Human Immunodeficiency Virus (HIV) is the causative agent for Acquired Immune Deficiency Syndrome (AIDS). HIV is transmitted through various ways involving contact with infected body fluids, but a majority of global cases are sexually transmitted (Makasa & Michelo, 2021). Living with HIV presents unique challenges, especially relating to sexuality and mental health. This paper focuses on the delicate interaction between sexuality and mental health in people living with HIV.
The mental health setting is a community mental health unit. () notes that it is vital for health provision to be inclusive, serving people from diverse origins or of different orientations. In line with this, the community mental health unit has a special section dedicated to members of the LGBTQ community and same-sex couples. This mental health unit aims to provide the LGBTQ community, especially those living with HIV, with comprehensive healthcare in an environment where they feel empowered and respected. By creating an environment that is safe, supportive, and inclusive, the mental health of the LGBTQ community can be improved (Hudson et al., 2023).
Despite having Human Immunodeficiency Virus (HIV), many LGBTQ members living with the virus maintain normal levels of sexual desire, as reported by De Vincentis et al. (2021). However, antiretroviral therapy (ART) and comorbidities of HIV may affect sexual function. For seropositive LGBTQ members, practising safe sex practices and access to pre-exposure prophylaxis and post-exposure prophylaxis can enable them to lead sexually fulfilling lives.
Physiologically, people living with HIV have lower CD4 cell count than the general population; the normal range is considered to be 500-1500 cells per mm³ of blood (Malik et al., 2020). With proper ART, viral load can be undetectable if it is below 50 HIV cells per mL of blood (Mariani et al., 2020).
Although HIV does not directly affect sexual function, side effects of ART, medical comorbidities of HIV/AIDS and psychological effects of living with HIV can result in sexual dysfunction (De Vincentis et al., 2021). Moreover, engaging in high-risk sexual behaviour can worsen disease progression, increase transmission rates and lead to acquired sexually transmitted infections (STIs) among same-sex couples and LGBTQ members (de Wit et al., 2023). same-sex couples and LGBTQ members may face additional challenges due to limited research tailored to this population.
Physiologically, failure to maintain undetectable viral load levels can indicate poor compliance with ART or treatment failure (Nega et al., 2020). Very low CD4 cell counts below 400 cells per mm3 indicate immunosuppression and a high risk of opportunistic infections (Malik et al., 2020). Shaw & Matin (2022) notes that opportunistic infections are the leading cause of death in all seropositive people, including LGBTQ members. Opportunistic infections can also cause derangements in vital signs. Pulmonary tuberculosis (PTB), for instance, can cause hyperventilation.
Farvid et al. (2021) report that same-sex couples and LGBTQ members, especially transgender individuals of colour, are more likely to face disparities in access to healthcare due to stigma and discrimination. Lack of access to HIV testing and ART may contribute to higher HIV transmission rates among this population.
Liu et al. (2022) report that depressive disorders and anxiety disorders are more prevalent in seropositive same-sex couples and LGBTQ members compared to the general population. Factors such as stigma, discrimination, self-isolation, and poor coping strategies can contribute to poor mental health in same-sex couples and LGBTQ members living with HIV.
Psychotherapeutic drugs include antidepressants, antipsychotics, anxiolytics and mood stabilizers, among other classes (Procyshyn et al., 2023). Psychotherapeutic drugs can impact the sexuality of people living with HIV in various ways, as discussed below.
Vasiliu et al. (20) note that many psychotherapeutic drugs have been associated with sexual side effects such as a decrease in libido, erectile dysfunction and difficulty in attaining orgasm. According to (Tandon et al., 2020), sexual side effects of psychotropic drugs can cause relationship strain due to reduced sexual activity owing to lower desire, difficulty during arousal and decreased satisfaction—psychotherapeutic drugs act by altering the levels of neurotransmitters (Preston et al., 2021). Neurotransmitters work with hormones to regulate sexual function. Alteration in the level of neurotransmitters can lead to decreased libido or anorgasmia (Peleg et al., 2022).
Nimb et al. (2020) report that sexual behaviour is affected by psychological factors as well as physiological factors. Psychotherapeutic drugs may affect mood and self-esteem, which are important psychological factors that affect intercourse. Moreover, psychological distress due to stigma against same-sex couples and LGBTQ members living with HIV can exacerbate the psychological impacts of psychotherapeutic drugs to cause impairment in sexual function (Dewitte et al., 2021).
The sexual side effects of psychotherapeutic drugs can reduce compliance to psychotropic drugs and ART as well. According to (Procyshyn et al., 2023), individuals are less likely to take medication if they experience adverse side effects. Sexual health is an essential measure of quality of life in same-sex couples and LGBTQ members living with HIV, as reported by (Khademi et al., 2021). Psychotherapeutic drugs affect sexuality and can contribute to reduced quality of life, increase psychological distress and impair social functioning (marital duties) (Tandon et al., 2020).
Mrs Y is a 44-year-old female patient who works as a social worker. Her sexual orientation is lesbian, and she is of African American origin. Mrs. Y is married to Mrs. X, and they live together. Mrs Y has been living with HIV for 15 years now. Mrs Y has previously been diagnosed with anxiety and is undergoing treatment via a community mental health unit.
In the context of Mrs Y, it is imperative to conduct a thorough assessment of her mental health. Liu et al. (2022) note that depressive disorders and anxiety disorders are more common in same-sex couples and LGBTQ members living with HIV compared to the general population. Subjective assessment would involve patient reports on her mood, sleep patterns and appetite changes lately. Objective data would include vital signs and a comprehensive mental state examination. Korkut et al. (2021) report that some vital signs, such as a rapid pulse, can indicate high anxiety levels. A mental state exam would involve observations of appearance, behaviour and speech, mood reports, observed affect, memory assessment, concentration, alertness and insight (Aquilina & Tucker, 2021).
The nurse will also assess her social support networks, including support from family and friends. A good social support network predicts positive outcomes in HIV treatment with ART (Fletcher et al., 2020). For same-sex couples, assessing the relationship dynamics, such as communication patterns, conflict resolution patterns, and levels of intimacy, can give insight into the effect of the relationship on the mental health of a patient.
Assessing Mrs Y’s physical health is also important. Vital signs can help to rule out most opportunistic infections. A viral load and CD4 cell count can indicate the response to ART or point towards treatment failure and non-compliance.
The nurse will consult Mrs. Y, and together, a schedule for follow-up sessions with a general practitioner and a psychiatrist can be scheduled. During follow-up, Mrs Y’s viral load, CD4 cell count, and vitals will be monitored to ensure they remain within the range. The nurse will discuss with Mrs Y during follow-up sessions to track any changes in the side effects of ART.
Moreover, the nurse will continuously monitor the relationship function for Mrs Y. Any changes in intimacy, communication, and conflict resolution strategies should be noted, as these can influence mental health. A comprehensive interview about relationship dynamics can be used to assess relationship functioning (Stanley et al., 2020). Assessment must be done carefully to avoid Mrs Y feeling like her privacy is being invaded.
To provide holistic support, Mrs. Y’s biopsychosocial approach requires her physical, emotional and psychosocial needs to be accounted for, as reported by (Mescouto et al., 2023). An integrated treatment approach that covers both HIV and the possibility of mental illness is vital for Mrs Y’s needs. The nurse will conduct psychoeducation with a particular focus on HIV and mental health—Dell’Osso et al. (2023) report that psychoeducation can improve compliance to treat patients with psychiatric patients. Moreover, the nurse can encourage Mrs. Y to attend couples therapy with her spouse. Couples therapy may help seropositive and serodiscordant same-sex couples and LGBTQ members to navigate the unique challenges they face in dealing with HIV (Antonini et al., 2021).
Simultaneously, the nurse will administer antiretroviral drugs as prescribed for Mrs Y and educate her on how to self-administer the drugs. The nurse will also educate Mrs Y on the expected side effects and how these can be managed. The nurse will advise Mrs Y on the need to seek the services of a psychiatrist or mental health nurse regularly for nearly.
Finally, the nurse will direct Mrs Y to peer support groups, social services, and other community support services or programmes available in her area for same-sex couples and LGBTQ members living with HIV. In link with (Golub et al., 2022) findings that health promotion education on HIV is effective in reducing stigma and eliminating stereotypes, it may be prudent for the nurse to participate in initiatives to educate the locals about HIV/AIDS.
Based on this lived experience case study, the following are recommendations when dealing with same-sex couples and LGBTQ members living with HIV and mental health issues. Healthcare professionals must learn about the LGBTQ community to provide culturally competent care (Donisi et al., 2020).
When dealing with this unique population, a holistic assessment must explore social, emotional and physical aspects. Moreover, nurses must learn to use language that respects and affirms the individual’s gender. Respecting the identity of an LGBTQ patient creates a platform for open, non-judgmental communication, as reported by (Donisi et al., 2020). Community mental health units should provide couples therapy to help same-sex couples and LGBTQ members navigate challenges regarding sexual intimacy and seropositivity. Finally, there is a need to advocate for policies that promote the rights of same-sex couples and LGBTQ members with a special focus on increasing access to healthcare services for seropositive members of this population. Logie et al. (2020) note that same-sex couples and LGBTQ members living with HIV are more likely to be denied access to healthcare due to social stigma and discrimination. To align with this finding, special focus should be on same-sex couples and LGBTQ members of colour.
Experiences of same-sex couples and LGBTQ members living with HIV highlight the delicate inter-relationships between sexuality, mental health and HIV. For nurses to provide holistic care for mental health consumers living with HIV, it is vital to understand the normal and abnormal parameters of health and physiology among seropositive people, as well as the impact of psychotherapeutic drugs on sexuality. The assessment, monitoring, and interventions for people living with HIV must be integrated and utilize a biopsychosocial approach. Finally, recognizing the reciprocal impact that sexuality has on mental health consumers, along with enablers and barriers to care, can help nurses improve the quality of life for individuals living with HIV.
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