Ask the Doctor: It's Not Just a River in Egypt -- HIV Denial

Q: My husband is HIV-positive. I found out about it five years ago, but he refuses to see a doctor to maintain his health. Recently he broke out with a bad case of shingles. He's complaining of tiredness and he's not eating like he used to, which has led to weight loss. He's in denial. Can you help?

A: Thank you for writing. One common but obviously risky response to receiving a diagnosis of HIV is persistent denial and avoidance. Denial is a protective mechanism against shock that is valuable in the short term. However, people need to move through it into action, usually accomplished by getting more information, sharing feelings, and going through a process of acceptance. Sometimes, as in the case of your husband, this phase persists, and can be complicated by depression as well as anxiety. In such cases, it blocks the person from taking important medical actions. Ironically, of course, the sooner one gets on medication the better the outcome.

As time goes on, the impact of HIV becomes hard to ignore. Shingles is an opportunistic infection that indicates that your husband's immune system is challenged. The fatigue and appetite changes may also be indicators, but they could be signs of depression as well.

I would recommend finding a support group (most places have agencies dealing with HIV/AIDS and can direct you) and encouraging him to attend. Sometimes the most powerful role models are others who share the experience. I would look for a group for yourself, as well. Caregivers/partners experience a high level of stress themselves and need to practice self-care on a daily basis.

If he is willing, I think he could also benefit from therapy. Trained professionals can often identify the specific barriers or beliefs keeping denial in place and provide tools to break through. He might also consider taking an antidepressant that could motivate him to further action. Remember, antidepressant medication combined with psychotherapy has the best outcomes.

Good luck to both of you.

David Fawcett, Ph.D., L.C.S.W., is a psychotherapist and clinical hypnotherapist in private practice in Fort Lauderdale, Florida. He is active in the gay men's health movement, writes regularly for TheBody.com, and is a national trainer for the National Association of Social Workers' "HIV Spectrum Project."