PSYCHOSOCIAL IMPACT OF HIV-RELATED CAREGIVING ON HEALTH PROVIDERS - AREVIEW AND RECOMMENDATIONS FOR THE ROLE OF PSYCHIATRY

Objective: The author considers current knowledge about the stresses o f HIV-related care and assesses available evidence for the presence of major occupational, physical, and psychiatric morbidity in health car e providers involved in intensive HIV-related caregiving. Method: The review is based on anecdotal reports of AIDS-care-related psychosocial distress and the literature concerning caregivers' attitudes toward p eople with HIV illness and HIV-related caregiving, the psychosocial im pact of HIV work, and stress related to the ethical and philosophical challenges facing HIV caregivers. Results: Few of the current publicat ions concerning HIV caregiver stress come from the psychiatric literat ure. Psychiatry appears to lack a strong clinical, educational, resear ch, or policy presence regarding psychosocial stress in HIV care provi ders. The numerous studies in the nursing, medical, public health, and health education literature do not include any controlled investigati ons documenting the incidence and prevalence of physical, psychologica l, occupational, or interpersonal symptoms or disorders in health care professionals who devote a substantial amount of their clinical activ ities to patients with HIV illness. Conclusions: Major HIV-related str ess in conjunction with other psychiatric morbidity, such as mood diso rders, anxiety disorders, substance abuse, and relationship and occupa tional problems, seems likely in susceptible caregivers. Decisions abo ut the structure and form of delivery of HIV-related care and programs for caregivers must be based on more carefully controlled psychiatric observations of occupational, physical, psychological, and social ada ptation to HIV-related work. The author suggests several areas in whic h psychiatric clinicians, educators, researchers, and policy experts c an make major contributions.