HIV, the virus that causes AIDS, is invisible without the aid of electron microscopy, yet it has the potential to precipitate every conceivable emotion. For some people its initial invisibility increases its sinister presence and fear-evoking potential. For others, it allows scope for denial and the familiar coping strategy that assumes that HIV ‘happens to other people’. In this chapter we shall consider the feelings and needs of those who are HIV positive, most of which are experienced by both men and women. We shall however highlight those issues that have particular implications for women.
The emotional impact of HIV may begin long before testing. Many people who present at pre-test counselling clinics tell of more than a year’s history of anxiety. By contrast some arrive ‘the morning after’ having taken a risk. Some are contemplating new relationships and a few are coerced into attending by partners. For some women the trigger to be tested may be that they are considering pregnancy; dreams of a future family life feel under threat from relationships or activities in the past or present. Frequently people present in response to some persistent physical symptom. Symptoms which would have been accepted at face value before the time of HIV/AIDS become, in some people’s fears, manifestations of a seroconversion illness or of HIV disease itself. A small number of people present with high levels of anxiety, out of proportion to their risk, with obsessional thoughts or incapacitating guilt. They may be suffering from a depressive illness and HIV has merely become a focus for their symptoms. These people need to be encouraged to seek appropriate help.
Pre-test counselling should include a discussion about health and about harm reduction in terms of sexual behaviour and drug taking practices, where appropriate. It is essential to give this process sufficient time and the client