The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric Problemsneuropathy, vascular disease, autonomic insufficiency, premorbid psychological disease, anddrug side effects should be addressed so that as normal a sexual life as possible is possible.Erectile dysfunction may be facilitated with sildenafil but caution must be urged with regard todosing in26thepicaspresence of protease inhibitors.Psychotherapy, particular behavior and cognitive therapies to treat sexual inhibitions and anxieties,and couples therapy may enhance both sexual function and adaptation to declining sexualfunction. 89PSYCHOLOGICAL AND PSYCHOSOCIAL ISSUES■ Even with the advent of multidrug therapy, the future of most people with HIV is uncertain.Living with such a tremendous burden of unpredictability often affects people’s ability to maintainemotional stability and retain control over their lives. Many issues arise throughout thecourse of HIV infection. Each change in medical status, every blood test result, and every recognitionof a new change in mental or physical function can create enormous stress on an infectedindividual and the people in his or her life. 90Primary care providers are increasingly faced with complex medical and social issues. The importanceof mental health and practical support to help patients meet these challenges cannotbe overstated. All too often, medical providers do not see the need for mental health care orunderstand the contributions that mental health clinicians can make to a treatment team, andmay convey that bias unwittingly to patients. Early involvement of mental health care in thetreatment of the HIV- infected patient allows the development of a relationship that can preventcrises from becoming disruptive to the care of the patient or the medical provider’s practice.Table 10-28 lists some of the most important issues facing people over the course of their HIVinfection. Two of the most emotionally difficult issues for many patients are permanency placementfor minor children, and creating advance directives.XU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 245