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

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 15: Special PopulationsSpiritual SupportSpirituality is an important aspect of the lives of people who are homeless. Many grew up infamilies26thatpicaswere deeply religious, and even if they are not actively practicing today, they maycarry those religious beliefs with them. Others have been exposed to the spiritual principles of12-Step programs such as Alcoholics/Narcotics Anonymous and find support and comfort in ahigher power. Addressing the spiritual aspects of palliative care is as important with the homelessas with other people.Clinicians should inquire about the religious background and current spiritual beliefs of peoplewho are homeless. Sometimes this is the first step toward bringing in other members of thepalliative care team, such as pastoral counselors or clergy. Asking these questions not onlydemonstrates personal interest in patients, but gives them permission to discuss this aspect oftheir lives.PEOPLE WHO ARE NEW IMMIGRANTS■ Immigrants come to the U.S. and to other countries from all over the world. Many are fromcountries where the spread of HIV/AIDS has been exacerbated by poverty or civil unrest resultingin social dislocation and economic disruption; for example, Guatemala, Myanmar, Russiaand Rwanda. Some come seeking safe asylum, while others seek educational and economic opportunities.They all hope for a better life for themselves and their children. However, somealready have become infected with HIV.People living with HIV who have immigrated to the U.S. from other countries may have culturaland legal issues that restrict their ability to access and accept palliative care. The culturalissues may include language barriers and differences between their cultures of origin and themainstream culture upon which the American health care system is based. The legal issuesrelate to whether or not they are in the country legally and, if they are, whether their HIV statusendangers their legal status and thus their access to benefits. An additional concern may bewhether their visas allow them choices regarding whether to stay in the U.S. or to return hometo die. Such issues are also relevant for immigrants in other countries.Unless palliative care providers are sensitive to immigrant clients’ cultural differences and canidentify legal barriers to their clients’ accessing care, they risk losing clients before follow-up orleaving them outside any system of care. The clinician’s first intervention with people who maybe immigrants should include assuring them that their relationship with the clinician and thehealth care agency is completely confidential. Only then will it be possible to determine eachindividual’s situation and provide referrals to agencies that can provide immigration counselingand legal assistance. As with all special populations, obtaining contact information for familymembers or close friends is important so that follow-up can take place.Cultural IssuesImmigrants may face many of the cultural issues common to minority groups in the U.S. (SeeChapter 14: Culture and Care.) In addition, however, their status as immigrants may compoundsome of the issues they face, as opposed to people who have lived in the community for a longtime.320U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau