Social Work in an HIV/AIDS Clinic
By: Joe Vanny Perez, LMSW
HIV (Human Immunodeficiency Virus) is a virus that destroys the immune system. Over time, most people with HIV become less able to fight off the germs that surround all of us every day, in our offices, on public transportation, on the street, and everywhere else. These germs usually do not make a person sick, but when the immune system gets weaker from HIV, these germs can cause infections and cancers that can kill a person. There are medications that fight HIV in the body and help the immune system stay stronger for a longer time. But there are no cures available for HIV.
As a social worker for New York Presbyterian Hospital’s Center for Special Studies, I am part of a medical interdisciplinary team that specializes in providing medical care to patients with HIV/AIDS.
Working with patients with HIV/AIDS has allowed me to focus on a population that has often been neglected and stigmatized by our society. Social stigmas, homophobia, and lack of education have caused many People Living With HIV/AIDS (PLWHAs) to feel like outcasts in their own families and communities.
As an HIV/AIDS social worker, I help patients navigate the complicated levels of public assistance requirements and other hierarchal social services. I help them advocate for basic human necessities like food and shelter and help in finding community-based organizations (CBOs) that can offer support as they come to terms with having HIV/AIDS. I work with patients who are undocumented from other countries, helping them secure medical care and support to help them establish a steady foundation in a country (the U.S.) that may be new to them. I help lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) patients tackle the double stigmatization of being treated as “different” and also living with HIV. Sometimes culture can have a negative impact on PLWHAs and their successes in managing the illness. Therefore, it is important that I incorporate cultural sensitivity into my daily work with patients tackling myths about HIV/AIDS by encouraging learning and advocacy.
I reinforce self-care and medication adherence alongside the medical team, which consists of a physician, nurse, psychiatrist, and social worker. I teach patients safer sex practices, encourage condom use, and provide a safe and nurturing environment that promotes healing and self-confidence. Ultimately, I help patients regain control of their lives through self-reflection and advocacy. Having the support of the multidisciplinary team can result in more successes, since each team member can help reinforce healthier lifestyles and encourage patient ownership of individual challenges utilizing the medical team as a foundation to build upon.
I provide short-term therapy for patients with concerns such as being recently diagnosed, disclosing their HIV status to loved ones, intimate partner violence, addictions (including substance and sexual), harm reduction, aging, and coping with grief and loss.
People of color continue to be at a disproportionate greater risk of being infected with HIV/AIDS. Lack of health insurance, inadequate medical attention, general poor health, and little or no access to proper education contribute directly to increased infection rates among these populations, representing a negatively increasing trend in new HIV infections. As social workers continue to develop cultural competency, complex psychosocial factors continue to evolve as HIV spreads across the globe.
Working with people of color, I have come to understand that social workers in my field are faced with not only working with the medical aspect of HIV/AIDS, but with other, just as powerful, forces that can create huge gaps in accessing medical and social services. Some of these forces include racism, discrimination, genocide, and ignorance.
Sometimes these forces can cause a patient to become ambivalent about his or her medical care, and this may result in poor adherence to medication regimens. A common problem I have seen with patients (not just people of color) is that they stop taking their medication because it may remind them of their illness, and somehow by taking the medication, they are admitting they are HIV-positive and/or have AIDS. To combat poor adherence, I help patients explore their fears about HIV, the impact of disclosing their HIV status with people in their immediate social circles, the influence of religion/folk/cultural beliefs, and ultimately encourage patients to establish support networks (either personal or through agencies), utilizing individual therapy and groups as a tool to network with other people who may share similar experiences.
Motivational interviewing can be a useful intervention with people struggling with medication adherence and safer sex practices. As I attempt to work with a patient who is ambivalent about behavior changes, I often think, “Is the patient able to understand core concepts I am trying to teach? Is he or she able to reflect upon the positive and negative attributes of the choices being made? How can I reframe the message I am attempting to convey in a way that the patient can relate to? What are the patient’s strengths and weaknesses? Does the patient advocate for other people? If so, how? How has the patient managed ambivalence in the past?”
HIV/AIDS is an exciting field that is constantly changing as medicine evolves. It will challenge social workers to understand complex psychosocial factors, societal stigmatization, and human injustice, and encourage advocacy on mezzo and macro levels, including advocacy on multi-tiered levels as government funding for HIV/AIDS programs is reduced. It will also encourage social workers to help patients navigate bureaucratic systems while recognizing individuality, self-respect, and self-worth.
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Joe Vanny Pérez, LMSW, has worked as a social worker at the Center for Special Studies/NY-Presbyterian Hospital for five years, focusing on HIV/AIDS. He holds a master’s degree in social work from New York University and a B.A. in sociology and art history from Hunter College-City University of New York. In 1990-1991, Mr. Pérez served in Operation Desert Storm as part of a United States Army unit embedded in Iraq and Saudi Arabia.
This article appeared in The New Social Worker, Summer 2012, Vol. 19, No. 3. All rights reserved. Please contact Linda Grobman for permission to reprint.