Psychological benefits and challenges of HIV/AIDS therapy

The advent of highly active antiretroviral therapies (HAART) for treating HIV infection was a major breakthrough in managing the HIV/AIDS crisis. These combinations of drugs target different stages of the HIV replication cycle, slow HIV disease progression, and prolong life. By using HAART, many people with HIV who have been diagnosed with AIDS become healthy enough to return to work or school. Returning to work or school is often considered the benchmark of successful HIV treatment (Brooks & Klosinski, 1999).

HAART also may give hope and optimism to people with HIV. Researchers have found that having hope and an optimistic outlook, in turn, improves people's physical health, decreases their levels of depression, and even extends their life spans (Low-Beer et al, 2000; Taylor, Kemeny, Reed, Bower, & Gruenewald, 2000). Despite these benefits, however, antiretroviral therapy can present significant psychological challenges to both those who respond well to the treatment and those who do not (Brashers et al, 1999). These can range from moodiness and aggressive behavior to severe depression, suicidal thoughts, paranoia, delusions, and hallucinations.

Challenges for people who respond well to therapy

Those who experience renewed health after being diagnosed with AIDS and treated with HAART must often recalibrate and renegotiate a number of aspects of their lives. These include:

• Feelings of hope and future orientation (eg, "Will recovery last?")
• Social roles and identities (eg, "How do I live as a person with a chronic illness?")
• Interpersonal relations (eg, "Will people accept me if I try to reenter the workforce?")
• Quality of life (eg, "What activities do I have to give up to stay healthy?")

Challenges for people who do not respond well to therapy

Although antiretroviral therapy makes many people with HIV healthier, between 15% and 35% of research participants in antiviral therapy studies do not improve with antiretroviral therapy, and even more people who are not research participants do not respond well to the treatment (Kelly & Kalichman, 2002). In addition, some people's health may initially improve with therapy, but then quickly deteriorate (Stone & Smith, 2004).

People whose treatments fail may feel a sense of personal injustice, like they were cheated, betrayed, or misled about the effects of antiretroviral therapy. They also may engage in self-blame for not having been able to tolerate a potentially effective treatment, especially when they had to discontinue therapy because of severe side effects. A sense of hopelessness and an unwillingness to try new therapies are also common (Rabkin & Ferrando, 1997).