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THE PERSON LIVING WITH HIV DISEASE

INTRODUCTION
Human
immunodeficiency
virus
infection / acquired
immunodeficiency syndrome (HIV/AIDS) is a disease of the
human immune system caused by the human immunodeficiency
virus (HIV). During the initial infection a person may experience a brief
period of influenza-like illness. This is typically followed by a prolonged
period without symptoms. As the illness progresses it interferes more
and more with the immune system, making people much more likely to
get infections, including opportunistic infections, and tumors that do not
usually affect people with working immune systems.

There is no cure or vaccine; however, antiretroviral treatment can slow


the course of the disease and may lead to a near-normal life expectancy.
While antiretroviral treatment reduces the risk of death and
complications from the disease, these medications are expensive and
may be associated with side effects.

Genetic research indicates that HIV originated in west-central Africa


during the early twentieth century. AIDS was first recognized by
the Centers for Disease Control and Prevention (CDC) in 1981 and its
causeHIV infectionwas identified in the early part of the
decade. Since its discovery, AIDS has caused nearly 30 million deaths
(as of 2009). As of 2010, approximately 34 million people have
contracted HIV globally. AIDS is considered a pandemica disease
outbreak which is present over a large area and is actively spreading.

HIV/AIDS has had a great impact on society, both as an illness and as a


source of discrimination. The disease also has significant economic
impacts. There are many misconceptions about HIV/AIDS such as the
belief that it can be transmitted by casual non-sexual contact. The
disease has also become subject to many controversies involving
religion.

DEFINITION
Acquired immune deficiency syndrome (AIDS) is an infectious disease
caused by the human immunodeficiency virus (HIV). There are two
variants of the HIV virus, HIV-1 and HIV-2, both of which ultimately cause
AIDS.
-www.medical-dictionary.thefreedictionary.com

SIGNS AND SYMPTOMS


Some people may develop a flu-like illness within a month or two after
exposure to the HIV virus, although, many people do not develop any
symptoms at all when they first become infected. In addition, the
symptoms that do appear, which usually disappear within a week to a
month, are often mistaken for those of another viral infection. These
may include:
Fever
Headache
Malaise
Enlarged lymph nodes
Persistent or severe symptoms may not surface for 10 years or more,
after HIV first enters the body in adults, or within two years in children
born with an HIV infection. The virus initially disables or destroys these
cells without causing symptoms.
As the immune system deteriorates, complications begin to surface. The
following are the most common complications, or symptoms, of AIDS.
However, each individual may experience symptoms differently.
Symptoms may include:
Lymph nodes that remain enlarged for more than three months
Lack of energy
Weight loss
Frequent fevers and sweats
Persistent or frequent yeast infections (oral or vaginal)
Persistent skin rashes or flaky skin
Pelvic inflammatory disease that does not respond to treatment
Short-term memory loss
Some people develop frequent and severe herpes infections that cause
mouth, genital, or anal sores, or a painful nerve disease known as
shingles. Children may have delayed development or failure to thrive.

During the course of the HIV infection, most people experience a gradual
decline in the number of CD4+ T cells, although some individuals may
have abrupt and dramatic drops in their counts.
The symptoms of an HIV infection may resemble other medical
conditions. Always consult your doctor for a diagnosis.
TRANSMISSION
i. Sexual Contact
HIV is spread most commonly by sexual contact with an infected
partner. The virus enters the body through the lining of the vagina,
vulva, penis, rectum, or mouth during sexual activity.
ii.

Blood Contamination

HIV may also be spread through contact with infected blood. However,
due to the screening of blood for evidence of HIV infection, the risk of
acquiring HIV from blood transfusions is extremely low.
iii.

Needles

HIV is frequently spread by sharing needles, syringes, or drug use


equipment with someone who is infected with the virus. Transmission
from patient to healthcare worker, or vice-versa through accidental
sticks with contaminated needles or other medical instruments, is rare.
iv.

Mother-infant

HIV also can be spread to babies born to, or breastfed by, mothers
infected with the virus.
v.

HIV/AIDS cannot be spread through

Saliva
Sweat
Tears
Casual contact, such as sharing food utensils, towels, and bedding
Swimming pools
Telephones
Toilet seats
Biting insects (such as mosquitoes)
DIAGNOSIS
Early HIV infection often causes no symptoms, and must be detected by
testing a person's blood for the presence of antibodies--disease-fighting
proteins-- to HIV. These HIV antibodies generally do not reach levels high
enough to detect by standard blood tests until one to three months
following infection, and may take as long as six months. People exposed

to HIV should be tested for HIV infection as soon as they are likely to
develop antibodies to the virus.
When a person is highly likely to be infected with HIV and yet antibody
tests are negative, a test for the presence of HIV itself in the blood is
used. Repeat antibody testing at a later date, when antibodies to HIV are
more likely to have developed, is often recommended.

HIV/AIDS is diagnosed via laboratory testing and then staged based on


the presence of certain signs or symptoms. HIV testing is recommended
for all those at high risk, which includes anyone diagnosed with a
sexually transmitted illness. In many areas of the world a third of HIV
carriers only discover they are infected at an advanced stage of the
disease when AIDS or severe immunodeficiency has become apparent.
RISK FACTORS
Behaviours and conditions that put individuals at greater risk of
contracting HIV include:
Having unprotected anal or vaginal sex;
Having another sexually transmitted infection such as syphilis,
herpes, gonorrhoea, and bacterial vaginosis
Sharing contaminated needles, syringes and other injecting
equipment and drug solutions when injecting drugs
Receiving unsafe injections, blood transfusions, medical procedures
that involve unsterile cutting or piercing
Experiencing accidental needle stick injuries, including among
health workers.
PSYCHOLOGICAL PROBLEMS OF INDIVIDUAL HIV/AIDS
If a person diagnosed with HIV, his physical health is not the only issue
to deal with. Along with the physical illness are mental health conditions
that may come up, such as depression and anxiety. Mental health refers
to the overall well-being of a person, including a person's mood,
emotions, and behaviour.

Many people are surprised when they learn that they have been infected
with HIV. Some people feel overwhelmed by the changes that they will

need to make in their lives. It is normal to have strong reactions when


you find out you are HIV positive, including feelings such as fear, anger,
and a sense of being overwhelmed. Often people feel helpless, sad, and
anxious about the illness.

There are many things you can do to deal with the emotional aspects of
having HIV. What follows are some of the most common feelings
associated with a diagnosis of HIV and suggestions on how to cope with
these feelings. You may experience some, all, or none of these feelings,
and you may experience them at different times.

i.

Denial

People who find out that they are HIV positive often deal with the news
by denying that it is true. You may believe that the HIV test was not
accurate or that there was a mix-up with the result, even after
confirmatory testing shows that it is a true positive. This is a natural and
normal first reaction.
At first, this denial may even be helpful, because it can give you time to
get used to the idea of infection. However, if not dealt with, denial can
be dangerous; you may fail to take certain precautions or reach out for
the necessary help and medical support.
It is important that you talk out your feelings with your doctor, a
therapist, or someone you trust. It is important to do this so that you can
begin to receive the care and support you need.

ii.

Anger

Anger is another common and natural feeling related to being diagnosed


with HIV. Many people are upset about how they got the virus or angry
that they didn't know they had the virus.
Ways to deal with feelings of anger include the following:
Talk about your feelings with others, such as people in a support

group, or with a counselor, friend, or social worker.


Try to get some exercise--like gardening, walking, or dancing--to
relieve some of the tension and angry feelings you may be
experiencing.
Avoid situations--involving certain people, places, and events--that
cause you to feel angry or stressed out. Using drugs or alcohol when
you feel angry can be dangerous for you and lead to conflict or
violence that might otherwise have been avoidable.

iii.

Sadness or depression

It is also normal to feel sad when you learn you have HIV. If, over time,
you find that the sadness doesn't go away or is getting worse, talk with
your doctor or someone else you trust. You may be depressed.
Symptoms of depression can include the following, especially if they last
for more than 2 weeks:
Feeling sad, anxious, irritable, or hopeless
Gaining or losing weight
Sleeping more or less than usual
Moving slower than usual or finding it hard to sit still
Losing interest in the things you usually enjoy
Feeling tired all the time
Feeling worthless or guilty
Having a hard time concentrating
Thinking about death or giving up
Persistent loss of libido or interest in sex
If the mood swings or depression get very severe, or if ever think about
suicide, call your doctor right away. Your doctor can help you.

Finding the right treatment for depression takes time; so does recovery.
If you think you may be depressed, don't lose hope. Instead, talk to your
health care provider and seek help for depression.

iv.

Fear and anxiety

Fear and anxiety may be caused by not knowing what to expect after
you've been diagnosed with HIV, or by not knowing how others will treat
you if they find out you have HIV. You also may be afraid of telling
people--friends, family members, and others--that you are HIV positive.
Fear can make your heart beat faster or make it hard for you to sleep.
Anxiety also can make you feel nervous or agitated. Fear and anxiety
might make you sweat, feel dizzy, or feel short of breath.
Ways to control your feelings of fear and anxiety include the following:
Learn as much as you can about HIV. HIV infection is now a very
treatable disease and most HIV-infected people can live long, healthy
lives if they seek medical care and take good care of themselves.
Current HIV medications can be very well tolerated and in general do
not lead to the body changes that were seen with older treatments.
Have your questions answered by your doctor.
Talk with your friends, family members, and health care providers.
Join a support group.
Help others who are in the same situation, such as by volunteering at
an HIV service organization. This may empower you and lessen your
feelings of fear.
Talk to your doctor about medicines for anxiety if the feelings don't
lessen with time or if they get worse.

v.

Stress

If you are HIV infected, you and your loved ones constantly have to deal
with stress. Stress is unique and personal to each of us. When stress

does occur, it is important to recognize the fact and deal with it. Some
ways to handle stress are discussed below. As you gain more
understanding about how stress affects you, you will come up with your
own ideas for coping with stress.
Try physical activity. When you are nervous, angry, or upset, try
exercise or some other kind of physical activity. Walking, yoga, and
gardening are just some of the activities you might try to release your
tension.
Take care of yourself. Be sure you get enough rest and eat well. If you
are irritable from lack of sleep or if you are not eating right, you will
have less energy to deal with stressful situations. If stress keeps you
from sleeping, you should ask your doctor for help.
Talk about it. It helps to talk to someone about your concerns and
worries. You can talk to a friend, family member, counselor, or health
care provider.
Let it out. A good cry can bring relief to your anxiety, and it might even
prevent a headache or other physical problem. Taking some deep
breaths also releases tension.

vi.

AIDS dementia

HIV/AIDS and some medications for treating HIV may affect your brain.
When HIV itself infects the brain, it can cause a condition known asAIDS
Dementia Complex (ADC). Symptoms can include the following:
Forgetfulness
Confusion
Difficulty paying attention
Slurred speech
Sudden shifts in mood or behaviour
Muscle weakness
Clumsiness

If you think you may have ADC:


Don't be afraid to tell your doctor that you think something is wrong.
These symptoms can be subtle in the beginning, and telling your care
providers about your concerns can help them to diagnose and treat
you early.
Keep a notepad with you and write down details about your symptoms
whenever they occur. This information can help your doctor to help
you.
Build as much support as possible, including friends, family, and health
care providers. Although it's possible to treat ADC successfully, it may
take a while for some symptoms to go away.

Coping tips
It is completely normal to have an emotional reaction upon learning that
you are infected with HIV, such as anxiety, anger, or depression. These
feelings do not last forever. As noted above, there are many things that
you can do to help take care of your emotional needs. Here are just a
few ideas:
Talk about your feelings with your doctor, friends, family members, or
other supportive people.
Try to find activities that relieve your stress, such as exercise or
hobbies.
Try to get enough sleep each night to help you feel rested.
Learn relaxation methods such as meditation, yoga, or deep breathing.
Limit the amount of caffeine, nicotine, alcohol, and recreational drugs
you use.
Eat small, healthy meals throughout the day.
Join a support group.
There are many kinds of support groups that provide a place where you
can talk about your feelings, help others, and get the latest information

about HIV/AIDS. Check with your health care provider for a listing of local
support groups.
More specific ways to care for your emotional well-being include various
forms of therapy and medication. Used alone or in combination, these
may be helpful in dealing with the feelings you are experiencing.
Therapy can help you better express your feelings and find ways to cope
with your emotions. Medicines that may be able to help with anxiety and
depression are also available.
You should always talk with your doctor about your options. There are
many ways to care for your emotional health, but treatments must be
carefully chosen by your physician based on your specific circumstances
and needs.
The most important thing to remember is that you are not alone; there
are support systems in place to help you, including doctors,
psychiatrists, family members, friends, support groups, and other
services.
PSYCHOLOGICAL TREATMENTS
Often drug therapies for mental health problems work better if used
along with special kinds of psychological therapy. Examples include
psychotherapy, and cognitive behavioural therapy (CBT), both of which
usually involve a short course of sessions with a psychotherapist or
psychologist.

WHERE TO GO FOR HELP AND SUPPORT


A good place to start would be your HIV clinic. Your HIV doctor should
take your mental health just as seriously as your physical health. Many
of the larger HIV clinics have expert HIV mental health teams. There are
also many HIV support organisations your HIV clinic will be able to tell
you about local support, or you can use our online database to search for
organisations.

PSYCHOLOGICAL NEEDS OF HIV/AIDS PATIENTS WHEN PHYSICAL HEALTH


BECOMES STABILISED

In order to live an adaptive life despite HIV infection, patients need to


negotiate between the demands of chronic illness and their goals of
living a "normal" life. In order to enjoy sustainable physical health, social
support and financial independence, patients have to work on a number
of areas that require persistent efforts. These are treatment-related
stress as well as relationships with significant others.

HIV COUNSELING
Counseling in HIV and AIDS has become a core element in a holistic
model of health care, in which psychological issues are recognised as
integral to patient management.
One to one prevention counseling has a particular contribution in that it
enables frank discussion of sensitive aspects of a patient's lifesuch
discussion may be hampered in other settings by the patient's concern
for confidentiality or anxiety about a judgmental response. Also, when
patients know that they have HIV infection or disease, they may suffer
great psychosocial and psychological stresses through a fear of rejection,
social stigma, disease progression, and the uncertainties associated with
future management of HIV. Good clinical management requires that such
issues be managed with consistency and professionalism, and
counseling can both minimise morbidity and reduce its occurrence. All
counselors in this field should have formal counseling training and
receive regular clinical supervision as part of adherence to good
standards of clinical practice.

AIMS OF COUNSELING IN HIV INFECTION


a) Prevention
Determining whether the lifestyle of an individual places him or her at
risk
Working with an individual so that he or she understands the risks
Helping to identify the meanings of high risk behaviour

Helping to define the true potential for behaviour change


Working with the individual to achieve and sustain behaviour change

b) Support
Individual, relationship, and family counseling to prevent and reduce
psychological morbidity associated with HIV infection.

REASONS FOR SEEKING COUNSELING AND TESTING


People consider counseling and testing for a number of reasons, some of
which may apply to you:

Knowing whether you have HIV infection would alert you to your
need to seek medical care to prevent or delay life- threatening
illness. Your test result (positive or negative) would also help your
doctor determine the cause and best treatment of the various
illnesses you may have now or in the future. For example, if you are
HIV-positive, tuberculosis (TB) and syphilis are treated differently
than if you are HIV- negative.

If you find out you are infected, knowing your result would help
you protect your sex partner(s) from infection and illness. If they are
not infected, you can avoid infecting them.

Knowing your result would help you assess the safety of having a
child.

Knowing your result, even if you are infected (positive test result)
may be less stressful for some people than the anxiety of thinking
you might be infected but not knowing. If your result indicates you
are not infected (negative), you can take action to be sure you don't
become infected in the future.

UNDERSTANDING THE HIV COUNSELING AND TESTING PROCESS


It is very important that you understand the confidentiality policies of
the testing center. Ask your testing counselor how they will protect your

test results. Most counseling and testing centers follow one of two
policies:

Confidential testing The confidential testing site records your


name with the test result. They will keep your record secret from
everybody except medical personnel, or in some states, the state
health department. You should ask who will know the result and how
it will be stored. If you have your HIV antibody test done
confidentially you can sign a release form to have your test result
sent to your doctor.

Anonymous testing (not available in all states) No one asks


your name. You are the only one who can tell anyone else your
result.

DECIDING WHERE TO GO FOR COUNSELING AND TESTING


Depending on the area where you live, there are different counseling and
testing places from which to choose. These options include publicly
funded HIV testing centers, community health clinics, sexually
transmitted disease (STD) clinics, family planning clinics, hospital clinics,
drug treatment facilities, TB clinics, and your doctor's office. In making
your choice, you may want to consider these factors:

If you have been to a particular place for health care before for
other reasons, you may feel more comfortable with the staff that will
counsel and offer testing.

If the center can provide immune system monitoring and medical


care if you are infected with HIV, it might speed up the beginning of
your medical treatment.

Some counseling and testing centers offer special features. For


instance, if you use drugs, you can receive counseling, testing and
help for addiction at a drug treatment facility.

THE PROCESS OF COUNSELING AND TESTING

Counseling
You should be given materials to read before you enter a group or
private session with a counselor or doctor. He or she might ask why you
want to be tested. Your counselor should also ask about your behaviour
and that of your sex partner(s). This will help your counselor and you to
determine whether testing is appropriate for you. If testing is
appropriate, your counselor or doctor should:

Describe the test and how is done


Explain AIDS and the ways HIV infection is spread
Discuss ways to prevent the spread of HIV
Explain the confidentiality of the test results
Discuss the meaning of possible test results
Ask what impact you think the test result will have on you
Address the question of whom you might tell about your result
Discuss the importance of telling your sex and/or drug-using
partner(s) if the result indicates HIV infection

If these questions are not covered, or if you have any other questions,
ask them. You should come prepared with questions that have been on
your mind. Also ask your doctor or counselor how you will be told of the
test result. If your test result is negative, the post-test counselor will talk
to you about how to avoid behaviours that will put you at risk.

Informed Consent
You have the right to refuse any medical procedure, to be fully informed
about it, and to agree to it. You should be asked to read a statement
saying that you have been informed about the HIV-antibody testing
procedure, you understand it, and you consent to have it done.

Counseling after the Test

Your counselor should tell you your result and, regardless of whether it is
positive or negative, how to protect your health and the health of others.
He or she will review methods to prevent the spread of HIV.
If your result is negative, your counselor may discuss retesting if, during
the 6 months before your test, you engaged in any behaviours that
might have infected you. You may be infected but your body may not yet
have produced enough antibodies for the test to detect. Since it takes
time for your body to develop antibodies, you may need to be retested.
If your test is positive, your counselor will tell you what this means for
you. Any questions you have should be answered and your counselor will
refer you for follow-up health care, support services, or further
counseling. Your counselor will also talk to you about telling your sex
and/or drug-using partner(s).

PREVENTION COUNSELING
Prevention counseling should be offered and encouraged in all healthcare facilities that serve patients at high risk (e.g., STD clinics), because
these facilities routinely elicit information about the behaviours that
place persons at high risk for HIV. Prevention counseling need not be
explicitly linked to HIV testing. However, some patients might be more
likely to think about HIV and consider their risk-related behaviour when
undergoing an HIV test. HIV testing presents an excellent opportunity to
provide or arrange for prevention counseling to assist with behaviour
changes that can reduce risk for acquiring HIV infection.

How to Counsel HIV Positive Patients


Human immunodeficiency virus (HIV) is a virus that causes the immune
system to begin to fail. This eventually leads to death from viruses as
simple as the common cold. According to sxmaidsfoundation.org, from
1981 to 2006, 25 million people have died from this sexually transmitted
disease. When a person contracts this disease, they begin to feel a lot of
emotions at once. They are scared and angry, confused and hurt. It is
recommended that HIV positive patients receive some type of
counseling.

Instructions
1. Educate yourself about the HIV and AIDS virus. It is important that
you are informed about various treatment options that you can
discuss with your patient. Take the time to think about what your
patient will be feeling before you talk to them. There are many
emotions that revolve around a positive HIV result.

2. Educate your patient about the virus. Discuss various drug-andtreatment options with your patient. Encourage them to take
charge of their health and stay up-to-date about the various
available treatments. Make sure they know that being diagnosed
with HIV is not an immediate death sentence. Many people live
completely normal lives for more than 10 years after being
diagnosed.

3. Recommend a support group. It is helpful for people with HIV to be


able to talk to others in the same situation. These support groups
will help your patients to deal with the many emotions that they are
feeling after being diagnosed. Also, support groups help with the
new aspects of life that your patient will have to deal with after
being diagnosed.

4. Be positive. There is a good chance that your patient has become


socially isolated. Many people diagnosed with HIV have been
rejected by friends and family. If this is the case, your patient will
feel disgusted with himself and lonely. Many people will feel
uncomfortable touching your patient. Make sure you tell them that
they are loved.

5. If your patient has not told their friends or family about having HIV,
help them come up with a way to tell them. The family needs to
know, the drug-using friends and the sexual partner(s) of your
patient need to know as well. Let your patients ask questions and
take the time to answer them.

Tips & Warnings

Listen to what your patient has to say.


Each patient is going to react differently to being informed that
they have HIV. Different counseling methods might be necessary
depending on the patient.

MANAGEMENT
There is currently no cure or effective HIV vaccine. Treatment consists of
high active antiretroviral therapy (HAART) which slows progression of the
disease and as of 2010 more than 6.6 million people were taking them in
low and middle income countries. Treatment also includes preventative
and active treatment of opportunistic infections.

PREVENTION
Individuals can reduce the risk of HIV infection by limiting exposure to
risk factors. Key approaches for HIV prevention, which are often used in
combination, include:
1. Male and female condom use
Correct and consistent use of male and female condoms during vaginal
or anal penetration can protect against the spread of sexually
transmitted infections, including HIV. Evidence shows that male latex
condoms have an 85% or greater protective effect against the sexual
transmission of HIV and other sexually transmitted infections (STIs).
2. Testing and counseling for HIV and STIs
Testing for HIV and other STIs is strongly advised for all people exposed
to any of the risk factors so that they can learn of their own infection
status and access necessary prevention and treatment services without
delay. WHO also recommends offering testing for partners or couples.
3. Voluntary medical male circumcision
Medical male circumcision, when safely provided by well-trained health
professionals, reduces the risk of heterosexually acquired HIV infection in
men by approximately 60%. This is a key intervention in generalized
epidemic settings with high HIV prevalence and low male circumcision
rates.

4. Harm reduction for injecting drug users


People who inject drugs can take precautions against becoming infected
with HIV by using sterile injecting equipment, including needles and
syringes, for each injection. A comprehensive package of interventions
for HIV prevention and treatment includes:
Needle and syringe programmes;
Opioid substitution therapy for people dependent on opioids and
other evidence based drug dependence treatment
HIV testing and counseling
HIV treatment and care
Access to condoms
Management of tuberculosis and viral hepatitis.
6. Elimination of mother-to-child transmission of HIV
The transmission of HIV from an HIV-positive mother to her child during
pregnancy, labour, delivery or breastfeeding is called vertical or motherto-child transmission (MTCT). In the absence of any interventions HIV
transmission rates are between 15-45%. MTCT can be nearly fully
prevented if both the mother and the child are provided with
antiretroviral drugs throughout the stages when infection could occur.

Treatment for HIV and AIDS


There are many regular procedures HIV patients need to undergo as part
of their ongoing treatment. Everyone diagnosed with HIV will be offered
counseling, and this can prove invaluable in coping and explaining the
illness to others.
There is treatment available for HIV which will slow down the progression
of the virus, allowing people to lead a normal live. This treatment is
called highly active antiretroviral therapy (HAART), and is a combination
of medicines administered in two or three pills to be taken once or twice
daily. The medication involves commitment the individual will have to
take these drugs every day for the rest of their life, as well as making
sure they stay healthy, eat well, exercise regularly and try and avoid
being exposed to illnesses where possible. They will also need to have
regular blood tests to monitor the HIV.
In the later stages of AIDS, a person will need palliative care and
emotional support as they prepare for death. Counseling can provide
support to both those diagnosed with the disease, and their friends and
family.

Every person who is HIV positive must work with his doctor to determine
a treatment plan that is tailored specifically to him. HIV carriers may
require a mixture of the three medications listed above and each case is
unique in determining treatment, particularly when side effects and
other risks are taken into consideration. Alternative therapies, such as
chiropractics, are also available in treating those with HIV. In addition to
medication and alternative therapy treatment, a person with HIV should
try to maintain a healthy lifestyle through diet and exercise.

See an HIV specialist as soon as possible after your diagnosis. An


HIV specialist is a physician, usually an internist, who has extensive
experience in HIV and AIDS care. You can get a referral from the
clinic where you received your diagnosis. According to Stovell, it is
crucial to find the right HIV specialist for you as you will be working
closely with this person throughout your treatment. He also
suggests finding a specialist who works for a clinic that can also
provide case management professionals, health experts and/or
psychologists who can work one on one with you to deal with the
emotional, psychological, health and lifestyle changes that come
with an HIV diagnosis.

Be honest with your doctor about any other medical conditions you
have or have had, no matter how minor they may seem, as this can
affect your treatment, says Stovell. These conditions include
everything from cancer, diabetes and high cholesterol to mental
health disorders and substance abuse.

Visit your doctor for blood tests to determine your viral load and
CD-4 counts (also known as T-cell counts). According to Smith,
these numbers will give you a clear picture of the state of your
health, including how much damage has been done to your organs
and immune system and the likelihood of transmitting the virus to a
partner. Your doctor will repeat these tests at regular intervals.

Make certain your doctor also runs tests to see if you are carrying a
strain of HIV that may be resistant to certain medications, which is
a very common occurrence, says Smith. "Twenty percent of HIVinfected people in California alone have a resistance to at least one
type of HIV medication, so it's extremely important to weed out
ineffective medications at the get-go," he says.

Research your financial options as soon as you have a clear picture


of the state of your health. If you have health insurance, it is a good
idea to learn what your insurance provider will cover before
committing to a treatment regimen. "Unfortunately, HIV
medications can be very expensive and not all prescriptions are
covered by all providers," says Stovell. If you do not have insurance
or any other means of funding your HIV care, talk to your doctor or
case manager about government programs that can help you.
Stovell adds that nobody who has HIV in the U.S. has to go without
treatment due to inability to pay.

Make a decision about your method of treatment. At this stage, you


will not only choose what medications to start taking but you'll also
decide if now is even the time to start taking them at all. "You and
your doctor will look at the health of your immune system and, if
your CD-4 and viral counts are still relatively good, you may decide
to wait to take medication in order to avoid the various side effects
caused by the majority of treatments or to avoid the development
of therapy resistance, which is when the same drug, taken over a
period of time, becomes less effective at combating the virus in
your body," says Smith. "Or you may decide to be proactive and get
started right away. It all depends on what you decide." Once you
decide to start treatment, whether immediately or when there is a
change in your counts, your doctor will help you build a medication
regimen.

Monitor your side effects. According to Smith, while most HIV


medications have side effects, some are worse than others in
certain individuals and you should work with your doctor to choose

medications that work best for you. "Never stop a medication


because you dislike the side effects without first talking to your
doctor," he warns. "Stopping a medication is the best way to
develop medication resistance."

Learn constantly about HIV and AIDS and what you can do to stay
healthy. Stovell agrees, "knowledge is power and new research on
the disease comes out all the time. The more you are on top of
these developments, the more you can take advantage of beneficial
new treatments and breakthroughs."

Cognitive-behavioural group treatment


Cognitive-behavioural group treatment is widely applied to patients of
various mental and medical problems. It has been reported 10 that
cognitive-behavioural group could be effective in improving the quality
of life and mood in HIV-infected patients in Hong Kong. Typically, these
interventions involve groups of 6-8 participants which are led by one or
two psychotherapist. These groups usually meet weekly for 2-3 months.
Most cognitive behavioural groups involve cognitive restructuring of
maladaptive thoughts, provision of knowledge on stress responses,
relaxation exercises, health behaviour change, and discussion on
constructive coping skills. The aims are to reduce distress of participants
and to promote their efficacy in dealing with stress related to HIV illness.

Counseling on drug adherence


There are various forms of intervention on HIV medication based on
different models and theories of health behaviours. One of the important
principles in drug adherence counseling is that patients should be
involved in treatment decision process. They need information and
explanation on the pros and cons of the medications prescribed to them.
HAART should not be prescribed without the commitment from patients.
Besides, strategies for enhancing drug adherence should be discussed
before commencement of treatment. Such strategies include setting
alarm via mobile phone or watch to ensure accurate drug taking time,
proper drug storage, and forming habit of stock taking of drugs.

Integration of medication schedule into life routine is the key to success


in treatment adherence.

Secondary prevention - counseling on safer sex


The development of rapport and regular contacts with HIV patients are
the pre-requisites for effective safer sex promotion in HIV patients.
Health care workers need to prepare themselves to discuss the topic of
sex and master the skills in addressing sexual need of patients. The
dimensions of safer sex education in clinical settings include: (a) risk
behaviour assessment, STDs screening and counseling at individual
level, (b) education on proper use of condom and (c) counseling on the
importance of safer sex practice. Spouses/partners shall be invited to
join the session to understand the couples' difficulties and barriers in
sexual relationships and offer counseling accordingly.