(relatives, lovers, and friends) are forced to learn a range of technical and emotional skills on the job, and many experience dysphoria—an emotional state of depression, anxiety, and restlessness (Folkman, Chesney, and Christopher-Richards, 1994).

Although stress experienced by formal HIV caregivers is reported in professional and lay articles, research has not included systematic documentation of the incidence and prevalence of physical, psychological, occupational, or interpersonal symptoms or disorders in health care professionals who devote a substantial amount of their clinical activities to patients with HIV illness (Silverman, 1993). Anecdotal reports of various symptoms, such as AIDS-related nightmares and psychological numbing, together with other symptoms related to stress and depression, suggest that some caregivers might be experiencing a form of posttraumatic stress disorder. However, according to Silverman (1993), only one published psychiatry article has addressed this possibility (Horstman and McKusick, 1986).

The psychological and physical implications of AIDS caregiving for health professionals undoubtedly is affected by their attitude toward AIDS. Surveys among nurses, physicians, dentists, social workers, psychiatrists, and health profession students are notable for revealing a consistent aversion among caregivers to the HIV/AIDS disease, to patients and their lifestyles, and to caregiving work itself, much of it based on fear of contagion (Silverman, 1993). A related issue is the psychological and social consequences (including occupational stress) of dealing with HIV/AIDS among outreach workers and service providers (Broadhead and Fox, 1993).

After reviewing the literature on disease progression and intervention in Chapter 4, the committee makes a number of recommendations:

4.1 The committee recommends that NIMH continue research on the pathogenesis of HIV infection of the brain, including the factors controlling virus replication such as local immune defenses and changes in the viral genome determining neuropathogenicity.

    4.2 The committee recommends that NIMH continue research on the pathobiology of nervous system injury underlying the AIDS dementia complex, including the morphological, biochemical, and molecular basis of neuronal dysfunction related to viral and cellular gene expression.

      4.3 The committee recommends that NIMH support collaborative



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