More than 1.2 million people in the United
States are living with HIV – and when they first heard the word
"positive," many were thrust into feelings of anger, sadness and
denial.

“There are some people who suspect they are HIV positive but go a very long
time without testing, and then there are other people who test for whatever
reason and turn out positive,” says Mallory Johnson, a clinical
psychologist and professor at the University of
California–San Francisco School of Medicine and co-director of the Center for AIDS Prevention
Studies. “Those tend to be the extremes of the experience.”

Disbelief and shock, Johnson says, are the most common responses.

Of those living with the virus in the U.S., nearly 1 in 7 are unaware of their infection. HIV weakens the immune system by
destroying cells meant to combat infection and disease; AIDS is the final stage
of the infection, when the immune system has been severely damaged. Not
all HIV-positive individuals will develop AIDS – medicine now allows
people with the virus to live long, healthy lives.

Still, receiving a chronic diagnosis like HIV is likely to produce
emotional distress. Here's a look at the toll such a diagnosis takes, as well as how patients can tend to their psychological health.

The Mental Side

In any given year, around 1 in 5 American adults will experience a diagnosable mental illness. And people living with HIV are at an increased risk of developing a mood, cognitive
or anxiety disorder, according to AIDS.gov. Depression, the most common
mental health condition among the general population, is particularly likely among those
who are HIV positive.

Depression's ramifications can extend beyond emotional health and cause physical problems as well, says Sheryl Catz, a
clinical psychologist and professor at the Betty Irene Moore School of Nursing at the University
of California–Davis. Often, depressed patients fail to stick to their
medicine regimens as they should.

“We did find across the board that people
who were depressed had a more difficult time with their adherence, “ says Catz,
who researches HIV, health behavior and chronic disease management.

Peter Vanable, a professor and chair
of psychology at Syracuse
University, has conducted extensive research on the behavioral aspects of HIV
and coping. He analyzed, for example, how
HIV stigma affects mental health
and medication adherence. “A significant subset of men and women who are HIV positive experience social
rejection from family, from loved-ones [and] from partners, and those experiences of
discrimination and rejection can really play out in difficult ways,” Vanable
says.

The way people react to news of an HIV diagnosis, he continues, can shape a patient's long-term psychological response. “People's experiences with social rejection, and people’s internalized feelings
of self-rejection tend to go hand-in-hand,” Vanable says. 

Coping Strategies

No one coping strategy will best serve all patients, experts say. Still, patients should disclose their status to at least one trustworthy person, says Robert Remien, a professor of clinical psychology and director of the HIV
Center for Clinical and Behavioral Studies at Columbia University.

“I am a big believer [that] psychologically, it is important people not be
entirely isolated with their HIV diagnosis, and they are not living entirely
alone with it,” he says. 

But who to tell – and when it makes sense to do so – is a personal decision.

"There’s not a need for everyone to have everyone in their life know,” Remien
says. “It’s a chronic illness, and people live with all kinds of chronic things
that they may or may not talk about.” 

Johnson agrees that telling at least one person typically helps patients deal with the diagnosis in the healthiest way.