Doctors urged to consider psychological as well as medical factors in HIV treatment

Doctors need to consider the social and psychological, as well as the medical, aspects of HIV diagnosis and care, advised Professor Rusi Jaspal in his keynote speech at the UK’s largest HIV conference.

The fourth joint conference organised by the British HIV Association and the British Association for Sexual Health and HIV, brought together around 400 clinicians from across the country to discuss the latest advances in treatment, care and initiatives to engage hard-to-reach communities. You can watch his lecture here.

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Prof Jaspal, Chair in Psychology and Sexual Health, explained how tenets of Identity Process Theory can help clinicians understand the factors that can lead people to engage in high-risk behaviours – and provided evidence-based recommendations on how clinicians can intervene to help reduce the risk of HIV infection, particularly among men who have sex with men (MSM).

In response to social and psychological trauma, such as homophobia or childhood abuse, some MSM may adopt unhealthy coping strategies. Some may not engage with treatment or care because they do not see themselves as in need of help or because do not want to see themselves as being “high risk”. By understanding more about how patients view themselves, their social networks and their psychological wellbeing, Prof Jaspal argued, clinicians may be better positioned to identify potential risk factors and improve patient outcomes.

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He said: “By discussing with patients the broader context of their lives, clinicians may be able to identify potential risk factors for HIV infection or for poor engagement with HIV care

“Crucially, doctors should be aware of the complexity of patients’ lives and identities – what may seem a good clinical solution to a particular medical problem can pose significant risks for psychological wellbeing, so this needs to be managed carefully. Understanding this can improve the effectiveness of the clinical solution.

“At a time when cuts are being introduced due to austerity, it is essential that policy-makers and commissioners do not overlook the importance of psychosocial support in sexual health. By investing in psychosocial support services, we have the potential to improve sexual health outcomes, and to prevent HIV, in patients.”

Rusi-book-cover560x876Prof Jaspal’s lecture introduced Identity Process Theory, which presents a model of how people attempt to cope with the adverse psychological events that can occur in their lives, so that clinicians might be able to predict coping patterns and encourage more effective and healthy coping strategies in patients.

The keynote discussed the temptation of engaging in ‘escapist’ behaviours like drug use in sexualised settings (or ‘chemsex’) in order to cope with psychological adversity. HIV is preventable with the use of condoms and/ or pre-exposure prophylaxis (PrEP). HIV infection is effectively treatable with the use of antiretroviral therapy.

Prof Jaspal’s book ‘Enhancing Sexual Health, Self-Identity and Wellbeing among Men Who Have Sex With Men: A Guide for Practitioners’, which presents practical recommendations for sexual health practitioners, is out on 21 June 2018.
Men who have sex with men (MSM) are the group most affected by HIV in the UK. Around 47,000 MSM were living with HIV in the UK in 2015 – approximately 46% of the HIV patient population in the Uk.

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