By David Martin, PhD (Senior Director, APA Office on AIDS)
I saw my first AIDS patient in 1983, a time when its etiology was unknown and when everyone—community members and healthcare professionals alike—was terrified about the prospects of contracting a rapidly fatal illness. I remember having to don a hospital gown, gloves, booties, and a mask prior to entering the isolation room where he was hospitalized to talk to him about his loneliness and social isolation and afterwards reflecting on the irony and seeming futility in the encounter (how much more alienating can it be than to have everyone who enters your room dressed in a moon suit?). I also can recall sitting with a medical student who approached me, white-faced and still in shock—she had been working with an AIDS patient and got stuck in her palm with a needle used in his care—her anxiety was palpable, and she was convinced she would not finish medical school, let alone go on to become a doctor. And a discussion I had with a neurology resident who thought that our AIDS patients got what they deserved and who vehemently expressed her resentment at having to care for them; I got a little heated and felt compelled to suggest that she reread the Hippocratic Oath—my own feelings of fear and helplessness got in the way of understanding the fear behind her anger.
Thirty years later new treatments have extended the life span and improved the lives of people with HIV. People don’t regularly die within months of their diagnosis. We don’t feel as helpless as we did back then. But HIV stigma still exists and people with HIV still experience isolation and shame over having the virus. About 50,000 people contract HIV each year in the United States; more than 1.1 million are living with HIV and a fifth of them don’t know they have HIV.
Each year on December 1, we remember those people who have died from HIV-related illnesses. It is also a day to:
- support those who have HIV
- renew our commitment to reducing new infections,
- ensure that those who have HIV are cared for, and
- work toward elimination of HIV-related stigma.
We still have much to do. As HIV/AIDS has made inroads into ethnic and cultural minority communities, discrimination and poverty have assumed a greater role in sustaining the epidemic; risk-reduction campaigns and programs to engage people with HIV in care are critically needed to address these factors.
We are moving into a new era of funding for HIV healthcare. There will be challenges in working to ensure that all people with HIV receive the care they need (including initial engagement in care, mental health care, substance abuse treatment, and other services to help them stay in care) and that they do not get lost in the transition from care under the Ryan White CARE Act to care under the Affordable Care Act.
I hope you will join me in remembering those whom we have lost, in supporting those we still have with us, and in working toward the ultimate goal of ending the epidemic. It’s a long road. Our contemplation could be likened to Robert Frost’s Stopping by Woods on a Snowy Evening; he observed that
The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.
We want to hear from you. Tell us in the comments:
- What does World AIDS Day mean to you?
- What challenges do you see for mental health care professionals treating people living with HIV?
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David Martin, PhD was appointed as the new Senior Director of the APA Office on AIDS in March 2013. He is a clinical psychologist who before joining the Association served on APA’s Ad Hoc Committee on Psychology and AIDS, as a mentor for the Cyber Mentors Program, and as a consultant to the HIV Office on Psychology and Education Program and Behavioral and Social Science Volunteer Program. Dr. Martin comes from the Harbor-UCLA Medical Center where he served as a professor in the David
Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences (Medical Psychology), director of HIV Mental Health Services, and chief psychologist and director of training in the Psychology Division at Harbor-UCLA Medical Center. Read more…
 Robert Frost, “Stopping by Woods on a Snowy Evening” from The Poetry of Robert Frost, edited by Edward Connery Lathem. Copyright 1923, © 1969 by Henry Holt and Company, Inc., renewed 1951, by Robert Frost.