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Some of the conditions that need to be considered are the severity of the illness:
that is, has the person just been diagnosed as HIV positive? Or is the individual well
advanced in the AIDS spectrum illness? And what was the method of transmission?
There is still a considerable amount of stigma attached to the route of transmis-
sion. Except for recipients of blood products, HIV/AIDS is one of the few terminal
diseases for which the person is often held responsible. A generally held, if erro-
neous, belief is that there is no socially acceptable method of contracting the disease.
It is often contracted from unprotected sexual encounters. Individuals may perceive
themselves, or be seen by others, as having poor morals. HIV may be contracted by
sharing contaminated needles, in which case the patient is labelled a drug addict.
Finally, what is the goal of the crisis intervention? This becomes an important
variable when considering the appropriate intervention. For those early in the pro-
gression of the illness, the goal is to shift the paradigm of thinking from a ‘death sen-
tence’ to one of health promotion. Experience shows that psychosocial interventions
that focus on human dignity and quality of life are critically important from the earli-
est stages of the HIV disease onward, and should not be reserved only for those who
are in the later stages of the disease process (Barnes et al., 1993). For those in the
later stages of the disease process the intervention is geared to helping them prepare
for death.
Psychosocial interventions
Working from a ‘situational distress’ model is useful for conceptualizing the reactions
that a life-threatening disease can provoke. These interventions can be implemented
at any point in the continuum. The important aspect of this model is that clinicians be
cognizant of where the client is in the crisis continuum and what the client’s needs are.
The clinician using this model cannot predict or prescribe the individual’s experience.
The client’s psychosocial adjustment to the HIV/AIDS spectrum illness will be fluid and
varied. Passage of time can have a varying amount of influence on the adjustment
process. There may have been an unconscious acceptance of the disease process prior to
test confirmation of seroconversion. As with any terminal illness the advent of new and
more catastrophic syndromes will have a strong impact on the adjustment process, and
consequently on the intervention needed. The four phases of this model are:
(1) the initial crisis
(2) transition
(3) acceptance
(4) preparation for death.
The client can be in any one of these phases at any time. Because of the nature of
the illness and the rapid advances in medical science, the client may suffer from mul-
tiple relapses, and periods of seemingly good health. Important in this regard is the
fluidity of the model and the clinician’s ability to assess and meet the client where
they are, rather than trying to fit the client into a conceptual mould.
(1) The initial crisis
The initial crisis phase is generally preceded by the confirmation of the HIV disease
through seropositive test results and diagnosis of HIV disease-related symptoms. This
phase is typically characterized by shock, denial, a disruptive impact on supportive
relationships and disorientation.
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