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Mental Therapy and HIV: One Patient's Perspective

By Ibrahim

April 26, 2013

The mental burden of being HIV positive is of substantial weight that could equal, if not exceed, the weight of the physical damage HIV can cause to the body. Unfortunately, this significance is met by a practice that still deals with broad categories of mental illness rather than the specificity of HIV-related mental problems. Mental health care providers in the case of HIV-positive persons are, mostly, social workers who lack the experience to deal with nuances of the problems rooted in the minds of poz folks.

The lack of attention to the importance of mental well-being is not merely a shortcoming of HIV patients. Rather, it's an end result of a general lack of progress in the field of mental therapy. In the U.S., a study suggested that non-professionals were as effective as professionals in providing mental therapy, which could be interpreted as a sign of the inefficiency of mental therapists as much as it's a testimony to the excellence of the non-professionals, who were teachers in this study.

Another factor to add to the glitches with mental therapy is a result of the small pool of regulations that apply to therapists and social workers when compared with other health care providers. A friend of mine, an HIV-positive person, had to deal with severe consequences as a result of the inability of a social worker to correctly diagnose his complex mental illness case. He couldn't pursue the path of charging his "therapist" with malpractice because there are no clear lines to define diagnosis when it comes to mental health care. He needed to see a second therapist to treat him from the severe damage caused by the wrong treatment methods of the first therapist.

This story demonstrates the seriousness of allowing providers equipped with, often, too general theories to engage a patient who suffers from of a very specific problem. While I believe that personal stories have, mostly, anecdotal value, I find them important in this case as they shed light on a serious situation that relates to the well-being of individuals with a very complex case.

The complexity of HIV-related mental problems is formed by the confluence of multiple factors related to sexual identity, the neurological effects of the viral infection, the side effects of medications and the social challenges faced by poz folks on a daily basis. This creates a case that is way too complicated to be addressed through common methods. Given the wide range of possible causes for their mental problems, there should be a predictably wide range of treatment methods to be considered with HIV patients. Treatment should consider past traumas that could have been recalled when the infection happened, and other problems that could appear suddenly due to the rapid change that occurs at each stage of the journey an HIV-positive person goes through.

Choosing an experienced therapist to provide mental care for you is crucial and as important as choosing a qualified medical doctor. With President Obama's promise to improve the mental health care clauses in his plan, I hope we will have chances to make better choices when choosing our therapists. This of course is in case Senator Bachmann doesn't win her case to include her husband's gay-to-straight therapy in the plan. :)

When choosing a therapist, many HIV-positive persons prefer gay therapists. While gay therapists possess certain qualities that an HIV patient can recognize, the issue of interacting with a gay non-HIV-positive therapist could create a dangerous dynamic that might harm the patient. This shouldn't undermine the importance of seeking therapists who are well informed about the gay culture and the challenges a gay HIV-positive person faces. A therapist who is treating an HIV patient should be ready to answer general questions related to sexuality, health of HIV-positive persons and other medical concerns or challenges they face on a daily basis.

Sometimes the challenges vary based on the background of the patient and might not be applicable to other HIV-positive persons. Here I recall how during one support group meeting for HIV patients, I noticed that everyone in the room with the exception of the man with the Caucasian background had problems dealing with family acceptance. This example reveals how things could get more complex in the case of HIV patients from non-white backgrounds.

The expanding population of HIV-positive persons from immigrant communities indicates the need for therapists to take extra measures when delivering care in a way that takes under consideration the patients' cultural heritage beyond multilingual knowledge. Cultural knowledge is essential when treating patients from Latino, African, Asian or Middle Eastern backgrounds. To better clarify, a therapist treating a Middle Eastern patient must be, at minimum, familiar with the diverse racial and social class structure of the Middle East and should keep in mind that disregarding the influence of religion in the American context is nothing but a disaster if applied to the case of immigrants from Jewish, Catholic or Muslim faith.

A story comes to my mind as I write about the issue of immigrant HIV patients: One day, I asked a friend if he knew who infected him. His response shocked me. "My therapist," he said with deep pain. Before I start to wonder if this was a case of wild and compromised imagination, my friend explained to me how his therapist recommended him the path of "sexually expressing himself" without outlining the caveat needed before allowing a "child" into a free-all-you-can-buy candy store. An immigrant from a country with almost no sex education was jumping from bed to bed under the blessings of his therapist who couldn't understand the simple fact that if you recommend someone to drive a Lamborghini, you can at least tell him to buckle up well, rather than to keep asking him to speed up. I by no means deny the responsibility of any adult when it comes to their actions, yet I can't help but wonder how the life of this man could have changed if this therapist took a minute to review sexual education in Catholic countries, discussed risk factors and provided my friend with enough knowledge on HIV.

Islam, unlike other religions, has an emphasis on sexual education which critics often use to attack the faith. Sex in Islam is not a bad desire; Mohammed told his followers that you get rewarded by God when you have sex with your wife ... I guess he meant the one you love. :)

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