Your Guide To...BHIVA Standards of Care for People Living with HIV

6. Psychological care

The Standards for psychological care for people living with HIV use the following terms:

  • Emotional wellbeing: this is how we feel and cope with the ups and downs of everyday life. It’s also about how we feel about living with HIV. It can include feelings about HIV stigma or telling people about HIV. It’s also about other things that HIV may or may not impact on. This could include things such as family and friends, relationships and sex, employment and society. In fact, it’s about anything that’s important to our confidence and self-esteem.

  • Mental health: although we all have good and bad days, sometimes the way we feel, think and behave can seriously stop us from living life well. Poor mental health can include anxiety or depression. It can also include post-traumatic stress disorder, or poor sleep. Some people with mental health difficulties experience suicidal thoughts. They might also injure themselves, or use alcohol or drugs, to cope with stress.

  • Cognitive function: this is about the health of our brain. It includes things like memory, concentration, using words and solving problems. If we have cognitive difficulties, we might forget things, be slower, or get confused easily. We might find it difficult to do the things we used to be able to do easily, like taking medication, or attending appointments.

Standard 6 - Psychological care

6b. Mental health

There are many reasons why people living with HIV are more affected by mental health issues than those not living with HIV. These can include drug or alcohol dependence, stigma, long-term medical conditions, and treatment side-effects.

Some groups can be more affected than others, perhaps because of other wider experiences of stigma and discrimination. These include black African men who have sex with men, trans people, people in prison, people who inject drugs, sex workers and people with disabilities. Anyone can experience poor mental health at some point in their life.

Poor mental health can make it harder to cope well with treatment and clinic visits. It might affect your ability to take your ARTART: Antiretroviral Treatment. For most people, this means taking three or more Antiretrovirals (ARVs), though it may be fewer in some cases. ARV: Antiretroviral .This is the name given to the drugs used in Anti-Retroviral Treatment (ART). For many people, a single tablet can contain all ARVs needed for your treatment. But others may need to take more than one tablet. regularly. If so, this can lead to detectable levels of virus. This can damage your own health and risk HIV transmission to partners. Regular mental health checks should be provided for everyone. Your HIV healthcare team should ask you about any changes that might affect your mental health. These could be things like changes to your HIV treatment, difficulty with relationships, loss of social support or benefits, and bereavement. But you should also feel able to raise any of these issues yourself, at any time, and ask for help and support, if needed.

Your medical team should provide referral to the most appropriate professionals. Mental health needs should be addressed quickly and professionally. Talk to your doctors and nurses if you have any concerns about your mental health. You should be referred to the right professional help at the right time.

You should have access to good healthcare that is culturally sensitive and respectful. You should be referred to other services if these are not available at your clinic.

Key messages

  • You should have annual check-ups for your mental health. Changes in your life should be reviewed. You should be referred to other services quickly if you have symptoms of depression, anxiety, post-traumatic stress, sleep difficulties, addictions, self-harm and suicidal thoughts.

  • When needed, you should be helped to access mental health services (including addiction services).

  • All your mental healthcare professionals should have up-to-date HIV knowledge. Their skills should be culturally sensitive. They must take into account things that have happened in your life, demographics, side effects and treatment interactions. Training should be provided for them, if necessary.