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Book Review   |    
Counseling Clients With HIV Disease: Assessment, Intervention, and Prevention.
Mark H. Townsend, M.D.
Psychiatric Services 1998; doi:
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by Mary Ann Hoffman; New York City, Guilford Press, 1996, 324 pages, $35

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Dr. Mary Ann Hoffman's book is unusual in that it provides information about both the medical and the mental health needs of people with HIV and it also describes interventions that reduce the risk of acquiring HIV. It is a mark of Dr. Hoffman's abilities, both as a writer and as a psychologist, that she successfully combines these topics into a concise handbook that is suitable for students, trainees, and practitioners of all stripes.

Hoffman begins with a straightforward review of the natural history of HIV infection and available treatments. Unfortunately, the book was written before triple antiviral regimens were more widely used by physicians—although the author mentions them and looks forward to a near future when AIDS is a manageable, chronic illness. Much of the book describes the effect of loss of bodily integrity, grief, and death, from the perspectives of both patients and caregivers.

The author uses most of the book to introduce and elaborate on her four-part model for assessing and treating clients with HIV. Her psychosocial model of HIV disease addresses factors both internal and external to the patient: the realities of the disease itself—its chronicity, its stigma; social support; the patient's individual life circumstances; and comorbid medical and psychiatric conditions. She demonstrates the usefulness of this model with many case examples and argues that traditional practices must be altered to meet the specific needs of an HIV-affected patient; for example, therapy may begin in the office and continue in the hospital or the patient's home, and it may benefit from a therapist's timely self-disclosure. Yet she also recommends maintaining clear boundaries with patients, and she discusses the necessity of attending to transference and countertransference issues.

The effect of stigma, as it affects both patients and caregivers, is a central theme. Hoffman addresses external and internalized forms of homophobia and HIV-specific stigma and discusses the effect of culture and ethnicity. She neatly fits together research involving gay men, heterosexual and bisexual women and men, lesbians, and people of color. Hoffman matter-of-factly affirms these communities and gives specific information about caring for members of each, both before the acquisition of HIV, by providing preventive counseling, and after.

Hoffman's recommendations about teaching students and trainees to provide informed care to HIV-affected individuals, as well as a major section devoted to preventive interventions, are especially helpful. She argues that training institutions must teach specific skills, such as examining one's attitudes toward gay men and other marginalized members of the diverse HIV-affected community. Hoffman reviews the complex variables governing our sex lives and the acquisition and use of substances of abuse. She also provides an informative survey of the current major models of preventive intervention, pointing out that most do not take into account the "irrational and illogical," such as the need for intimacy and the unpredictability of alcohol and substance use.

Hoffman concludes Counseling Clients With HIV Disease with an epilogue that represents a call to arms, revealing the passion underlying the book itself: we must learn from this pandemic so that we never again experience anything like it.

Dr. Townsend is associate professor of psychiatry at Louisiana State University School of Medicine in New Orleans.

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