Providing Spiritual Care According to Disease Process: HIV/AIDS The content of this articles will not provide a compendium of information about the disease process, but a summation. Please consult your IDT Physician for more complete information about the disease process. Symptoms of AIDS in the Hospice Patient (based upon the AIDS.gov information) In the late stage of HIV infection, people infected with HIV may have the following symptoms: •Rapid weight loss •Recurring fever or profuse night sweats •Extreme and unexplained tiredness •Prolonged swelling of the lymph glands in the armpits, groin, or neck •Diarrhea that lasts for more than a week •Sores of the mouth, anus, or genitals •Pneumonia •Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids •Memory loss, depression, and other neurologic disorders. These symptoms have a definite spiritual impact upon the AIDS patient. Some of the spiritual and existential issues AIDS patients experience include: • Fear of rejection • Reduced financial security and employment options • Career loss • Suicide • Anxiety Information a Chaplain Should Know According to the Journal of General Internal Medicine, found online at http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2006.00642.x/full#leftBorder, “the overwhelming majority of participants reported that spirituality is an important factor in their lives, as most indicated some sense of meaning/purpose in their lives and reported deriving comfort from their spiritual beliefs. The majority of our patients with HIV/AIDS belonged to an organized religion but participated more often in nonorganized religious activities (e.g., prayer, meditation). This finding may reflect the possibility that some religious organizations have generally not been supportive of people with HIV/AIDS and thus patients may have felt unwelcome or ostracized in their own communities of faith,16,17,38 or that private religious activities may be more accessible given that formal religious services are often offered only weekly.” The hospice Chaplain needs to be cognizant of the fact that the AIDS patient may not be welcoming of the Chaplain for fear of further rejection. The Chaplain must convey a non-judgmental and non-condemnatory presence. In addition, the Chaplain must convey a non-anxious presence in the face of the disease process. My experience with AIDS patients informed my chaplaincy in regard to interactive and reflective listening. Also, when the patient became emotional and I reached out to hold the patient’s hand, it communicated to the patient that I was not threatened by the disease and this communicated a strong message of love and acceptance to the patient. Discussion Guide for Initiating and Deepening Difficult Conversations A key catch-phrase that hospice clinicians of all disciplines will use is, “It’s not about me. It’s about the patient.” The Discussion Guide will assist the patient to bring reality to the phrase. The University of California at San Francisco published online in HIV Insite, http://hivinsite.ucsf.edu/InSite-KB-ref.jsp?page=kb-03-03-05&ref=kb-03-03-05-tb-03&no=3, some helpful questions and phrases the hospice Chaplain will find useful in providing spiritual care. Getting started "Tell me how things are going for you." "Can you tell me about your understanding of about your illness?" "What is the most difficult part of this illness for you?" "As you think about what lies ahead, what concerns you the most?" "As you look ahead, what do you hope for?" Continuing phrases "Tell me more about that." "Sounds like you're really worried about..." "What do you mean by '__' ('futile,' 'vegetable,' 'hopeless,' 'giving up,' 'everything')?" I trust this article with provide you, the Hospice Chaplain, with a few more tools for your spiritual care tool-bag for the ongoing spiritual care of your AIDS patients. Bless you, Chaplain Friends, for your ministry and labor of love.