Strengthen Connections With Patients With HIV
Recognize the Patient Mindset
Before starting patients with HIV on treatment, a readiness assessment is warranted to evaluate their knowledge about HIV treatment (including the importance of adherence and consequences of non-adherence) and assess their motivation to succeed on treatment, which includes identifying potential adherence barriers.1
Patients with HIV often face psychosocial challenges—poverty, depression, mental illness, substance abuse, and more—which may interfere with treatment success.1, 2 Furthermore, HIV diagnoses often bring a flood of emotions from shock to anger to fear. A feeling of loss may be particularly poignant as patients weigh chances for continued health, employment, and community connection. HIV stigma can also compound emotions experienced by patients with HIV.
Am I going to lose...
When patients are overwhelmed by negative emotions, they may find it difficult to keep up with medical issues and appointments.2 Taking the following steps may help address patients' mental and emotional health.
1. Assess patients' cognitive function and emotional state, including whether they have an emotional support system or need counseling to help them come to terms with their diagnosis. Screen for mental illnesses and substance use.2
2. Provide or make appropriate referrals to crisis counseling, support groups, and mental health or substance abuse treatment.2
3. Connect patients to case managers or patient educators who can help patients learn to adapt to healthcare systems and lifestyle changes.2
4. Educate patients to confront stigma. When patients understand clearly how HIV is transmitted, for example, they may be better prepared to fight the stigma surrounding HIV and the fear of contagion.2
5. Help patients with disclosure. Patients with HIV may benefit from support groups or therapy sessions around disclosure. Clinic staff might also invite partners for in-clinic disclosure or refer patients to the local health department to assist with anonymous partner notification.2
Uncertainty, fear, and misinformation can interfere with relationships between patients with HIV and the healthcare professionals who treat them.2 Patients may have strong emotions tied to HIV, like shame and fear of death. They may also have had negative experiences that led to mistrust in medical care and treatments. Here are a few ways to bridge the gap of mistrust:
1. Offer a nonjudgmental and supportive environment to help patients overcome their fears and misconceptions and to foster trust, openness, and engagement in care.
2. Protect patient confidentiality. Establish clinic practices that keep patients' information secure and private, like closing computer screens with sensitive information or getting patients' permission to leave a personal phone message.
3. Give accurate information on prognosis and treatment so patients have a clear vision of what to expect on the journey ahead.
4. Respect cultural diversity. The clinical setting may influence the success of adherence. The multidisciplinary care team can help by offering a welcoming environment, being familiar with different cultures and the medical and legal issues each may face, and by pointing out community resources that are available. Additionally, cultural groups may have varying beliefs about healthcare. Explore how each patient thinks about health, including what are appropriate treatments and who should be involved in healthcare decisions.
5. Break down cultural and language barriers. Train interfacing staff members to be knowledgeable and compassionate with all racial, ethnic, and sexual minorities. Having diversity among staff members can also improve the experience of different patient groups.
Patients with HIV need to be informed about treatment goals, medication regimens, the importance of adherence, and the consequence of nonadherence.1 Below are a few best practices in communicating with patients with HIV to help keep the lines of communication open and to educate patients with a solid understanding of what to expect and how to succeed in HIV care.
1. Set the stage for open dialogue. Share expectations early on with patients regarding communication: ask patients to be actively engaged in care, welcome questions and feedback, and invite openness about treatment and side effects.2
2. Speak in language patients easily understand. You may have to adjust the message to fit the literacy level of the patient, and information should be given in the patient's primary language. Use professional interpreters, case managers, and culturally diverse peer educators to bridge language and social barriers.2
3. Give information in simple terms. Patients' attention span and ability to absorb information may decline after the first 15-20 minutes of medical visits. Provide information in small amounts to help facilitate patient understanding.2
4. Repeat information in subsequent visits. Expect a learning curve with HIV patient education and repeat messages often to help patients digest important details about HIV care.2
5. Extend communication access. Welcome questions between visits by setting up a patient portal that allows patients to send private messages securely to clinic staff.2
Patients with HIV have complex needs that require connection to multidisciplinary HIV care teams and networks of support.1,2 Help your patients with HIV by connecting them to well-rounded care and make it easy for them to connect with you.
Take a multidisciplinary team approach to patient care by connecting patients to nurses, pharmacists, mental health counselors, nutritionists, social workers, case managers, and patient navigators. A well-rounded HIV care team will be better equipped to effectively address patients' varying healthcare needs. Provide prompt interventions and referrals to appropriate services to help patients overcome challenges like homelessness, substance abuse, mental illness, or inconsistent medication access, all of which interfere with patients staying on track with HIV treatment and care.1,2
Make it easy for patients to connect to you with flexible scheduling options, co-located services, and ample time allotted at each appointment to give patients the attention they need. Reinforce the importance of keeping appointments by2:
- Giving appointment reminders
- Following up and rescheduling missed appointments
- Helping patients address transportation issues, as well as childcare and work conflicts
Healthcare professionals are in a unique position to help patients with HIV adapt to lifelong treatment. The strategies listed here are just a few ways to begin fostering stronger relationships with HIV-positive patients in your care. By taking the steps necessary to strengthen patient connections, you can help pave the way for patients to be more actively engaged in care in order to achieve long-term treatment adherence and potential improved long-term health outcomes.
1. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. AIDSinfo website. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0. Published October 25, 2018. Accessed May 21, 2019.
2. U.S. Department of Health and Human Services, Health Resources and Services Administration, Guide for HIV/AIDS Clinical Care – 2014 Edition. Rockville, MD: U.S. Department of Health and Human Services, 2014. Published April 2014. Accessed May 21, 2019.
HVUWCNT190025 August 2019