The evolution of adjustment issues in HIV/AIDS

The issues of emotional adjustment to AIDS have been inextricably linked to medical advances in fundamental knowledge about the human immunodeficiency virus and its potential therapies. In 1987 patients were struggling with the advantages and disadvantages "to do or not to do AZT (zidovudine)," whereas the choices imposed by combination therapies and the protease inhibitors in 1997 are fundamentally different and are occurring in an evolving context created by a number of striking medical advances, expanding populations, the availability of environmental support, and changing public sentiments. As the psychiatric treatment of HIV-positive individuals shifts increasingly from "AIDS specialists" to the wider therapeutic community, it is important that the therapist who has had relatively little experience with this population not assume that contemporary issues and concerns of the seropositive patient, or the patient with AIDS, are essentially those discussed widely in the earlier years of the epidemic. Patients living with this virus for a number of years have traveled a long and arduous journey and will experience more empathy from a therapist who has some knowledge of that path. Awareness of the evolution of emotional adjustment, counseling, and ethical issues of AIDS should amplify the general fund of knowledge required for good clinical management of the person living with AIDS.