HIV and Cancer: Dual Diagnosis Compounds Challenges in Coping
A dual diagnosis of both cancer and HIV places a greater psychosocial burden on the patient.
AIDS-associated cancers—lung, head and neck, liver, and anal cancers—are becoming more common in people who are HIV-positive. This means that oncology professionals are seeing more people with both HIV/AIDS and a type of cancer that, until recently, has not been associated with HIV/AIDS the way that AIDS-defining cancers (eg, Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer) have been.1 Statistically, people with an HIV diagnosis are 25 times more likely to develop anal cancer, 5 times more likely to develop liver cancer, 3 times more likely to develop lung cancer, and at least 10 times more likely to develop Hodgkin lymphoma than people not infected with the HIV virus.2
From a medical perspective, a dual diagnosis of cancer and HIV complicates treatment for both diseases. Potential drug interactions, compounded side effects, and chemotherapy's tendency to negatively impact CD4 count or HIV-1 viral load, can all complicate treatment.3
From a psychosocial perspective, a dual diagnosis of HIV/AIDS and cancer can increase a patient's difficulty in coping. The unique factor that HIV brings to the patient's dual diagnosis, more than heart disease, COPD, diabetes, or other types of illness, is stigma.
Stigma is social disapproval that segregates individual people and groups into categories rejected by society. Individual or social reactions to someone who is a member of a stigmatized group range from subtle to overt. At the more extreme end of the spectrum, social stigma manifests as prejudice, discrimination, or even violence. Living in a society that categorizes a person as morally or physically defective can have significant impact on quality of life for patients presenting with dual HIV/AIDs and cancer diagnoses.
Cancer itself is not without stigma. Anyone working at a treatment center has seen how uncomfortable the diagnosis can make people. Above and beyond the uneasiness that serious illness elicits from many people, otherwise well-intentioned friends and family members may be overwhelmed with anxiety or feelings of inadequacy. Not knowing what to say or how to help, would-be caregivers may avoid the person with cancer without being aware of what they are doing or why.
SUPPORT MAY BE LACKING
A dual HIV/AIDS and cancer diagnosis compounds the stigma associated with one or both diseases, thereby increasing a patient's difficulty in coping. This happens, in part, because people with HIV/AIDS receive less social support, largely due to the association with homosexuality and IV drug use. Studies show diagnoses associated with deviant, socially unacceptable behavior tend to elicit negative reactions (anger and/or blaming) instead of positive social reactions (pity, admiration, offers of help).4
Therefore, stigma is more than a general sense of not being welcome. If we look, for example, at the critical emotional and practical support that many cancer patients find in their religious communities, whether in the form of a structured support program or, as occurs more often, in the form of informal support such as rides, meals, friendly visiting, we see how important this support is to our patients. However, someone with an HIV/AIDS diagnosis, particularly those who are gay, lesbian, or transgendered, may not be welcome in a traditional religious community. That critical support, then, is not available. Coping is more difficult.
A similar dynamic may be evident in traditional family groups. The patient may not have access to support from a traditional family that has disowned the patient for deviant, embarrassing behavior. A patient with an HIV/AIDS diagnosis may need to conceal aspects of identity, behavior, or diagnosis, if that is possible let alone desirable, to access support that is more readily available to people without a stigmatizing illness.