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Psychosocial Support

Contents

::What it is
:: Why it is Important
:: How it is Done
:: Human Resources, Infrastructure and Supplies Needed
::Cost Information
::Key References

What it is

Psychosocial support addresses the ongoing psychological and social problems of HIV infected individuals, their partners, families and caregivers.

Why it is Important

  • HIV infection affects all dimensions of a person’s life: physical, psychological, social and spiritual. Counselling and social support can help people and their carers cope more effectively with each stage of the infection and enhances quality of life. With adequate support, PLWHA are more likely to be able to respond adequately to the stress of being infected and are less likely to develop serious mental health problems. Assessment and interventions may be aimed at the acutely stressful phase following notification of HIV infection, the ensuing adjustment period, and the process of dealing with chronic symptomatic HIV infection and disease progression through to death.
  • HIV infection often can result in stigma and fear for those living with the infection, as well as for those caring for them, and may affect the entire family. Infection often results in loss of socio-economic status, employment, income, housing, health care and mobility. For both individuals and their partners and families, psychosocial support can assist people in making informed decisions, coping better with illness and dealing more effectively with discrimination. It improves the quality of their lives, and prevents further transmission of HIV infection.
  • For people with HIV/AIDS who must adhere to TB treatment, long-term prophylaxis or antiretroviral therapy, on-going counselling can be critical in enhancing adherence to treatment regimens.

How it is Done

Developing guidelines and training for psychosocial care

  • Psychosocial support should be specifically included in national guidelines for the management of HIV/AIDS.
  • Training on the provision of psychosocial support should be incorporated into the curriculum for all health care providers.
  • Guidelines for home care services can be developed and should include the provision of basic psychosocial care by community volunteers and family caregivers.
  • Training courses for community volunteers can be organised and provided by health care workers.
  • Training in professional disciplines (counselling, psychology, psychiatry) can be made available at the national and international level.
  • Strategies for providing psychosocial support can be developed for specific groups (e.g. women, youth, men who have sex with men, injecting drug users, health care workers, etc.).

Developing services for HIV infected people, family members and health workers

  • Assess what mental health and supportive services are available at both the governmental and non-governmental level that could be strengthened or replicated. Assess what additional services are needed.
  • At the community level, groups can be started to provide for the needs of individual patients and affected family members. Psychosocial support services that address the specific needs of vulnerable groups can be especially important (e.g. women, children, etc.).
  • A comprehensive support system linking and coordinating existing psychosocial services with each other and to health services needs to be established.
  • At the hospital or clinic level, groups for health care workers in high HIV prevalence areas will be especially important for the support of nurses, physicians and other health care personnel who may be seeing large numbers of HIV infected patients. Supervision of health care workers will be key in assisting health workers to cope with issues related to HIV/AIDS.
  • Peer groups (whether of heath workers working under stressful conditions, people living with HIV/AIDS, or family members of people with HIV/AIDS) can be a very effective way of providing psychosocial support.
  • A comprehensive support system linking and coordinating existing psychosocial services with each other and to health services thus maximizing all resources needs to be set up.
  • Building community capacities to provide counseling and support will ensure sustainability, continuity of interventions and community development.

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Human Resources, Infrastructure and Supplies Needed

In hospitals, clinics and home care settings, existing health care workers can provide basic psychosocial support. Pre-service and in-service training in psychosocial support is crucial for nurses and other health care personnel. Care provided by health care workers can be bolstered with the training of volunteers and others to assist HIV infected individuals and their families in the community setting. Volunteers may be other PLWHA or people affected by HIV in their personal lives.

In resource constrained settings there are often insufficient numbers of adequately trained health care personnel able to provide sophisticated psychological care. Identification of needs and the training of adequate personnel (e.g. social workers, counsellors, psychologists, psychiatrists) will be an important step taken at the national level to ensure that psychosocial support becomes a viable part of the care of PLWHA, their families and their caregivers.

The provision of psychosocial support is an important part of care at both institutional and community level. Space may need to be arranged in hospitals and clinics to ensure privacy and confidentiality.

Medications needed for psychological care may not be available in many public clinics and hospitals. A review of the national essential drug list will be important to ensure that pharmacological supplies are available when needed. Information detailing potential interactions between medicines used for psychological care and antiretroviral therapy should be available.

Cost Information

Little information is available on the cost of providing psychosocial support for HIV/AIDS in resource poor settings. Such care is either infrequently provided, has not been documented – or is provided as part of overall care and support of people with HIV/AIDS (e.g. by way of home care services, palliative care, etc.). As noted above, basic psychosocial support can be provided by health care personnel and incorporated into the care provided in hospitals and clinics. Accordingly, cost should not be prohibitive. Further, community groups can be trained in the provision of psychosocial care. This will entail training costs but should not be expensive to maintain. More costly will be the addition of specialist services. Given the importance of these services to the overall health and support of people with HIV/AIDS, their families and caregivers, they should be included as an integral part of care and support strategies.

Key References

  • UNAIDS. Caring for carers: managing stress in those who care for people with HIV/AIDS. Best Practice Collection. UNAIDS/00.08E, 2000.
  • Ankrah, M. The impact of HIV/AIDS on the family and other significant relationships: the African clan revisited. AIDS Care, 1993, 5:5-22.
  • Baggaley, R. et al. HIV counselling and testing in Zambia: the Kara Counselling experience. SAFAIDS, 1998, 6(2):2-9.
  • Lippman S., James, W., Frierson, R. AIDS and the family: Implications for counselling. AIDS Care, 1993, 5: 347-357.

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