Psychosocial impact of HIV-related caregiving on health providers: a review and recommendations for the role of psychiatry

OBJECTIVE: The author considers current knowledge about the stresses of HIV-related care and assesses available evidence for the presence of major occupational, physical, and psychiatric morbidity in health care providers involved in intensive HIV-related caregiving. METHOD: The review is based on anecdotal reports of AIDS-care-related psychosocial distress and the literature concerning caregivers' attitudes toward people with HIV illness and HIV-related caregiving, the psychosocial impact of HIV work, and stress related to the ethical and philosophical challenges facing HIV caregivers. RESULTS: Few of the current publications concerning HIV caregiver stress come from the psychiatric literature. Psychiatry appears to lack a strong clinical, educational, research, or policy presence regarding psychosocial stress in HIV care providers. The numerous studies in the nursing, medical, public health, and health education literature do not include any controlled investigations documenting the incidence and prevalence of physical, psychological, occupational, or interpersonal symptoms or disorders in health care professionals who devote a substantial amount of their clinical activities to patients with HIV illness. CONCLUSIONS: Major HIV-related stress in conjunction with other psychiatric morbidity, such as mood disorders, anxiety disorders, substance abuse, and relationship and occupational problems, seems likely in susceptible caregivers. Decisions about the structure and form of delivery of HIV-related care and programs for caregivers must be based on more carefully controlled psychiatric observations of occupational, physical, psychological, and social adaptation to HIV-related work. The author suggests several areas in which psychiatric clinicians, educators, researchers, and policy experts can make major contributions.