Dear Editor,
Human immunodeficiency virus (HIV) is an interdisciplinary issue with biological, psychological, social, and spiritual aspects. One important aspect of this chronic disease is its psychological dimensions and the interventions needed to improve the mental state of people living with HIV (PLWH). Depression and anxiety are the most common mental disorders in PLWH, with a prevalence of about 80% among PLWH. Therefore, the prevalence of these two disorders in PLWH is about 3 to 5 times higher than in the general population, making psychological interventions for this group of patients essential (1).
In studies conducted at the Iranian Research Center for HIV/AIDS (IRCHA), various interventions have been used, including positive thinking, social support, mindfulness, social-cognitive interventions, Silva-based relaxation therapy, acceptance and commitment therapy (ACT), compassion-focused therapy, schema therapy, lifestyle and life skills modification, group therapy, narrative therapy, computerized cognitive rehabilitation therapy (CCRT), social marketing, neurofeedback, neuro-linguistic programming (NLP), aerobic exercise, and mobile applications for self-management, the majority of which employed randomized controlled or quasi-experimental designs. In these studies, each intervention had significant effectiveness compared with the control or no-intervention group. Also, there was a significant difference before and after each intervention, while there was no significant difference in the control group before and after the study. No conclusions regarding the comparative superiority of specific psychological interventions can be drawn from the available studies. This summary is based on multiple published intervention studies conducted at the IRCHA, representing approximately two decades of clinical and research experience (2-9).
Another common disorder in PLWH is personality disorder. Borderline and antisocial personality disorders are more common among these people, and these disorders can make a person susceptible to HIV infection. In a way, people with these disorders are prone to unprotected risky sexual behaviors due to their impulsive characteristics, and their impulsivity has been examined in various studies, indicating a high prevalence of impulsivity among PLWH. Also, in various studies, the prevalence of personality disorders, especially borderline and antisocial types, has been high (10), which may complicate psychological care. However, evidence regarding the effectiveness of specific psychological interventions for personality disorders in this population remains limited. It seems that interventions such as schema therapy, compassion-focused therapy, mindfulness, or group therapy for these personality disorders among these people are somewhat effective (6).
Our two-decade experience at IRCHA, as an expert opinion based on long-term clinical experience, indicates that psychological interventions such as mindfulness, positive thinking, schema therapy, and group-based approaches consistently improve mental health outcomes in PLWH, particularly in reducing depression and anxiety. Although no single intervention shows definitive superiority, tailoring strategies to individual psychological profiles, including co-occurring personality disorders, may enhance treatment outcomes.
