Living well with HIV

“Being diagnosed with HIV can be devastating for some people. They need time to adjust to how they’re going to live with the virus from that point on,” says David, a clinical nurse specialist in mental health and HIV at the Kobler Clinic at Chelsea and Westminster Hospital.

“There has been progress, but there’s a need for more education about HIV because of the ongoing stigma towards those living with it. They can feel isolated and lonely; many develop anxiety and depression following a diagnosis. It can have a huge impact on their self-esteem and confidence, which in some cases leads to unemployment and financial problems.”

David’s role is to make sure people diagnosed with HIV are supported with their mental health and continue to take their antiretroviral medication. Not doing so can put them at risk of becoming physically unwell, leading to increased hospital appointments and possible admission.

David is one of just two nurses across London who specialise in supporting the mental health of people living with HIV. Increasingly, he gets referrals for people over 50, partly because people are living longer with the virus.

“Since the clinic opened in 1988, the management of patients with HIV has changed. Rather than managing a peaceful death, we manage how people live with HIV. Getting old can be a frightening and lonely experience and if you’re living with HIV, it can present even greater challenges.”

Depression is twice as common among people who have HIV and David often sees people with associated problems such as drug or alcohol addiction. Symptoms of post-traumatic stress disorder (PTSD) related to a diagnosis of HIV are also common. This can lead to depression, anxiety and insomnia.

David holds outpatient clinics, receiving referrals from the community HIV team and also from the specialist inpatient ward at the hospital where he works. He makes sure people have access to a counsellor or psychiatrist if needed but is also on hand to offer brief intervention therapy.

“Lots of what I do is listening,” he says. “Sometimes that’s all that’s needed; a listening and sympathetic approach to people’s problems. I also act as an advocate to help people get financial support and provide a bridge between the general hospital and mental health services. It’s my job to make sure our patients receive good mental health care while living with HIV.”

Cost savings

David’s role is vital in saving the NHS avoidable costs in the treatment of HIV-related illness caused by people stopping their medication when experiencing a mental health crisis.

“You might think, ‘why would anyone not want to take their medication?’, but for people struggling with a mental illness, they may stop taking medication due to depression or suicidal thoughts. Taking a tablet every day for the rest of your life is a challenge for most people, but with a mental health problem, this challenge is increased hugely,” says David.

“I regularly keep in contact with patients who are more vulnerable and offer follow-ups alongside their normal mental health care. It’s so important we monitor and maintain that level of adherence to medication.”

If people with HIV take their medication correctly, the virus can become undetectable, so it can’t be transmitted. It’s vital to maintain undetectable levels of HIV in the fight against transmission.