Overview. Retrieved from Bill and Melinda Gates Foundation: http://www.gatesfoundation.org/What-We-Do/Global-Health/HIV
Blalock, A. C., Mcdaniel, S. J., & Farber, E. W. (2002). Effect of Employment on Quality of Life and Psychological Functioning in Patients With HIV/AIDS. Psychosomatics, 400-404.
Carter, M. (2008, July 2). NAM aidsmap. Retrieved from Poverty and unemployment common amongst HIV-positive Londoners: http://www.aidsmap.com/Poverty-and-unemployment-common-amongst-HIV-positive-Londoners/page/1430755/
Centers for Disease Control and Prevention. (n.d.). PReP 101. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/hiv/pdf/library/factsheets/prep101-consumer-info.pdf
Lee, R., Kochman, A., & Sikkema, K. J. (2002). Internalized Stigma Among People Living with HIV-AIDS. AIDS and Behavior, 309-319.
Rennie, S., Perry, B., Corneli, A., Chilungo, A., & Umar, E. (2015). Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi. Global Public Health, 679-691.
UNAIDS. (2016). AIDS By the Numbers. Retrieved from UNAIDS: http://www.unaids.org/sites/default/files/media_asset/AIDS-by-the-numbers-2016_en.pdf
World Health Organization. (2012, July). HIV/AIDS Voluntary medical male circumcision for HIV prevention. Retrieved from World Health Organization: http://www.who.int/hiv/topics/malecircumcision/fact_sheet/en/