Sexuality in Australia’s Unworried Unwell: Confounding Factors in the Management of HIV
Advances in antiretroviral medications over the last two decades have greatly improved the quality of life for people living with the human immunodeficiency virus (HIV). Acknowledgment of HIV status improves adherence to antiretroviral medication regimes that aim to reduce the viral load to be undetectable, reducing virus transmission and delaying immune system deterioration and associated symptoms. This state of wellness supports a person’s ability to engage in healthy sexual relationships.
However, for a variety of reasons some people living with HIV do not adhere to their medication regime and live with denial and fear of disclosure. This potentially contributes to HIV transmission and increased susceptibility of developing AIDS defining illnesses, which when left untreated may prove fatal. The term ‘unworried unwell’ is ascribed to people who are medically unwell yet unworried about health deterioration. Working with unworried unwell HIV positive clients in Australia can be challenging for professionals when clients resist medical or therapeutic intervention and do not acknowledge their health status.
The promotion of healthy sexual relationships within this population requires acceptance of HIV status and sexual health risk to address the unworried aspect, as well as engaging the client in dialogue around the advantages of medication to improve wellness in all aspects of the individual’s life. Addressing factors contributing to denial and the confounding factor of being unworried through education and therapeutic alliance supports the individual’s rights to sexual citizenship. Two case studies of unworried unwell clients enrolled in an Australian hospital based HIV outreach service will be presented to explore the therapeutic challenges and contributing factors in client’s noncompliance.
