Case study

Person living with HIV (‘Xavier’)

Amy Mullins, University of Southern Queensland

‘Xavier’ is a 43 year-old male who is living with HIV and was diagnosed nearly 10 years ago. Recently he has become depressed and anxious due to changes in his immune functioning (his HIV is no longer fully suppressed) and he is needing to change HIV medications upon the advice of his doctor (an HIV specialist). He is wondering, what’s the point of it all? and spends much of the day thinking, ‘I don’t believe HIV is actually real’ and ‘I believe the medications are poisoning me’.

He reported that he has been feeling down, tearful, socially withdrawn and having difficulties sleeping, and has recently been self-medicating depressive symptoms with daily alcohol use. He has stopped seeing his friends due to having ‘no hope’ for the future, but is continuing to walk daily and attend weekly group BBQs with other people living with HIV.

Xavier has a pre-morbidly shy temperament and a history of bullying in childhood; he works part-time as a teacher. After a couple of psychology sessions, Xavier has agreed to make a plan to reduce his alcohol use. He stated that drinking less helps to improve his artistic abilities and his desire to walk each morning.

Xavier remains ambivalent regarding changing medications and is continuing to take HIV medication due to feelings that his HIV infection and future feared decline in health is confirmation that he is defective and unlovable. He is reminded of these feelings every time he visits the sexual health clinic, and has started avoiding appointments with the medical team—however continues to attend psychology appointments.

Discussion questions

1.   What further information would you want to know about Xavier in order to develop a formulation and treatment plan with him?

2.   What would be possible targets for psychological intervention (therapy goals)? How would you determine how to prioritise these goals?

3.   What do you see as challenges and protective factors?