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has the changing face of HIV had an impact on mental health

May 27, 2000

since 1981 and the first reported AIDS in the UK and the introduction of ARV's and HAART there has been a major change in the life expectancy of HIV + people? Would you know if there is also a greater impact on the mental health maybe due to the combination therapy or the greater stressors of longer life in general?

Response from Mr. Shernoff

This is a really sophisticated and complicated question that requires a much more detailed response than I can offer briefly here. In fact I just completed a new book that deals solely with the mental health issues of people on combination therapy. It will be published by University of California San Francisco AIDS Health Project in two months.

People have had to adjust to living with a greater degree of uncertainty in their lives than prior to HAART. Many clients speak of being "guardedly optimistic" and not allowing themselves to invest too much hope in the new treatments. Since no one knows how long the treatments will be effective or what the long-term effects on the body's systems are, this has the potential to create a very potent form of anxiety.

For people who had literally been on the brink of death and now are contemplating returning to work and a full life there is an incredibly complex set of psychodynamics and interpersonal realities that must be dealt with.

Underlying psychopathologies are more obvious now and require mental health treatment. All the stressors of resuming personal lives, romantic lives, and professional lives complicate the issues for people on HAART as well.

Not everyone is overjoyed by their own good fortune if they have buried entire friendship groups or lovers. Thus some feel survivor guilt for having lived long enough to benefit from the new treatments while so many others did not.

Of course there are also the people who are not benefiting from combination therapy, either due to their inability to be adherent to the rigorous dosing schedules, or because they have a multi-drug-resistant form of the virus.

The evolving emotional and psychological landscape for people living with HIV and the professionals serving them will continue to remain as much on the cutting edge as the actual medical questions.

Michael Shernoff, MSW

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