HMN 2024: How to Help Therapy Clients Adapt to an HIV+ Diagnosis

HIV/AIDS is perhaps one of the most stigmatized chronic illnesses, due to its stigmatized origin at the intersection of sex negativity, purity culture, anti-Blackness, anti-queerness, ableism—particularly ableist constructions of cisgender-heterosexual masculinity––and substance abuse discrimination.

This historical context explains why contemporary discussions about HIV/AIDS sound so much different from those from the early 1980s to the early 2000s. In fact, the nomenclature of HIV/AIDS in and of itself tells a story, with today’s iterations evolving from “rare cancer seen in 41 homosexuals,” “gay plague,” “gay-related immune deficiency,” and “4H disease” (allegedly denoting “homosexuals, heroin addicts, hemophiliacs, and Haitians).

Throughout the 1980s and 1990s, televangelists preached that AIDS was a curse from G-d. Television shows and stand-up comedians often broadcast jokes about AIDS that were homophobic and also spread misinformation about HIV/AIDS allegedly being contagious via saliva and skin-to-skin contact.

Even former President Reagan’s deputy press secretary Larry Speakes joked about AIDS in public press conferences. From October 15, 1982—when journalists first asked Speakes about AIDS—to September 15, 1985—when President Reagan uttered “AIDS” in public for the first time, nearly three years passed and at least 5,636 individuals had died from AIDS without any mention from Reagan’s administration.

Today, we know that HIV precedes AIDS and is not contagious via saliva or skin-to-skin contact, that HIV is preventable and manageable, that gay men are not the only demographic that HIV/AIDS affects, and that the right treatment can enable those who are HIV-positive to live as long as people who are HIV-negative.

Despite these advancements, HIV is still a relevant sociopolitical concern because persistent stigma, structural barriers, and health disparities continue to negatively impact the quality of life of many people.

Not to mention, we are living during an era of rampant misinformation, amidst a pandemic with serious implications for immunocompromised people, and expect to soon have a Secretary of Health and Human Services who does not believe in vaccines. Taken together, these factors mean anxiety, depression, and suicidality will continue disproportionately affecting individuals who are HIV-positive.

If you are a mental health professional supporting individuals who are HIV-positive, below are some tips to help ensure that the care you provide is empathetic, humanizing, sociopolitically informed, and structurally competent.

Financial Anxiety

The cost of HIV treatment can amount to $1,800 to $4,500 per month—at least within societies with capitalistic healthcare systems and little to no social safety net. The “market value” of antiretroviral medications (ART) accounts for approximately 60 percent of that estimate, while remaining expenses might consist of other prescriptions and appointment fees.

These costs alone are enough to place financial strain on the average worker, not to mention the cost of health insurance. And, unfortunately, even the cost of health insurance increases for those who are unemployed and living in states without robust public healthcare systems. That’s because employers usually subsidize an average of 83 percent of an employee’s coverage.

Clients in this predicament may benefit from career counseling; referrals to resources like The Ryan White HIV/AIDS Program, AIDS Drug Assistance Programs (ADAPs), Medicare, or cheaper generic options; discussing the impact of financial trauma on their relationship to money; or simply processing the intersection of ableism and capitalism through the lens of disability justice.

Health Anxiety

For some people who have been recently diagnosed with HIV, it may take time to fully trust that ART medications are helping their immune system function at optimal levels.

This might present as health anxiety or excessive and persistent worry that worry that their health is in a precarious state. Symptoms like misinterpretation of normal bodily sensations and repetitive checking/reassurance-seeking may even interfere with daily life. At the same time, some of this anxiety is reasonable, given that we are living through a pandemic in which the masses refuse to mask and social distancing guidelines are relaxed.

Clients who are grappling with health anxiety may benefit from psychoeducation about how health anxiety presents. One study of health anxiety among women living with HIV, for instance, found that the disorder impacted sleep, concentration, appetite, and desire to socialize. Talking through triggers and maladaptive coping responses may prove helpful for clients, in addition to mindfulness and meditation interventions.

Sexual Anxiety

Immediately resuming a healthy sex life may be a challenge following a recent HIV-positive diagnosis.

Intimacy may trigger people who associate HIV with sexual addiction/compulsion or the social construct of “promiscuity”; who are blaming and/or punishing themselves for their diagnosis; who are struggling to process denial, shock, and uncertainty; who are experiencing flashbacks and other signs of sexual trauma; and/or who are hyperconscious about transmitting HIV to sex partners, even despite preventive measures like condoms, PrEP, or ensuring their viral load is undetectable and untransmittable.

Clients with these concerns can benefit from a therapist whose professional boundaries and skills include the ability to discuss sexual concerns without awkwardness, immaturity, or the pressures of respectability politics and sex negativity.

Social Anxiety

The likelihood of anxiously anticipating rejection and serophobia often increases with each new encounter of sex negativity, over-spiritualizing (framing HIV as a moral consequence or religious punishment), and misinformation that fuels irrational fear/contempt.

Frequent confrontation with these biases may cause generalized social anxiety or a situational form of social anxiety specific to disclosing one’s HIV status. For example, anxiety may arise while broaching the conversation when dating or when asked about the reason for taking daily medication(s).

Clients with this concern may benefit from a therapist affirming the need to employ differing levels of disclosure, based on levels of trust across various contexts and relationships. Others may benefit from rehearsing broaching or boundary-setting conversations.

Political Anxiety

To be sure, coping with HIV is not just an individualized issue. Living with HIV is also a macro-level issue determined by the laws and policies shaped by presidential administrations, Congress, courts, and local and state legislatures.

For example, many states have laws that criminalize the transmission of HIV, and many also have mandated sex offender registration and instituted HIV-specific sentencing enhancements. Political issues such as this—along with concerns about the rollback of public healthcare, the eradication of sex education, the banning of books that promote understanding of issues related to gender and sexuality, and the election of politicians who promote hate—political anxiety is not uncommon among those living with HIV.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Therapy Directory.