Is it Mental or Is it Physical? – A Discussion on HIV-Related Pain
Most of us have a loose understanding of what it means to have HIV; we think of doctors, medicine, and research, but many of us forget the painful experience of what it is like to be HIV positive. How might HIV impact levels of pain, and how does this pain show up in the mind and body? By definition, human immunodeficiency virus (HIV) infection and acquired deficiency syndrome (AIDS) are both a disease which attacks the immune system. HIV/AIDS is primarily spread through sexual behaviors and needle or syringe use. Although attacks on the immune system cause physical symptoms such as fatigue, illness, and peripheral neuropathy, we often forget the psychological symptoms which co-occur and complicate physical pain. In other words, we can not divorce emotional distress from physical pain; especially in the context of HIV/AIDS, the two demonstrate a complicated relationship.
The chronic nature of HIV complicates the pain which accompanies it; the physical symptoms of HIV are often overwhelming and comorbid with one another. HIV-related pain typically stems from nerve damage, infection, or other underlying conditions such as substance abuse. One such example is HIV-associated peripheral sensory neuropathy, or HIV-SN. Patients with HIV-SN typically show symptoms of numbness or tingling which starts in the toes, spreading proximally across the body (HIV.va.gov, 2011). In addition, physical symptoms such as excessive fatigue make living with HIV even more painful.
Treating HIV-related pain may become complicated when medication side effects also cause pain. Treatment methods vary, depending on the severity and nature of the pain. For example, HIV-SN treatment typically includes analgesics, anticonvulsants, and topical medication (HIV.va.gov, 2011). HIV-positive patients who are using antiretroviral therapy (ART) can have a near-normal life expectancy, however, comorbid conditions such as substance abuse and psychiatric illness often arise as well (Merlin et al., 2014).
However severe the physical manifestations of pain may be, we often overlook the serious psychological impact of living with HIV. Patients often experience serious mental distress which makes living with the condition even harder. Severe mental illness (SMI) is not uncommon among those with HIV; rates of HIV infection are estimated to be 76 times greater among those who have a severe mental illness such as chronic anxiety or depression (CDC, 2016). Many people living with HIV experience feelings of fear, stress, and depression.
One problem which complicates the experience of living with HIV is something we can’t physically see; stigma. Cultural norms and negative attitudes towards HIV and behaviors associated with HIV cause great feelings of shame and internalized guilt, especially. One psychological explanation for this relationship is the minority stress hypothesis. This theory suggests that that experiencing discrimination causes mental and emotional distress and therefore poor mental health (Meyer, 1995). According to this model, people with HIV experience stigma-related discrimination, causing stress and a variety of mental health problems such as anxiety and depression. Consequently, feelings of shame, guilt, and fear of rejection are all linked to poor mental health outcomes such as depression and anxiety. Such distress and fear can be extremely painful for those with HIV.
However discouraging the relationship between HIV-stigma and mental health, there is a great abundance of potential healing. Dr. Nadav Antebi, a social psychologist who specialises in LGBT resilience research, believes that there is still hope yet. According to Dr. Antebi,
“The fact is that most LGBTQ and HIV-positive people do not develop mental health concerns despite minority stress and social stigma. That means that most of them are resilient. We are working hard to identify what factors make people resilient, and so far, it's safe to say that social support is probably the best resilience factor.” Examples of social support include programs and campaigns which aim to eliminate stigma. The goal of community-based social support is to create and foster an optimistic and courageous public discourse, according to Dr. Antebi. Ultimately, both individuals and larger communities have the option to withstand stress and challenge.
Although patients with HIV experience both physical and emotional manifestations of pain, it is possible to strive for resilience and well-being. Although medical attention and medication is critical, it is never wise to neglect the powerful impact of social support and feelings of acceptance. Consider engaging in positive conversations which promote both awareness and acceptance. Promoting empathy and compassionate listening may be powerful tools to combat the physical and psychological manifestations of HIV-related pain.