BHIVA Standards of Care for People Living with HIV

6. Psychological care

People living with HIV should receive care and support that assesses, manages and promotes their emotional, mental and cognitive well-being and health, and is sensitive to the unique aspects of living with HIV.

For people living with HIV to be able to access psychological care it is necessary to have clear standards, referral pathways, screening, and interventions. While there has been a growing recognition of the importance and parity of mental health alongside physical health, resources and provision have been restricted. Language and terminology in this area can be confusing and controversial, with different words used by different groups.

Standard 6 - Psychological care

These Standards use the following:

  • Emotional well-being: the emotional, practical, and lived experiences of people living with HIV (e.g. stigma, telling others about one’s status, relationships, sex, employment, travel);

  • Mental health: diagnostic labels such as anxiety, depression, post-traumatic stress disorder, insomnia, suicidal thoughts and self-harm, and addictions;

  • Cognitive functioning: the neurological health of the brain and how this is expressed cognitively (including memory, language, processing speed) and how HIV, its treatment, and other health and lifestyle factors can sometimes affect this.

These Standards draw upon the ‘Standards for Psychological Support for Adults Living with HIV’ and the two should be read in conjunction. Key to this is the stepped-care model in which the psychological care needs of people living with HIV should be considered and managed by all health and social care providers they encounter, with self-help and peer support throughout (Figure 1, Table 1).

Reference: 116

Figure 1. Stepped-care model of psychological support for adults living with HIV (2011)

Figure 1. Stepped-care model of psychological support for adults living with HIV (2011)

Level 1

Key information, support and signposting that can be provided by all staff working with people living with HIV

e.g. healthcare assistants, health advisors, nurses, pharmacists, doctors

Level 2

Enhanced support that screens for difficulties or provides brief interventions (e.g. psycho-education, motivational interviewing)

Staff with extra training and supervision: e.g. nurses, health advisors, peer mentors

Level 3

HIV-specialist psychological therapies, counselling, cognitive screening and pharmacological interventions that are HIV-specific for common mental health difficulties (e.g. anxiety, addictions, moderate depression, psychosexual or relationship issues, post-traumatic stress) and HIV-related issues

Qualified and accredited clinicians: e.g. clinical and counselling psychologists, advanced nurse practitioners, general practitioners, dietitians, physiotherapists, psychiatrists, occupational therapists

Table 1. Examples of interventions and healthcare groups within stepped-care model

6a. Emotional well-being