The Faculty for HIV and Sexual Health provides a forum for both psychologists and other professionals working in these areas to discuss common issues.
We work tirelessly to promote current research and learning in the field and to keep our members appraised of ongoing developments.
Updates and announcements
Updated standards for psychological support for adults living with HIVShow content
The faculty is working alongside the British HIV Association, the UK Community Advisory Board and the National HIV Nurses' Association on the update of the standards for psychological support for adults living with HIV.
In order to inform this process we are inviting relevant stakeholders to consult on the existing document to help us understand changes that need to be made.
We are therefore asking members of the faculty for your ideas, feedback and opinions in relation to this process.
The deadline for submissions is Friday 10 December 2021.
DCP Faculty for HIV and Sexual Health - Call for statements of interest 2022 - Now closedShow content
The Division of Clinical Psychology, Faculty for HIV and Sexual Health were calling for statement of interests.
The deadline for submitting an statement of interest form is now closed
Elections will be formally ratified at the next Committee meeting for Division of Clinical Psychology, Faculty for HIV and Sexual Health on Thursday 24 February 2022
If you have any queries regarding submitting an statement of interest please email Member Network Services
2021 newsletter articles
Getting HIV on the radar: Collaborating to define effective psychological practice in physical health care - Dr Sarah RutterShow content
We have known for a long time that there is a strong and growing evidence base relating to how physical health outcomes can be improved considerably by attending to psychological needs. Over recent years there seems to have been a surge of interest in this area, with documents emerging to collate the existing evidence and advocate for improved mental health support within the realm of physical health, in particular chronic health diagnoses. These include documents such as The King's Fund (2016) paper relating to the integration of physical and mental health, and more recently a Psychological Professions Network (PPN; 2020) discussion paper about how we might maximise the impact of psychological care in physical health settings.
Although IAPT for long term conditions (LTC) set out to meet some of the psychological need, this is aimed at common mental health issues within the LTC population, and is not sufficient to address complex and inter-relating physical and mental health problems. Nor does it create optimum conditions for effective inter-disciplinary working, known to support the delivery of more holistic care.
Regular DCP cross-faculty meetings have led to opportunities to feed into two projects, which are currently looking at further developments around psychological practice in physical health care. One of these is being run by the BPS clinical health group, perhaps focusing more on clinical psychology input into physical health services and the other by the Psychological Professions Network, which is likely to refer to a broader scope of psychological practice. A working group designed to feed into the two projects has been set up, and the HIV and sexual health faculty has a place at this particular table. In addition, more recently we were also invited to sit on the PPN external reference group, which perhaps offers further assurance that HIV and sexual health are to be included in the thinking and in any documents that are produced. With HIV being already made of many marginalised groups, we do not wish for this to be replicated in the health system itself.
The projects are all in the early stages, and so the initial strategic questions we are asking are: what would integrated care look like? How do we achieve equity of psychological provision when there are such disparities between specialist areas, and also across geographical regions? The working group has representatives from the four nations, to ensure that we are addressing the relevant issues, clinical frameworks and wider structures as broadly as we can.
Progress on updating The Standards for Psychological Support for Adults Living with HIV - Dr Sarah RutterShow content
As you may be aware from last year’s newsletter, there has been a longstanding plan to update The Standards for Psychological Support for Adults Living with HIV (2011), with strong backing from the HIV community. Additionally, it has been encouraging to see that the importance of addressing mental health issues is increasingly central to multidisciplinary discussions around HIV care, and actually on a global scale, making this is a timely project. The plan is for the completed document to be a British HIV Association (BHIVA) standard, with the hope that this will enhance its influence, given the size and power of this national organisation.
The members of the core working group, drawn from BHIVA, the UK community advisory Board (UK-CAB) the National Nurses Association (NHIVNA) and, of course, members of our own BPS HIV and sexual health committee have been working to develop a pre-consultation process to inform the update. We thought it important to collect the ideas of those delivering or receiving care before making any changes. The questionnaire went out live to a range of relevant stakeholders in October, and you as members should have received an invite to take part. The consultation is still live and so if you have not seen it and would like to participate, there is still time, as the deadline is 10th December 2021. Please contact Jacob Daniel with any enquiries at [email protected].
Once we have all of the responses, the plan is for the members of the core group to begin to re-write the standards, taking into account the pre-consultation thoughts and ideas we received. This is likely you to be a mammoth task, however, hopefully one that will be more than worth it. If you have already responded, we thank you sincerely for your input, as the voices of those working in the field are essential when trying to create a useful, valid and meaningful document.
My personal hope is that this updated version of The Standards, as official BHIVA guidance, will brighten the spotlight on psychological issues within HIV and what is required to not only deliver safe and effective care to patients, but also to support our non-mental health MDT colleagues to deliver psychologically informed care, which in turn can reduce the negative impact of complex work. Despite the distress that Covid has brought, perhaps one thing it has nudged into view is the impact of emotional strain on our healthcare workers. With all of this brought into focus, the aim is to create the foundation and framework for the appropriate stocking of specialist HIV services, whereby psychological needs, and the complex dynamics that can stem from this work, can be addressed by practitioners qualified to do so, who are integral to the teams that provide the care.
Providing HIV care: Lessons from the field for nurses and healthcare practitioners - Tomás CampbellShow content
Editors: Croston, Michelle, Hodgson, Ian (Eds.) Springer.
HIV is a small word with a big impact: Psychosocial interventions to support children, young people and families with HIV
The advances in HIV treatment over the last 25 years have changed the lives of many people living with HIV. Early in the epidemic, mother-to-child HIV transmission (MTCT) contributed significantly to the numbers of children living with HIV worldwide.
There has been an increased and welcome focus on strategies to strengthen families’ capacity to respond most effectively to the challenges of HIV. Advocates for a family-focused approach point to a number of reasons for this perspective: firstly, HIV infections frequently occur within the family context via sexual relationships, pregnancy, delivery and breastfeeding. Secondly, the family is the unit in which most HIV-positive children and young people are raised and the one best placed to meet their needs – both developmentally and medically. Lastly, all members of the family (both positive and negative) are affected by the social consequences of HIV, including stigmatization, social exclusion and discrimination. Perinatally-infected HIV-positive young people are developing into adulthood and are now having children of their own and we are seeing a new generation of people and families in which there is HIV.
In the past three decades, prevention of mother-to-child HIV transmission (PMTCT) interventions have been implemented including routine testing for pregnant women, increased uptake of highly active antiretroviral therapy (HAART) among pregnant and breastfeeding women living with HIV and provided antiretroviral prophylaxis for exposed newborn infants. These interventions have led to sharp declines in maternal transmission resulting in currently very low transmission rates.
In this chapter, I explored how most people with HIV live in families and as such all members are affected to some extent or other. I argued that the presence of HIV disrupts usual family functioning with consequences for all family members. The disruption occurs because challenging and unwanted decisions need to be made and may include HAART treatment, how to discuss the diagnosis with others, how to seek support and what to expect and how to prepare for the future. Challenges include the personal medical management of HIV but also the consideration of treatment for others, coping with daily and life-long adherence to HAART and the management of possible side-effects to HAART. For families, there are always issues regarding decisions about explaining and discussing the diagnosis with schools (or not). Further challenges include the psychological issues associated with positive status (e.g. coming to terms with HIV, management of HIV related mental health difficulties), social issues (e.g. housing, employment), and social issues (e.g. the effects of HIV related stigma, discussion with family members, friends and sexual partners about the presence of HIV).
I argued that all members of the family need to be considered regarding the effects of HIV and that the family can be a source of strength and support. I suggested that the most effective care models are those that support effective family functioning as these have been demonstrated to be effective in supporting good outcomes for children including better psychosocial functioning in children and have been demonstrated to assist parents in making decisions about disclosure of HIV status, planning for childrens’ long term adjustment to HIV, and the development of long term coping skills to cope with HIV infection.
The core concepts of family-centred care for children and young people can be described as:
1. Families are the constant in the lives of children (and adults) while interventions are intermittent and generally short lived and contact with services might be infrequent and brief.
2. Families must be variously and inclusively defined.
3. Family-centred approaches are those that are comprehensive and integrated.
4. Love and care within families, when recognized and reinforced, promote improved coping and wellness among children and adults.
Finally, I explored family focused HIV interventions and considered the impact and effectiveness of those psychological and psychosocial interventions that address the emotional and psychological effects of HIV infection on children, young people and families.
I concluded that HIV is a family issue that requires both individual and family responses. Effective parental coping factors are very important, not only because parents need to look after themselves to be able to take care of those dependent on them, but also because through their own HIV-related behaviours, parents provide a model to children and young people of more effective and less effective ways of managing the disease. It is not surprising that parents who cope better and who manage the HIV stressors in their lives are better able to assist their children to mitigate the negative psychological and psychosocial effects of HIV in their lives. Conversely, children and young people who are exposed to poor parental coping will find it harder to develop effective HIV coping strategies themselves. Within this complicated context, a multi-disciplinary and multi-factorial approach is key. Early identification of families in which there are coping difficulties is essential as interventions are more likely to be successful if addressed in a timely way.
As we are now in the fourth decade of the disease, we need to ensure that families and young people are equipped as well as possible with psychological and emotional tools to manage this infection in the long term. However, it is unlikely that once-off interventions’ will be effective in facilitating the development of effective coping strategies. If psychological interventions are to be of maximum efficacy, they need to be interwoven into the provision of medical and social care for young people and their families. There is no doubt that this is a challenge. Health care teams delivering HIV care in the developed world have disproportionate access to such resources and young people in resource poor settings (which is where the bulk of young people with HIV live) are much less likely to be able to access sophisticated psychological interventions. However, much of the work that needs to be undertaken does not require sophisticated technology or highly trained staff. It could be argued that what is necessary is a paradigm shift for those who provide the medical care. Being aware of the likely issues that arise at different points of the life-span and what are effective interventions to address the common issues that are underpinned by stigma are likely to be successful. I suggest that it is through a stance of curiosity about the ways in which HIV is managed in the lives of both individuals and their families that allows for different and transforming conversations to occur.
Sexual satisfaction among people living with HIV - Cecilia MacDougaldShow content
A systematic review examining the correlates of sexual satisfaction among People Living with HIV (PLWH)
HIV can affect all aspects of a person’s life, including their sexual well-being. While research has explored the factors that affect sexual functioning (e.g., erectile function, orgasm, libido) in PLWH, the relationship between HIV and sexual satisfaction is less well known. Better understanding of this may help guide theoretical frameworks and interventions for couples and individuals struggling in this area.
What did I do?
A systematic review that aimed to understand the factors that might be correlated with better sexual satisfaction among PLWH was completed. The research question was: ‘What are the factors linked to sexual satisfaction among people living with HIV?’. Searches were run on PubMed and PsychInfo databases. Studies were included if they reported variables related to sexual satisfaction in PLWH. Methodological quality assessment was conducted on all eligible studies using the Mixed Methods Assessment Tool (MMAT; Hong et al., 2019).
Thirty-five out of 921 studies identified met the inclusion criteria. Studies were published between 1995 and 2019, from a range of countries. Participants ranged in age, gender and sexuality. Variables were grouped into six categories: biological, psychological, social/relational, clinical, demographic and behavioural factors. Variables consistently related to sexual satisfaction included depression, anxiety, quality of life, body image, appraisals of HIV’s impact on sex life, relationship status, relationship satisfaction, health status, social support/inclusion, education, employment, frequency of sex, and disclosure concerns. Variables found to be unrelated included CD4 count, viral load, gender, HIV transmission and symptom frequency, and sexual orientation. Equivocal findings included age, ethnicity, income, co-morbidities, HIV stigma, bodily changes, HAART, mediation adherence and time since HIV diagnosis.
Some notable findings:
- Psychological correlates, particularly depression, were the most frequently reported variable across studies.
- Being in a supportive relationship with regular sex was strongly linked to sexual satisfaction
- Higher education repeatedly correlated with higher sexual satisfaction. Rather than education itself being relevant, it is possible that the additional barriers to living well faced by those who have low education impacts on other aspects of quality of life such as connections with others, sexual satisfaction and general health.
- Very little evidence for a relationship between sexual satisfaction and HAART/ART. Majority of studies that concluded no relationship between HAART and sexual functioning were conducted within the last 10 years. Participants in these studies may have therefore been on newer antiretroviral medications associated with fewer side-effects (Gakhar et al., 2013).
This review demonstrated that sexual satisfaction among people living with HIV is associated with biological, psychological, demographic, clinical, social and relational factors, all of which are important to consider when supporting this client group. Future research could examine the causes of sexual (dis)satisfaction in this client group.
Developing a model of Sexual Satisfaction in Younger Women Living with HIV (YWLWH) in Serodifferent Relationships
HIV is a virus that, without medication, can be sexually transmitted. Young women are at increased risk of contracting HIV and often experience difficulties in their intimate and sexual relationships after HIV diagnosis. Those who want to have sexual relationships with men who do not have HIV can often be fearful of passing on HIV. This can make sexual relationships difficult. However, recent improvements in the treatment of HIV mean that people living with HIV are living longer, healthier lives and are less likely to give HIV to sexual partners (Rodger et al., 2016; 2019). This study aimed to explore how younger women living with HIV build and maintain sexual satisfaction in relationships with men who do not have HIV (i.e., serodifferent relationships) and whether recent medical advances are having a positive impact on younger women living with HIV’s sex lives. The research question was: ‘How do younger women living with HIV build and maintain sexual satisfaction in serodifferent relationships?’
What did I do?
Seven YWLWH (aged 22-49) were recruited through two UK HIV advocacy forums and social media. Participants took part in semi-structured interviews about their sexual experiences in past/current serodifferent relationships.
Grounded Theory analysis identified eight theoretical codes:
(1) Beliefs about future sexual relationships shortly after HIV diagnosis: Participants often expected their sexual relationships to end and felt put off having sex after HIV diagnosis.
(2) Sexual and relationship behaviour after HIV diagnosis: Participants often experienced changes to their sexual behaviour following diagnosis. For example, some stopping having sex or only pursued sexual relationships with other people living with HIV.
(3) Feeling sexually satisfied due to individual factors: Participants described sexual pleasure and sexual openness (e.g., feeling able to ‘let go’ during sex) as important to sexual satisfaction. While orgasm was important, it wasn’t always necessary for sexual enjoyment. Participants also described personal sexual pleasure (e.g., masturbation) being important, possibly because it helped them learn what felt good for them during sex.
(4) Feeling sexually satisfied due to relational factors: Participants described communication, consent, sexual creativity, mutuality (e.g., thinking both are enjoying sex) and having an emotional connection with their partner as important to sexual satisfaction. While frequency of sex was important, participants did not report needing regular sex to feel sexually satisfied, and instead valued sexual spontaneity.
(5) Feeling sexually satisfied due to HIV-related factors: Participants reported feeling more comfortable having unprotected sex since medical advances showing they cannot pass HIV to sexual partners.
(6) Other emotional/cognitive factors linked to sexual satisfaction: Participants reported self-confidence, beliefs that they are deserving of good sex and improved mood as factors that also helped sexual satisfaction.
(7) Experiences of status sharing with HIV-negative partners: Participants often felt sexually satisfied in relationships where their partners had responded openly and positively to hearing their HIV status.
(8) Feeling supported with living with HIV: Participants thought support from their clinical team, peers, and partner were important in helping them re-build sexual relationships after HIV diagnosis and promote female sexual pleasure.
A theoretical model indicating the relationship between codes highlighted how fears of HIV transmission, rejection from sexual partner, and internalised HIV-stigma influences sexual behaviour and beliefs about sex after HIV diagnosis. However, sexual satisfaction is facilitated by factors that assist YWLWH to overcome such fears, including professional and peer support, partner acceptance, knowledge of transmission risk, and positive re-interpretations of HIV. Sexual satisfaction is then maintained through dyadic relational factors (e.g., communication) and individual factors (e.g., sexual pleasure).
Increased access to peer support and information sharing regarding negligible transmission risk with undetectable viral loads may improve WLWH’s sexual wellbeing. Findings also suggested HIV services could focus more on asking about WLWH’s sexual wellbeing. Further recommendations include: (1) the promotion of female sexual pleasure following HIV diagnosis (2) access to peer support and increased awareness of low transmission of HIV among people diagnosed with HIV and HIV-negative people (3) support around communication during/about sex and assertive status sharing, (4) tailored services that respond to women living with HIV’s sexual needs, offer peer support, and promote positive sexuality (5) training for healthcare professionals in how to have conversations about sex and offer interventions promoting the above.
 While the BPS Faculty for HIV and Sexual Health have recently recommended not to use acronyms for people living with HIV, for the sake of brevity, acronyms will be used throughout this thesis.
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