Tuesday, September 27, 2022

Working With Hiv Positive Clients

Developing New Substance Abuse Treatment Goals

Immunology wars: The battle with HIV

Altering admission requirements

A one-size-fits-all abstinence-based approach to admission effectively serves only a small number of clients. Insisting that clients detoxify and remain substance free prior to admission to substance abuse treatment programs assumes a homogeneity of substance abuse and substance abuse behavior that does not exist.

Providers should realize that some clients use substances as a way to control mood, monitor affect, and adhere to a schedule of activity. Drug use as a life management strategy may seem dysfunctional but is not necessarily a personal deficit. Eliminating substance abuse without understanding the context and role it plays in the lives of clients may, in counterintuitive fashion, increase the chances of lapse and relapse among clients. Stopping substance abuse without substitutes or proxies for its socially constructed meaning is fraught with risk.

Programs should include a harm-reduction treatment track that can accommodate the retention in treatment of clients who are active substance abusers but willing to control their substance use . Admission requirements might be altered depending on level of care, motivation and coping resources of client, and treatment agency and philosophy.

Psychological Responses To An Hiv Positive Result

Many reactions to an HIV positive diagnosis are part of the normal and expected range of responses to news of a chronic, potentially life threatening medical condition. Many patients adjust extremely well with minimal intervention. Some will exhibit prolonged periods of distress, hostility, or other behaviours which are difficult to manage in a clinical setting. It should be noted that serious psychological maladjustment may indicate pre-existing morbidity and will require psychological/psychiatric assessment and treatment. Depressed patients should always be assessed for suicidal ideation.

Effective management requires allowing time for the shock of the news to sink in there may be a period of emotional ventilation, including overt distress. The counsellor should provide an assurance of strict confidentiality and rehearse, over time, the solutions to practical problems such as who to tell, what needs to be said, discussion around safer sex practices and adherence to drug therapies. Clear information about medical and counselling follow up should be given. Counselling may be of help for the patient’s partner and other family members.

Hiv And Risk Of Relapse

HIV/AIDS milestones are significant for the client, her significant others, and her support network. Counselors often can anticipate crisis, upset, or a readiness for change when a client reaches an HIV/AIDS milestone. Counselors who know and understand these milestones have an opportunity to prepare clients through the development of coping skills and strategies. It is a time of great opportunity for change or for relapsing. Milestones can create the impetus for a new way and learning new behaviors, or they can serve as an impetus for clients to act in self-destructive or harmful ways.

Following are some of the milestones of HIV infection that counselors should learn to recognize.

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People Have Very Low Awareness Of What Hiv Is And That It Is Not As Scary As They Imagine

People have very low awareness of what HIV is and that it is not as scary as they imagine. Society has a perception that HIV always leads to death, as we often see terrifying images in media. This information only reinforces discrimination and stigma against people living with HIV, which creates a barrier for them to accept their status, Munira Mahmudova, trainer.

Munira Mahmudova has a masters degree in Social Work and practical experience in helping families with children in Tashkent. For more than three years, Munira has been sharing her knowledge and experience with students of the Mirzo Ulugbek National University of Uzbekistan. She conducts trainings for specialists providing social services and offers retraining courses in social work.

This year, after completing courses at Columbia University’s School of Social Work, Munira was honored to lead training sessions for psychologists at AIDS Centers in Uzbekistan financed by UNICEF and UNAIDS. Munira was passing on her knowledge to develop communication skills, client involvement, and motivational interviews to offer better support to their clients.

Status acceptance is the biggest issue of working with this group of people since closed status makes it difficult for us to offer them support.

Parents are always ashamed if their child has been diagnosed as HIV positive.

The Importance Of State’s Law And Hiv/aids Reporting

PPT

Thus, it is important to keep in mind the requirements of your states laws. This includes duty to warn, protect, and treat laws as well as those relevant to reporting HIV. Some states do not all require the reporting of HIV or AIDS status by licensed psychotherapists while other states require the reporting of it . So, knowledge of the relevant laws in ones jurisdiction is essential. It is also important to keep in mind that breaching confidentiality due to harm to others has strict limitations. The harm must be threats of harm in the future, not in the past or ongoing. Additionally, the harm typically must have potentially imminent lethality .

Finally, if these issues can effectively be addressed in treatment, that is preventing the risk of future harm through treatment, that should carefully be considered unless your states law contraindicates this. When addressing these issues are addressed in treatment it is important to thoroughly document all discussions, recommendations, interventions and actions taken, your clients responses, and all consultations. Further, its not just important to document what you did, but also all that you considered and the rationale behind your decisions.

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Dealing With Discrimination When You Have Hiv

We’ve come a long way in our understanding of HIV and AIDS, but discrimination against people with HIV/AIDS is still rampant. Advances in research have made it possible to live with the disease, as people do with other chronic illnesses. But the greatest challenge for many people is still the stigma that accompanies the illness.

You may worry about what others will think about your diagnosis. Or you may fear coming out as gay or bisexual, or as an intravenous drug user. These worries and fears can encourage behaviors that put you and others at risk. These behaviors include:

  • Avoiding getting tested for HIV

  • Not using condoms

  • Hiding an HIV-positive status from sex partners

  • Avoiding medical care that can save or prolong your life

  • Not taking medication as directed

  • Hiding health problems from your family

The burden of AIDS is much higher among African-Americans. Homophobia and fear of people with HIV/AIDS are particularly strong in the African-American community. These fears mean that many people are afraid to acknowledge their sexual orientation or HIV-positive status. For these reasons, many prefer to risk infection rather than face the stigma of HIV/AIDS.

Perceived Breaches Of Confidentiality: Brief Explanation

Those respondents who perceived breaches of confidentiality were given the chance to discuss or explain how and where they experienced the breaches of their HIV-related medical information. Accordingly, most of the respondents gave their reflection and these reflections were summarized into three main categories to answer the questions of where and how the breaches of confidentiality were experienced, and then applied to the way that they perceived the breaches of confidentiality .

Table 4 Concepts Raised by HIV/AIDS Clients at Different Working Units of the Hospital, With Explanation and Application to Perceived Breaches of Confidentiality

Regarding areas where the respondents experienced breaches of confidentiality in the Nekemte Specialized Hospital, six potential areas were identified. Respondents mentioned these breaches and explained them briefly from their point of view. Consequently, the ART clinics open location, inpatient/ward admission, provider approaches, medication refilling area, the way that clients transferred/linked, and the laboratory request form were issues raised by the respondents. In particular, a large number of respondents complained about the ART clinics open location, while many other respondents complained about the care providers approach .

Figure 2 Areas where breaches of confidentiality were perceived among HIV/AIDS clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021.

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What Is Hiv Counselling

Counselling in HIV and AIDS has become a core element in a holistic model of health care, in which psychological issues are recognised as integral to patient management. HIV and AIDS counselling has two general aims: the prevention of HIV transmission and the support of those affected directly and indirectly by HIV. It is vital that HIV counselling should have these dual aims because the spread of HIV can be prevented by changes in behaviour. One to one prevention counselling has a particular contribution in that it enables frank discussion of sensitive aspects of a patient’s lifesuch discussion may be hampered in other settings by the patient’s concern for confidentiality or anxiety about a judgmental response. Also, when patients know that they have HIV infection or disease, they may suffer great psychosocial and psychological stresses through a fear of rejection, social stigma, disease progression, and the uncertainties associated with future management of HIV. Good clinical management requires that such issues be managed with consistency and professionalism, and counselling can both minimise morbidity and reduce its occurrence. All counsellors in this field should have formal counselling training and receive regular clinical supervision as part of adherence to good standards of clinical practice.

This article has been adapted from the forthcoming 5th edition of ABC of AIDS. The book will be available from the BMJ bookshop and at www.bmjbooks.com

Continuum Of Care: Different Treatment Strategies For Different Levels Of Care

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Detoxification

Most of the client work during this stage of care is directed to surviving the physical and psychological traumas of separation from addictive substances. The degree and range of trauma will vary greatly depending on the substance used. Often clients will benefit from an initial placement in a 12-Step program to begin the long process of breaking through denial, consciousness raising, and discussing feelings.

Medical supervision during this process is critical. Detoxification of HIV-infected clients presents considerations not usually encountered in other clients. Many HIV-infected clients either are on, or will soon be on, a complicated schedule of medications to which strict adherence is necessary. These clients may also suffer from medical conditions that have occurred as a result of the disease, which can interfere with the detoxification process. Thus, while the counselor focuses on the client’s psychosocial issues, it is imperative that an experienced physician monitor her closely and supervise treatment during this process.

Inpatient and residential treatment

Care strategies during inpatient treatment consist of consciousness raising, contemplation of behavior and personal changes around risky behaviors, and developing plans for action. It is recommended further that clients begin to discuss the problems of relapse and interaction of competing problems from sex and drug domains.

Individual therapy strategies

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Leslie Dematteo Lmt Ms

Leslie L. DeMatteo, LMT, MS, has been an active massage therapist since 1998, after graduating from the Sarasota School of Massage Therapy in Sarasota, FL. There she completed the massage therapy program along with a certificate program in Nuad-Bo-Rarn: Traditional Massage of Thailand. Since then, she has completed continuing education in cranial-sacral fundamentals, cancer and mastectomy massage, reflexology, trigger point therapy and prenatal massage. She is also certified by the National Certification Board for Therapeutic Massage and Bodywork and is a Professional Level member of Associated Bodywork and Massage Professionals . Her work in massage therapy continuing education and teaching in a massage school ignited a passion for adult training and education, which led her to pursue her Bachelor’s Degree in Adult Learning: Vocational Instruction, followed by her a Master’s Degree in Adult Learning.

Characteristics Of The Worried Well

  • Repeated negative HIV tests
  • Low risk sexual history, including covert and guilt inducing sexual activity
  • Poor post adolescence sexual adjustment
  • Social isolation
  • Dependence in close relationships
  • Multiple misinterpreted somatic features usually associated with undiagnosed viral or postviral states or anxiety or depression
  • Psychiatric history and repeated consultation with general practitioners or physicians
  • High levels of anxiety, depression, and obsessional disturbance
  • Increased potential for suicidal gestures

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Diagnosis: Then And Now

When Donald Hughes, a hairdresser and community activist living with HIV, got his diagnosis, it was 1986. Access to antiretroviral therapy was still a few years off, and Hughes felt there was no way out.

A year after his diagnosis, Hughes began his journey to sobriety and recovery. He started attending support groups, many of which looked to alternative medicine approaches for treating his HIV, such as taking Echinacea supplements and drinking aloe vera juice, and some of his colleagues even underwent urine therapy. Throughout his experience, there was a strong undercurrent of fear, isolation, and loneliness. I kept looking around in support group meetings, thinking, its about time I got sick, Hughes said.

An HIV diagnosis in the late 1980s was full of unknowns that taxed a persons mental health. No one knew how long they would stay healthy. People hid their diagnosis from insurance companies, afraid that they would lose coverage. As a hairstylist, Hughes was often called into the hospital to do haircuts for individuals in hospice care or who were homebound. He found himself personally cleaning and caring for HIV-positive patients because they were neglected by hospital support staff.

Many HIV-positive individuals also struggle to access supplementary services they need to live healthy lives, such as Ryan White funding for their medications, housing assistance, or drug and alcohol rehabilitation.

What Personal Protection Should I Wear

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Wear gloves:

  • When you have open or healing wounds, or skin infections.
  • When in contact with blood or body fluids, secretions, excretions or non-intact skin.
  • When in contact with surfaces or articles contaminated with blood or body fluids.
  • When performing venipuncture or other vascular access procedures.
  • When carrying out cleaning or decontamination procedures.

Replace torn or punctured gloves immediately.

Use new gloves for every patient.

Wear protective eye wear, masks or face shields during procedures likely to generate droplets of blood or body fluids.

In general, protective eye wear, masks and clothing are not needed for routine care of AIDS virus-infected persons.

Wear gowns when the splashing of blood or body fluids may occur.

Wash hands:

  • Before and after direct patient contact.
  • Immediately and thoroughly when contaminated by blood or body fluids.
  • After removing gloves.
  • After a glove tear or suspected glove leak.
  • Before leaving a work area.

The use of gloves does not eliminate the need for hand washing. Hand washing is one of the most important procedures for the prevention of transmission.

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Factors Associated With Perceived Breaches Of Confidentiality

Bivariable Analysis

Binary logistic regression model analysis was computed to identify potential factors. Accordingly, 17 potential independent variables were found to be associated with the outcome variable at a P-value of < 0.2 and were considered as candidates for the multivariable logistic regression model .

Table 5 Results of Bivariable Analysis and Factors Associated with Breaches of Confidentiality Among HIV/AIDS Clients on ART at Nekemte Specialized Hospital, Western Ethiopia, 2021

Multivariable Analysis

The multivariable logistic regression analysis was conducted on the 17 candidate variables. Eight variables remained significantly and independently associated with perceived breaches of confidentiality among HIV/AIDS clients at a P-value of < 0.05.

Accordingly, respondents with a delayed ART start had a two-fold higher perceived breach of confidentiality compared to their counterparts . Female respondents were four times more likely to have perceived breaches of confidentiality compared to male respondents . Widowed respondents were four times more likely to have perceived breaches of confidentiality compared to those who were married .

Respondents who had completed primary school, secondary school, and college and above were eight, 16, and 11 times more likely to have perceived breaches of confidentiality compared to respondents with no formal education.

Your Rights As An Employee With Hiv

As an employee with HIV, you have a right to remain in the workforce to the fullest extent possible, and a right to equal employment opportunities. Several federal, state, and local laws determine how employers design workplace programs pertaining to employees with HIV.

Employees with HIV are protected from discrimination in employment by law under the Americans with Disabilities Act . This law prohibits most private employers, state and local governments, employment agencies, joint labor management committees, and labor unions from discriminating against qualified individuals with disabilities. These provisions include, but are not limited to:

  • Job application procedures
  • Compensation
  • Job training

The ADA applies to employers with 15 or more employees for each working day in each of 20 or more calendar weeks. Read more from the Equal Employment Opportunity Commission about HIV and employment discriminationexternal icon.

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How Is Transmission In The Workplace Prevented

The Centers for Disease Control recommend using routine practices to protect workers at risk from HIV exposure. This approach stresses that all situations involving contact with blood and certain other body fluids present a risk. Routine practices outline the use of barriers to prevent workplace exposure to HIV and other viruses. These barriers include the use of:

  • engineering controls such as retractable needles
  • safe work practices and administrative controls
  • protective equipment such as gloves, gowns or aprons, masks, and protective eye wear.

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What Types Of Accommodations Should Be Considered For Hiv

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It is helpful if employers have established policies on non-discrimination for persons with life-threatening illnesses. These policies should emphasize that employees with illnesses such as cancer, AIDS, and heart disease may wish and be able to work a regular or modified work schedule. Most people infected with HIV do not show any symptoms of disease for many years after infection.

If the HIV-positive employee eventually becomes unable to perform essential functions, the employer must consider whether reasonable accommodation will permit him/her to do so.

Examples include:

  • Flex-time to allow for medical appointments, treatment and counseling
  • Auxiliary aids and services, for example, large print for someone with AIDS who has developed a vision impairment and
  • Additional unpaid leave.

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