Living With HIV

HIV, or human immunodeficiency syndrome, is a chronic illness.

HIV is a chronic illness, and with proper treatment, individuals with HIV can live long lives, generally without changes to one’s life expectancy. Untreated HIV can advance to what is called “AIDS”— or Acquired Immuno-Deficiency Syndrome. However, treatment can prevent this, and people living with HIV need to take care of themselves in new ways to optimally benefit from existing treatments for this illness.

Frequency

Over 1 million individuals are living with HIV in the U.S. and 36.7 million are living with HIV worldwide. HIV disproportionately impacts communities that are marginalized by structural factors, including poverty, violence, and discrimination (based on race, sexual orientation, using substances, etc.). These marginalized communities include Black and Latino individuals, gay and bisexual men, transgender persons, and sex workers.

Self-Care

Sexual activity is an important component of quality of life for many people, including both people

For the HIV-positive person:

• Taking medications prescribed by one’s doctor
• Consistently using condoms to prevent contracting another STI or a different strain of HIV

Having an HIV-negative or unknown-status partner:

Individuals with HIV can prevent transmission of HIV in other ways besides condom use. These ways include:

• Limiting sex with HIV-negative or unknown-status partners to when the person living with HIV knows their viral load is “undetectable”;
• Limiting sex with HIV-negative or unknown-status partners to when the person living with HIV knows the HIV is fully controlled with medications;
• The HIV-negative partner can be prescribed a once-per-day pill called PrEP (pre-exposure prophylaxis) to prevent getting HIV.

Using Drugs That Involve Needles

• Using clean needles if the person engages in injection drug use, and not sharing needles with other people

Medications

Antiretroviral Therapy and Viral Load

Medications for HIV are called antiretroviral therapy. These medications, when taken properly, decrease the amount of virus in one’s blood. The amount of virus in one’s blood is called the viral load. When antiretroviral therapy is successful, it decreases the virus in one’s blood so much that it is considered “undetectable” or that the HIV is “suppressed.”

The Immune System

HIV virus, untreated, attacks the immune system. This affects one’s CD4 cell count. CD4 cells are a type of white blood cell that fights viruses. If a person’s CD4 is low, then they are susceptible to infections to which they would normally not be susceptible. These are called “opportunistic infections” because, in the context of a low CD4 count, these infections have the opportunity to infect the body. With proper HIV treatment, and a low viral load, one’s CD4 count should increase. HIV is called an “immunodeficiency” syndrome because, untreated, the immune system becomes deficient, and does not work properly to fight off viruses.

Important Health Behaviors

Medication Adherence

Taking one’s medicine as prescribed, or adhering to one’s medication regimen, is one of the most important things, if not the most important thing, for HIV treatment to be successful. A CBT-oriented therapist can help with this, mainly by helping increase motivation for change, helping one identify the steps needed to do this, breaking them down into manageable steps, and coming up with a plan to deal with barriers.

Other Health Behaviors

Using condoms can help protect individuals from acquiring sexually transmitted infections (STIs or STDs). Preventing STIs is important because they can affect HIV. Using condoms and having sex when the virus is undetectable also reduces the risk of transmitting HIV to partners who are not HIV-positive. Using clean needles (and not sharing needles) can help prevent individuals receiving or getting other infections that would affect HIV, such as hepatitis C. These health behaviors can be hard to change for many people, and a CBT therapist can help increase motivation for changing, identify barriers, and increase skills to change.

Co-Occurring Mental Health Struggles

Individuals with HIV may struggle with mood (e.g., depression), anxiety, and/or substance use disorders. Further, some people living with HIV have experienced abuse/trauma (e.g., 67% of women with HIV) and intimate partner violence (e.g., 55%) that may result in posttraumatic stress disorder (PTSD). These mental health struggles can interfere with a person’s ability to take medication and take care of his or her health in general. Fortunately, there are established CBT treatments that can help to reduce mental health symptoms, such as depression and PTSD, and help individuals living with HIV.