How to Help Therapy Clients Adapt to an HIV+ Diagnosis

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HIV is perhaps one of the most stigmatized chronic illnesses, due to its emergence 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 AIDS allegedly being contagious.

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 Reagan uttered "AIDS" publicly for the first time––nearly 3 years had passed and at least 5,636 individuals had died.

Today, we know that HIV and AIDS are not contagious via saliva or skin-to-skin contact, that gay men are not the only affected demographic, that antiretroviral treatment (ARV/ART) can prevent both the replication of HIV and progression to AIDS, and individuals who are HIV-positive can live as long as people who are HIV-negative.

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

Not to mention, we are living during an era of misinformation, amidst a pandemic with serious implications for the immunocompromised, and also expect to soon have a Secretary of Health and Human Services who does not believe in vaccines. These factors are likely fueling anxiety, depression, and suicidality disproportionately affecting many folks who are HIV-positive.

If your work entails supporting folks who are HIV-positive, below are tips for ensuring the care that you provide is empathetic, humanizing, sociopolitically informed, and structurally competent. These recommendations come from research, clinical experience, and anecdotes of HIV/AIDS advocates. They are also centered around 5 anxieties that may be worth exploring, with the consent and mutual interest of your client(s).

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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 (ARV/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 generic prescriptions; discussing the impact of financial trauma on their relationship to money; or unpacking 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 ARV/ART treatment is helping their immune system function at optimal levels.

This might present as health anxiety or excessive and persistent 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.

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Clients who are grappling with health anxiety may benefit from psycho-education about health anxiety. One study of health anxiety among women living with HIV, for instance, found that health anxiety impacted sleep, concentration, appetite, and desire to socialize. Talking through triggers and maladaptive coping responses may prove helpful, in addition to mindfulness and meditation interventions. Additionally, clients might benefit from charting how other health domains have improved since managing their overall health more proactively.

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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 sexuality without awkwardness, immaturity, or 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 when broaching the conversation while 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.

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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, the Supreme Court, and local and state legislatures and courts.

For example, more than two-thirds of U.S. states have enacted laws that criminalize the transmission of HIV, and some also mandate sex offender registration and impose HIV-specific sentencing enhancements. This normalized and widespread structural oppression—along with concerns about the rollback of public healthcare, the censorship of K-12 sex education, book bans targeting literature about gender and sexuality, and the election of politicians who promote hate—explain why 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 Psychology Today Therapy Directory.