The HIV Mental Health Spectrum

Abstract

The growing mental health needs that are related to HIV are immense and diverse. The HIV mental health spectrum is a model that identifies and characterizes populations in need of HIV-related services which can be offered by Community Mental Health Centers. The spectrum describes the specialized service requirements for each of these populations, the challenges in providing these services, and staff training needs. The authors propose this as a useful model for clinicians, researchers, educators, and administrators in planning to meet the needs of this expanding epidemic. HIV/AIDS is likely to become the major mental health issue of the decade. In the time since AIDS was first recognized and reported in the United States (1981), it has become a leading cause of death among men and women under 45 years of age, and children one to five years of age.1 The increasing proportion of cases attributable to heterosexual exposure is reflected in an increased number of AIDS cases among women and adolescents.2 Any epidemic of this proportion will have profound psychological effects on those afflicted and the communities in which they live. Several other characteristics of this illness add to its psychological impact. First, because AIDS originally occurred in the United States disproportionately among the stigmatized populations of gay men, IVDUs, and, later, African-Americans and Hispanics, social ostracism is added to the emotional challenge faced by those with the disease. Second, HIV and associated secondary infections directly attack the CNS producing serious and debilitating neuropsychological symptoms. Third, because there is currently no cure for or vaccine against HIV, the only way to reduce its spread is through behavioral change. Finally, psychoneuroimmunologic research suggests that behavioral factors may influence immune function in HIV-infected individuals and behavioral interventions including stress management, relaxation training, and exercise may provide some benefit.3-5 Taken together, these characteristics make it clear that Community Mental Health Centers (CMHCs) can play a central role in the prevention and treatment of HIV infection and AIDS. Mental health professionals are often unprepared to serve clients with HIV-related needs.6 The comprehensive nature of the mental health services required must be more broadly recognized, and training which allows practitioners to assume a major role in serving AIDS-related cases must be offered.7 Research has already identified significant needs for continuing education of mental health providers to increase knowledge and clinical skills, change attitudes, and reduce the level of discomfort.8 This article proposes a conceptual framework, called the HIV mental health spectrum (see Figure 1), from which program development and training needs may be determined. The spectrum model will help identify necessary services and staff training requirements specific for each level in the model. Mental health workers need to focus on the cognitive, behavioral, and emotional concomitants of the HIV epidemic at all spectrum levels.