How Therapy Can Help People Starting Treatment with HIV Meds

Close-up of a woman's hand as she holds a prescription bottle; her reflection from the bathroom mirror is out of focusLiving with HIV/AIDS can be emotionally challenging, no doubt. There are numerous issues that a person living with HIV/AIDS might find difficult to navigate, including:

  • Coming to terms with the diagnosis
  • Deciding when and how to disclose their status to others
  • Finding a good HIV/AIDS doctor and other medical providers
  • Learning to manage a sex life with an infectious disease

However, for many individuals, one of the most emotionally charged issues is accepting the need to start treatment with medication.

There are many medications and classes of medications on the market for the treatment of HIV/AIDS. This article will not discuss those different classes and the specific properties of individual medications, including side effects. Instead, it will focus on the emotional issues that arise for many people after their doctors have recommended that they begin treatment. It will also focus on how therapy might help a person deal with these issues and feelings, and perhaps help them make decisions that feel best for them.

Triple combination HIV therapy (“the cocktail”) was introduced in 1996. At the time, the treatment guideline was basically “hit hard, hit early.” This meant that medical providers were encouraged to start newly diagnosed HIV-positive people on powerful medications as soon as possible.

Unfortunately, little to nothing was known of the possible unwanted side effects. As years went by, doctors and patients learned about the side effects, many of which changed the physical appearance of patients. In response to this, guidelines changed to encourage doctors to delay putting people on medication for as long as possible.

People coming to terms with an HIV diagnosis often report that their medical providers, particularly their physicians, are not good at listening to their concerns. A good therapist can provide this much-needed role.

Fast-forward to 2015: Current HIV medications more effectively reduce the amount of virus in the body, in addition to causing fewer negative side effects than the first generation of drugs, and doctors are more aware of how to treat those effects. Thus, guidelines are again encouraging patients to go on medication as soon as possible.

As noted earlier, many individuals with HIV, if not most, need time and support to come to terms with being diagnosed. Being told to start treatment with previously unknown medications only adds to the anxiety. Many people I have counseled report that being urged by a doctor to begin treatment shortly after diagnosis has added to their sense of loss of control. Frequently, individuals feel that once HIV medications are started, they must be continued for the rest of their lives. That, along with a life-altering diagnosis, makes some people feel incredibly overwhelmed.

Unfortunately, I cannot count how many times an individual has entered therapy with me feeling depressed and anxious after having started treatment at the urging of a doctor, only to have skipped many daily dosages due to an emotional inability to keep up with the strict regimen. Such individuals often feel afraid and embarrassed that they may have developed resistance to HIV medications.

So How Can Therapy Help?

For starters, therapy can give people living with HIV/AIDS a safe place to air their fears and concerns. People coming to terms with an HIV diagnosis often report that their medical providers, particularly their physicians, are not good at listening to their concerns. A good therapist can provide this much-needed role.

Some individuals express guilt about not being ready to start medications when their doctor thinks they need to. Therapy can be a place where someone can air those feelings without feeling judged. Additionally, therapy can help the individual understand why he or she is feeling unprepared, as well as the reason for feeling shame or guilt. This can be particularly helpful for someone with a history of chemical addiction. An individual who relapses into addiction in response to their diagnosis may not be a good candidate to immediately begin medication treatment. A skilled, caring, and patient therapist can help the individual through the relapse to become physically and emotionally prepared for treatment.

Numerous individuals have reported feeling a lack of control over their bodies when living with a chronic illness. This is often particularly true when someone is diagnosed with HIV. It can be empowering to be reminded that each of us has control over what we put in our bodies and when, including medication. Someone who feels in control of his or her body and mind will likely feel more prepared and ready to begin HIV treatment.

© Copyright 2015 All rights reserved. Permission to publish granted by Joseph Robert Scrivani, MSW, LCSW, HIV / AIDS Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Matt

    September 17th, 2015 at 8:39 AM

    Can you imagine the devastation that could come along with this diagnosis? I mean, in an instant your whole life changes and instead of seeing the promise that your future holds in a positive way all the you can now see is the hurt that it can promise. So talking with a therapist could be an excellent way to help you manage some of those fears and to come to terms with your new diagnosis.

  • Julianne

    September 17th, 2015 at 2:02 PM

    This is also the thing that you are going to have in life that will emphatically show you that yes, there is someone who is there for you and on your side.

  • Jaden

    September 18th, 2015 at 7:32 AM

    Establishing new habits can be so difficult especially once you have received news like this. Taking meds is going to be the last thing you are focused on and yet it will be such a vital part of your treatment.

  • marquis

    September 19th, 2015 at 8:50 AM

    I would like to know how they are counseled on being able to have a sex life when you do have a disease like this that is so highly contagious?
    I think that many people think ok there goes the sex life but apparently there are still some ways to make this remain a part of your life?

  • Joseph S

    September 20th, 2015 at 6:50 PM

    marquis – You ask an excellent. Many people living with HIV/AIDS do struggle around re-starting a sex life. Fortunately, when taken correctly, modern HIV medications allow the virus in the body to drop to very low levels. Studies have shown that low virus levels, along with on-going safer-sex practices, have made the probability of an HIV positive person passing the virus through sexual connect nearly zero. Yes, they are still positive, and yes, the possibility is still there, but more and more HIV positive individuals are able to have fulfilling and stress-free sexual lives again. This is yet another reason why HIV positive people are being encouraged to begin treatment as soon as possible.

  • JED

    September 21st, 2015 at 7:48 AM

    I would have to hope that there is concurrent treatment with their physician and a therapist- so is it a big chance that patients are getting the referrals that they need to find someone to work with?

  • Mel

    September 22nd, 2015 at 4:34 AM

    I advocate for therapy for all! plwhiv and people living, having an opportunity to be listened to unconditionally allows our awareness and compassion to increase. I was diagnosed in 2001, I have a loving negative partner and a great sex life! I received counselling for over 2 years and understand myself much more, this has helped me accept my status and more importantly accept myself. I would like to share a new study that actually shows starting medication the day you receive diagnosis does help!

  • Reed

    September 22nd, 2015 at 10:35 AM

    I think that the positive thing here is that it is evident that we are learning more and more about this disease as well as the best ways to treat it. Not everything is going to be a winner, but I think that over time we will see that more and more people can thrive even after they have been diagnosed simply because we know so much more today about the trajectory of the virus than we ever have in the past.

  • rhonda l

    September 23rd, 2015 at 10:46 AM

    When it comes to something like this I would also think that it could be a great idea to get the families of the patients involved as well,. Of course there will be some who have severed ties with them and will not have anything to do with them, but I guess if there is any kind of support network they should get involved and should learn what they can do to help during this time as well. I wouldn’t want anyone to have to feel like they are alone and trying to digest news like this.

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