By: Jennifer McMillen Smith, LISW-S, HIV Social Worker at MetroHealth Medical Center and medically reviewed by Ann K. Avery, MD, Infectious Disease Physician at MetroHealth Medical Center
When people hear the word resilience, they tend to picture a movie moment. Think slow motion, swelling music, and someone crossing the finish line against all odds. But resilience is a lot more ordinary, grounded in everyday habits like taking your pill every single morning, or showing up for your three-month appointment when you'd rather stay home in bed with the covers pulled over your head.
Emily Mally, LISW-S, has seen a lot of emotional resilience in her career. She has spent more than 20 years at MetroHealth helping people through some of life's biggest challenges. After 18 years in the emergency department, she joined the HIV care team, where she focuses on behavioral health. She connects patients with therapy and psychiatric care and leads activity-based groups.
"I think resilience is quiet," Emily says. "People don't realize they have the resilience and strength to get through tough situations, but they really do."
Resilience lives in the daily routine
For Emily, emotional resilience starts with something simple: taking medication consistently.
"When living with HIV, it doesn’t matter if you feel sick or groggy in the morning, you still have to take your meds every day, at the same time," she points out. "If you have the flu, you still have to come in for your injectable. Someone who isn't living with HIV can skip the pill or reschedule the doctor's appointment. But the daily routine is very important for maintaining U=U, and the consistency is what helps build emotional resilience."
That routine isn't always easy. Emily sees a lot of pill fatigue. It's different from having a bad day. It's the deeper weariness of doing the same thing every day, forever.
"It's more of, 'I am so tired of waking up every day and having to take this freaking pill. It reminds me of my virus, and I'm just so over it," she says.
Her advice for getting through it has three parts:
Think in days, not a lifetime. "Try not to look at the big picture. Instead, take it one day at a time."
Remember you're not alone. HIV is like other chronic conditions. "If you have AFib, you have to take medication every day. If you have high blood pressure or diabetes, you have to take medication every day. Lots of people out there have to take meds every day."
Talk about it. Find other people who are experiencing the same thing and talk about it with them. A mentor with similar lived experience can make a real difference.
Speaking up is part of resilience
Emotional resilience also grows when people learn to speak up for themselves. Emily says patients at MetroHealth are encouraged to ask questions and take an active role in their care. Learning to speak up builds confidence that carries into other parts of life.
Speaking up gives people a sense of control. When you understand what's happening with your health and have a say in your care, the diagnosis starts to feel less like something happening to you.
Knowledge is a big part of that, and one piece of information changes everything for many people: U=U, or Undetectable = Untransmittable.
For many, learning about U=U is a relief. It makes dating feel less scary. Telling a partner doesn't carry the same fear. And it gives the daily pill a real purpose, because taking it on schedule is what keeps the virus undetectable.
Navigating disclosure and stigma
Living with HIV means making careful decisions about disclosure. Telling someone about your diagnosis is a big decision and sometimes can even be risky. Emily says it comes down to safety and boundaries. “You get to decide who hears it and when, and you don't owe that information to anyone. Once people realize they're in control of that choice,” Emily says, “it helps build their resilience.”
Stigma is one of the hardest parts of living with HIV. Emily thinks of one patient who has never told anyone about his diagnosis.
"Stigma can really hurt your resilience because it drains you," she says. "It drains your mental strength, it reduces your social supports, and it makes you doubt your own worth."
Stigma can lead to isolation, unfair treatment at work or in healthcare, and constant stress that wears people down physically and emotionally.
How a person understands HIV before their diagnosis also matters. Someone from a family with little knowledge of HIV may struggle more to disclose, while someone from a family with higher health literacy may feel less afraid.
"We're all bigger than this virus," she says, "and we've got to be bigger than the stigma. We all have to work together to stop it, and we do that through education."
Learning to relax and have fun
Emily's patient group originally started out as a plant club. Over time, these groups grew into something bigger. They’ve made candles together, spent time at local parks, and shared plenty of meals. The activities change, but the idea stays the same.
"During our get-togethers, we don't talk about diagnoses," she says. "Everyone there has HIV, but we socialize and have fun. HIV isn’t our focus.”
For Emily, that's what makes the groups special. Most of the time, living with HIV means thinking about it. There are medications to take, appointments to keep, and choices to make about who to tell. In the groups, all that gets set aside for a while. "You don't have to worry about disclosing," she says. "We're not there to talk about the diagnosis and medications and all the things that go with it."
Instead, people just get to enjoy themselves. "We focus on positive relationships, doing fun activities, and having a nice meal together," Emily says.
She believes that time together is more important than people might expect. Learning to socialize and try new things without the diagnosis hanging over them helps people build resilience. The fun is part of it, but what people are really looking for runs deeper. They want to feel healthy, happy, and accepted, and for a few hours at a time, these groups give them exactly that.