The mental health challenges associated with HIV/AIDS have evolved and changed as the dynamics of the epidemic have developed. These challenges include knowledge of HIV status and disclosure to members of social networks, the impact of stigma on people living with HIV, alternative styles of coping with HIV illness and their consequences, suicidality among people with HIV, and the special challenges of HIV among persons with severe mental illness and among injection drug users. Key issues include: How have mental health needs and policies as related to HIV/AIDS been affected by changes over time in public fears of infection? How has the context for mental health treatment in the HIV/AIDS population changed as the social, cultural, and economic profile of this population has evolved? How is this care affected by evolving organizational and financing factors?
The HIV–Mental Health Challenge
The Centers for Disease Control (CDC) first noted five cases of the disease we now know as acquired immunodeficiency syndrome (AIDS) in the June 1981 issue of the Morbidity and Mortality Weekly Report (MMWR): it described young men who had sex with men (MSM) who were treated in the prior eight months at three different hospitals in Los Angeles for a type of pneumonia that appears almost exclusively in immunosuppressed patients (pneumocystis carinii pneumonia; CDC, 1981). From that time to the present, the challenges posed to mental health professionals and policy makers by AIDS and its cause, human immunodeficiency virus (HIV), have been conditioned by multiple, sometimes rapidly changing, influences. These influences include disease-related characteristics, such as its epidemiology, symptoms, common comorbidities, course, and outcome; developments in our understanding of the disease and how best to respond to it in terms of prevention, therapeutics, and palliation; and the evolving social and cultural contexts that assign meaning to the disease, the battle against it, and the effort to live with it.
While the most prominent feature of the landscapes we survey is the dramatic change brought about by the development of effective antiretroviral therapies, traditional biomedical “search for the cure” narratives neglect the continuing important role played by psychological, social, and behavioral processes in understanding, and responding to, the epidemic.