1. HIV and Its Impact onHIV and Its Impact on
Mental Health andMental Health and
Emotional WellbeingEmotional Wellbeing
The PLUS SeminarThe PLUS Seminar
Rafael Chang, LMFTRafael Chang, LMFT
UCSF Alliance Health ProjectUCSF Alliance Health Project
7/29/20137/29/2013

2. ItIt’s Normal To Have Some Reaction!’s Normal To Have Some Reaction!
• Receiving an HIV+ diagnosis is a major lifeReceiving an HIV+ diagnosis is a major life
stressor. Itstressor. It’s’s naturalnatural to have some reaction ofto have some reaction of
distress, sadness, denial, anxiety and/or anger.distress, sadness, denial, anxiety and/or anger.
• No matter what you are feeling, you have a rightNo matter what you are feeling, you have a right
to feel that way. There are no "wrong" or "right"to feel that way. There are no "wrong" or "right"
feelings.feelings.
• Feelings come and go. You have choices aboutFeelings come and go. You have choices about
how you respond to your feelings.how you respond to your feelings.

3. Common Emotional Changes andCommon Emotional Changes and
SymptomsSymptoms
• DenialDenial
• Very common to want to deny oneVery common to want to deny one’s HIV’s HIV
infection and ‘pretend’ it isn’t there.infection and ‘pretend’ it isn’t there.
• This is a natural and normal psychologicalThis is a natural and normal psychological
response. But, it can be harmful to you if itresponse. But, it can be harmful to you if it
prevents you from seeking support or medicalprevents you from seeking support or medical
attention.attention.

4. Common Emotional Changes andCommon Emotional Changes and
SymptomsSymptoms
• Shame and StigmaShame and Stigma
• HIV is still a very stigmatized and misunderstoodHIV is still a very stigmatized and misunderstood
disease in our communities. Itdisease in our communities. It’s common to feel shame,’s common to feel shame,
guilt and fear of others’ reactions or judgments aboutguilt and fear of others’ reactions or judgments about
our HIV status.our HIV status.
• Some HIV+ LGBT people feel as though they have toSome HIV+ LGBT people feel as though they have to
go backgo back ‘in the closet’ about their HIV status, and hide‘in the closet’ about their HIV status, and hide
again who they are, for fear of rejection by others.again who they are, for fear of rejection by others.
• It is a common response to not want to beIt is a common response to not want to be ‘singled out’‘singled out’
or identified as HIV+, however it also may limit theor identified as HIV+, however it also may limit the
support or services you can receive.support or services you can receive.

5. Common Emotional Changes andCommon Emotional Changes and
SymptomsSymptoms
• AngerAnger
• Common to be angry at oneself or at theCommon to be angry at oneself or at the
person(s) we believe may have led to HIVperson(s) we believe may have led to HIV
infection.infection.
• A natural reaction, but, if it goes unchecked andA natural reaction, but, if it goes unchecked and
worsens, can result in harm to yourself orworsens, can result in harm to yourself or
someone else.someone else.

6. Common Emotional Changes and SymptomsCommon Emotional Changes and Symptoms
• Sadness and DepressionSadness and Depression
• Common to have feelings of sadness, depressedCommon to have feelings of sadness, depressed
mood, desire to pull away from others after an HIVmood, desire to pull away from others after an HIV
diagnosis.diagnosis.
• Tearfulness, crying episodesTearfulness, crying episodes
• Sleeping more or less than usualSleeping more or less than usual
• Pulling away from loved ones, isolating from activitiesPulling away from loved ones, isolating from activities
• Feelings of guilt and shameFeelings of guilt and shame
• Difficulty concentratingDifficulty concentrating
• Thoughts about oneThoughts about one’s own death or dying’s own death or dying

7. Common Emotional Changes and SymptomsCommon Emotional Changes and Symptoms
• Anxiety, Nervousness, StressAnxiety, Nervousness, Stress
• Being fearful for oneBeing fearful for one’s own health, and worrying about’s own health, and worrying about
health of partners, family, friendshealth of partners, family, friends
• Fear about telling others around you about your HIVFear about telling others around you about your HIV
statusstatus
• Difficulty sleeping, due to worryingDifficulty sleeping, due to worrying
• Constant worrying andConstant worrying and ‘running thoughts’ about HIV‘running thoughts’ about HIV
• Worry about how to share your diagnosis with family,Worry about how to share your diagnosis with family,
friends and potential dates.friends and potential dates.

8. What Can I Do To Cope?What Can I Do To Cope?
• Self-Care: Eat right, trySelf-Care: Eat right, try
to get sleep, exerciseto get sleep, exercise
(cortisol/oxytocin)(cortisol/oxytocin)
• Manage stress byManage stress by
engaging in relaxing,engaging in relaxing,
enjoyable activitiesenjoyable activities
• Get support! Talk toGet support! Talk to
your partner, friends,your partner, friends,
family, religiousfamily, religious
community or join acommunity or join a
support group.support group.
• Educate yourself aboutEducate yourself about
HIV. Talk to yourHIV. Talk to your
doctor. Attend an HIVdoctor. Attend an HIV
education forum oreducation forum or
training.training.
• Breathe! Inhale 5 countBreathe! Inhale 5 count
hold for a count of 5hold for a count of 5
exhale – 8 countexhale – 8 count
Manage feelings by placingManage feelings by placing
them outside of yourselfthem outside of yourself
through a journalthrough a journal

9. When To Look For HelpWhen To Look For Help
• DepressionDepression
• If symptoms persist or worsen over 2 weeks, and youIf symptoms persist or worsen over 2 weeks, and you
are noticing increased depressed mood, lack ofare noticing increased depressed mood, lack of
enjoyment in activities, weight gain or loss, sleepingenjoyment in activities, weight gain or loss, sleeping
more or less than usual, feeling excessively guilty ormore or less than usual, feeling excessively guilty or
ashamed, increasingly hopeless.ashamed, increasingly hopeless.
• If you are having thoughts about suicide, seek helpIf you are having thoughts about suicide, seek help
immediatelyimmediately! Seek support, counseling.! Seek support, counseling.
• Join a support group. Enter into therapy. Discuss withJoin a support group. Enter into therapy. Discuss with
your doctor or see a psychiatrist.your doctor or see a psychiatrist.

10. When To Look For HelpWhen To Look For Help
• AnxietyAnxiety
• If you are having increased and worsening symptoms ofIf you are having increased and worsening symptoms of
shortness of breath, muscle tension, irregular heart rate,shortness of breath, muscle tension, irregular heart rate,
difficulty sleeping due to worrying about HIVdifficulty sleeping due to worrying about HIV
• If you are unable to focus or concentrate, and findIf you are unable to focus or concentrate, and find
yourself putting yourself at risk of harm (e.g., erraticyourself putting yourself at risk of harm (e.g., erratic
driving, walking without noticing your surroundings,driving, walking without noticing your surroundings,
etc.)etc.)
• Consider entering into therapy and discussing with yourConsider entering into therapy and discussing with your
primary doctor or psychiatrist if anxiety medicationsprimary doctor or psychiatrist if anxiety medications
might be right for you.might be right for you.

11. When To Look For HelpWhen To Look For Help
• Suicidal ThoughtsSuicidal Thoughts
• Call 911 or go to the nearest ERCall 911 or go to the nearest ER
• Seek crisis counseling services from the SFSeek crisis counseling services from the SF
Suicide Prevention Hotline (781-5000), AHPSuicide Prevention Hotline (781-5000), AHP
Crisis Team (476-3902), CBHS Mobile CrisisCrisis Team (476-3902), CBHS Mobile Crisis
Team (355-8300).Team (355-8300).
• Inform your doctor or loved ones immediatelyInform your doctor or loved ones immediately
and ask for help!and ask for help!

12. When To Look For HelpWhen To Look For Help
• Increased use of alcohol and/or drugsIncreased use of alcohol and/or drugs
• It is common to use increased amounts of drugs orIt is common to use increased amounts of drugs or
alcohol to want to cope with onealcohol to want to cope with one’s HIV status and’s HIV status and
‘avoid’ thinking about it.‘avoid’ thinking about it.
• However, increased use can lead to problemsHowever, increased use can lead to problems
maintaining your physical health, can worsenmaintaining your physical health, can worsen
depression or anxiety, and can lead to problems in yourdepression or anxiety, and can lead to problems in your
life (at work, with your partner or family, or legallife (at work, with your partner or family, or legal
problems).problems).
• Consider seeking support through a support group (likeConsider seeking support through a support group (like
AA or NA) or seeking substance abuse counseling.AA or NA) or seeking substance abuse counseling.

13. Available Services and ResourcesAvailable Services and Resources
• Positive Force -Positive Force - Plus seminar, Doctor is In, Urban Adventures, 1-1Plus seminar, Doctor is In, Urban Adventures, 1-1
• Positive Life – newly positive UCSF-AHP.orgPositive Life – newly positive UCSF-AHP.org
individual psychotherapy, psychiatric services, drop in groupindividual psychotherapy, psychiatric services, drop in group
• Poz.comPoz.com AIDSMeds.com ProjectInform.orgAIDSMeds.com ProjectInform.org
• Gaylesta.orgGaylesta.org
• SFAF.org Stonewall ProjectSFAF.org Stonewall Project
• 12-Step Groups12-Step Groups
• SF Behavioral Health ACCESS- centralized referral hotline for SFSF Behavioral Health ACCESS- centralized referral hotline for SF
public behavioral health services (255-3737)public behavioral health services (255-3737)
• Contact your insurance provider to see how and what mentalContact your insurance provider to see how and what mental
health services are provided and covered under your healthhealth services are provided and covered under your health
insurance plan.insurance plan.