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HIV Mental Health for the 21st Century

Mark Winiarski

Publication Year: 1997

As we approach the 21st century, we also approach the third decade of the AIDS epidemic. Mental health care providers must face the crucial fact that the human immunodeficiency virus (HIV) and the condition it causes, Acquired Immune Deficiency Syndrome (AIDS) is the leading cause of death among Americans aged 25-44 years.

HIV Mental Health for the 21st Century provides a roadmap for mental health professionals who seek to develop new strategies aimed at increasing the longevity and quality of life for people living with HIV/AIDS, as well as at controlling the future spread of the disease. Divided into five sections, this volume covers basic concepts in HIV/AIDS mental health; specialized aspects of HIV/AIDS clinical care; models of clinical care; program evaluation; and HIV mental health policy and programs. Chapters treat issues such as feelings of caregivers, the role of spirituality in mental health care, rural practice, mental health home care, and working with children.

Published by: NYU Press

Title Page, Copyright, Frontispiece

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pp. vii-ix

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pp. xi-xxiv

Since 1981, when the first clinical descriptions of cancers and opportunistic infections associated with what is now known as the Acquired Immune Deficiency Syndrome (AIDS) were reported, the epidemic of the causative agent, the Human Immunodeficiency Virus...

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pp. xxv-xxxiv

As we approach the 21st century and the third decade of the AIDS epidemic, mental health care providers must face a crucial fact: The human immunodeficiency virus (HIV) and the condition it causes, Acquired Immune Deficiency Syndrome...

I. Basic Concepts in HIV/AIDS Mental Health

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pp. 1-133

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1. Understanding HIV/AIDS Using the Biopsychosocial/Spiritual Model

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pp. 3-22

Our everyday lives are complicated enough and, too often, painful and hard to understand. Imagine, then, being faced with a condition that in the early 1980s manifested itself through a quick and unexplained illness and death. Then, within a decade...

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2. Psychotherapy and Counseling: Bending the Frame

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pp. 23-38

Human immunodeficiency virus and AIDS are established among the general population, and traditional notions of counseling, psychotherapy, and case management are being tested as never before. Mental health practitioners have responded to the challenges presented by the medical...

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3. Countertransference Issues in HIV-Related Psychotherapy

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pp. 39-51

Since Freud (1910/1959) first suggested the ideas of transference and countertransference, clinicians have learned to be especially aware of the ways their own emotional issues may influence the course of psychotherapy. While the debate about the validity...

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4. Spirituality

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pp. 52-66

In the early years of my practice with HIV-infected patients in an acute-care hospital, I met Edwin. Ed, who died several years ago, was an Hispanic man in his early forties, born a Roman Catholic in New York City. He had spent most of his adult life in and out of prison...

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5. Grief and Loss in HIV/AIDS Work

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pp. 67-81

Loss and grieving echo throughout the course of HIV/AIDS. For persons infected and for those who care for them, including the mental health provider, one of the greatest challenges is the relationship we are invited to make with loss...

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6. Cross-Cultural Mental Health Care

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pp. 82-97

Most of us would readily admit that our society is multicultural, encompassing many complex differences in values, beliefs, and perceptions of self and others, not to mention idiom and language. And most of us would say we are sensitive to the cultural difference...

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7. The Role of Psychiatry in HIV Care

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pp. 98-115

Psychiatry plays a significant role in the treatment of the immense and complex mental health needs related to HIV/AIDS. Although psychiatrists have a unique place in overseeing psychopharmacological interventions, it would be a travesty if the role of psychiatry...

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8. Secondary Prevention: Working with People with HIV to Prevent Transmission to Others

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pp. 116-133

When John and Susan married eighteen years ago, they thought his hemophilia would be their greatest health challenge. Having learned to live with its unpredictability and treatment needs, they went on to have two children, at which point they decided that their...

II. Specialized Aspects of HIV/AIDS Clinical Care

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pp. 135-205

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9. Psychoeducational Group Work for Persons with AIDS Dementia Complex

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pp. 137-156

In the early 1980s, a number of neurological manifestations of HIV were noted, most commonly a decline in cognitive and behavioral functioning. It is now widely recognized that most HIV-infected individuals have at least mild neurobehavioral changes...

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10. Rural Practice

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pp. 157-172

HIV disease has come to small-town and rural America. It may be less visible because of the relatively thin spread of cases over larger geographic areas and because those affected by the disease in less populated areas feel that they must keep it secret...

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11. Mental Health Issues of HIV-Negative Gay Men

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pp. 173-189

These words were spoken in a therapy session by a high-functioning, intelligent, and successful gay man. This patient was suffering from the physical pain of a shingles episode and he was anxious about whether this meant he was HIV-positive. He was obsessively...

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12. Working with and for Children

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pp. 190-205

We sat together on his hospital bed. Beautiful dark eyes looked up at me and then at the picture he had just drawn. It was a six-year-old's typical rendition of a house. I asked, "Are you in this picture?" He pointed to the center of the paper and said quietly...

III. Models of Clinical Care

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pp. 207-271

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13. HIV Mental Health Services Integrated with Medical Care

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pp. 209-223

HIV-affected clients in the inner city present with a Gordian knot of biopsychosocial and spiritual problems. For many, HIV is just one more strand in the knot that already includes medical problems such as diabetes, asthma, and hypertension...

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14. Delivering Mental Health Services to the Home

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pp. 224-240

In the mid-1980s, when persons with AIDS first began to survive bouts of pneumocystis cavinii pneumonia with the help of intravenous antibiotics, home infusion team nurses with the Visiting Nurse Association of Los Angeles...

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15. Case Management: Coordination of Service Delivery for HIV-infected Individuals

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pp. 241-256

Case management is an essential component of HIV care because most individuals living with HIV/AIDS have complex needs that exceed those caused by medical or health conditions. Individuals with HIV infection are likely to require...

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16. A Comprehensive Center for Women with HIV

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pp. 257-271

For HIV-infected women, HIV/AIDS is at the nexus of who they are in society — daughter, mother and mate —how they are positioned in society — in terms of power and control over their own lives — and who they are within themselves...

IV. How Do We Know It Works?

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pp. 273-304

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17. How Do We Know It Works? Quantitative Evaluation

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pp. 275-290

In these times of shrinking resources and cost containment, funders and providers of HIV-related services want more than ever to know that they get results for dollars spent. In fact, the pressures to demonstrate whether health service...

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18. Qualitative Approaches to Evaluation

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pp. 291-304

Qualitative evaluation is a much underused and underappreciated tool that can help mental health professionals answer questions that quantitative techniques cannot address. Questions that qualitative techniques can answer include...

V. HIV Mental Health Policy and Programs

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pp. 305-334

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19. HIV/AIDS Mental Health Care: Politics, Public Policy, and Funding Decisions

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pp. 307-324

Most HIV/AIDS mental health providers — and certainly almost all who work in institutions such as hospitals or community health and mental health centers — provide services that are paid for by federal programs. Two federal programs in particular...

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Afterword: New Treatments, New Hopes, and New Uncertainties

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pp. 325-334

In 1996 something extraordinary occurred in the clinical care of persons with HIV/AIDS, which had stagnated after years of only moderate biomedical gains through the use of zidovudine (ZDV, AZT, Retrovir) and many disappointing clinical...

Appendix A: Medical Primer

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pp. 335-342

Appendix B: Resources — Obtaining HIV/AIDS Information Fast

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pp. 343-346


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pp. 347-351


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pp. 353-357

Back Cover

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E-ISBN-13: 9780814784600
E-ISBN-10: 0814784607
Print-ISBN-13: 9780814793114
Print-ISBN-10: 0814793118

Page Count: 376
Publication Year: 1997