The HIV mental health spectrum

Building comprehensive HIV/AIDS care services

This article presents the experiences of three innovative programs for HIV/AIDS-related health care funded by the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The Comprehensive Healthcare projects were funded as part of a larger initiative for innovative HIV service delivery models, consisting of 27 grantees, the funding agency (HRSA), and an Evaluation and Dissemination Center. These projects--the University of Nevada School of Medicine's Early Nutrition Intervention in HIV and AIDS project, the University of Vermont and State Agricultural College's Rural HIV Service Delivery project, and Washington University School of Medicine's Helena Hatch Special Care Center for Women--have developed specialized medical care models within the context of a continuum of services in a medical clinic. This article serves to describe the initial experiences of these three service demonstration projects, and some of the lessons learned as a result of their implementation. All of these projects share the goal of providing integrated services, such as medical care, nutrition, case management, and social and mental health services to people living with HIV/AIDS. However, the projects target different populations, (e.g., those in rural areas versus those in a large inner city), and use contrasting service delivery models of comprehensive HIV care. These projects have undertaken diverse activities and have used numerous effective strategies to increase their ability to provide a continuum of care and services for people living with HIV/AIDS. Based on the valuable lessons that the Comprehensive Healthcare projects learned during the first 2 years of funding, a number of collective recommendations have been made. It is expected that these suggestions will prove extremely useful to other programs that consider offering comprehensive health-care services to people living with HIV/AIDS or other complex medical conditions.

Caregivers of children with HIV/AIDS: quality of life and coping styles

The purpose of this study was to explore the quality of life and coping styles of caregivers of children with HIV/AIDS and to identify if there were differences between mothers and alternative caregivers in these areas. There were 54 mother-caregivers and 25 alternative caregivers in the study. The alternative caregivers scored significantly higher in each area of quality of life than the mothers, except for physical health. The mothers used passive and emotive coping significantly more than the alternative caregivers. The study concluded that caregivers provide support to children with HIV/AIDS, but they also need physical and emotional support themselves. Nurses must be aware of the importance of providing interventions for these caregivers to improve coping mechanisms, decrease stress, and thereby improve their quality of life.

Psychological states in HIV disease and the nursing response

The authors review the four major psychological states of HIV infection as described by Nichols (1985) and adapt these manifestations for use by the nurse in the clinical setting. The states and their likely impacts are described. The diagnostic tools for recognizing the states, assessment questions that help establish the patient's psychological state, and nursing interventions are included.

Training HIV specialists for community mental health

There is a critical need for trained HIV mental health specialists who possess the knowledge and attitudes necessary to meet the challenges of the HIV epidemic. A model for an intensive and experimental continuing education tutorial is briefly described, and evaluative data are presented. Upon completion of the three-day workshop, participants show an increase in HIV-related knowledge and a positive shift in attitudes regarding working with people affected by HIV disease.