The course of human immunodeficiency virus (HIV) disease has changed dramatically due to scientific research that has led to the discovery of remarkable new treatments and medications. Now, instead of being considered an automatic death sentence, HIV disease is considered a chronic and manageable illness for most people. Corresponding to this tremendous growth in data-based biomedical research, there has also been increasing interest and research into holistic treatment of the patient: body, mind, and spirit. The National Center for Complementary and Alternative Medicine was established in 1998 at the National Institute of Health, to focus on and study nontraditional treatment approaches, including “mind-body” methods. Research on religion and spirituality in medical illness has shown that faith plays a significant role in wellness and healing for most patients.¹ Despite the supposed secular nature of the country and the separation of church and state, U.S. citizens are known to be very religious, with the majority reporting belief in God and regular attendance at religious services.² Persons who endorse that spirituality is an important part of their lives have been shown to have decreased anxiety and depression, better health, and greater longevity.¹ Religious beliefs have been shown to help people find meaning in suffering from their illness and help them move toward acceptance. It also provides a buffer against depression, hopelessness, and desire for hastened death.³

Treating persons with HIV infection and acquired immunodeficiency syndrome (AIDS) brings up issues related to sexuality, serious illness, and death, and these subjects intersect with religion and spirituality. Religion dictates our sexual mores, and religious or spiritual beliefs are essential in coping with and understanding serious illness and death.⁴ Being diagnosed with HIV disease exposes a person to multiple stressors: living with a potentially life- threatening disease, accommodating a complicated medical regimen with multiple side effects, and uncertainty about the future. In addition, there are also many psychosocial stresses, including the stigma of AIDS, possible social rejection or isolation, discrimination in work, housing or medical care, the threat of transmission of the disease, and preexisting issues such as wrestling with sexuality and substance abuse. This emotional turmoil can lead to what is termed “spiritual distress,” a disturbance in a person’s belief system.

This spiritual crisis can lead to questioning of the meaning of life, death, and suffering; doubts about one’s beliefs; a sense of detachment from others; a feeling of spiritual emptiness;
and feeling that life is not worth living.⁵ Irving Yalom⁶ has written about the four existential issues that we all face: death, meaninglessness, isolation, and freedom. An existential crisis may lead a person to search for spiritual answers, which can be a source of strength and provide a sense of meaning for their struggle. As Victor Frankl⁷ discovered in the concentration camps, one can endure incredible suffering if a sense of meaning and purpose can be found. The AIDS epidemic has caused many people to face their own mortality at an early age rather than late in life, and many have embraced spirituality.⁸

The North American Nursing Diagnosis Association (NANDA International) defines spiritual distress as a disruption in the life principle that, when intact, suffuses a person’s entire self, integrating and transcending one’s biologic and psychosocial aspects.⁹ The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), in the section entitled “Other Conditions That May Be a Focus of Clinical Attention,” has a similar diagnostic category of “Religious or Spiritual Problem.” “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution.”¹⁰ In this chapter, several examples of spiritual distress or “Religious or Spiritual Problem” are discussed. Awareness of these diagnoses is critical to addressing this aspect of the patient’s distress in the treatment plan and depends on the clinician’s comfort with discussing religion and spirituality with their patients.