Now that You are HIV Positive, What Next?
It's hard to imagine what could chill one's soul more than finding out you are HIV positive. So frightening is the prospect that many people do not get tested just to avoid the possibility of being given the bad news. Although very frightening, finding out you are HIV positive is not a death sentence. It also doesn't mean you have AIDS. HIV is the virus that can cause AIDS defining illnesses. One can be HIV positive without having AIDS. Although there is no cure for HIV, there are several medicines that can keep the virus in check, and allow the HIV positive person to lead a long, healthy, productive life. This being said, the fact remains that finding out you have been infected can be scary, confusing, and depressing. So what can we do to get through this rough time and go on with our lives.
Adjusting to the change will be challenging and won't come over night. It won't be easy, but by seeking out the right support system, the process can be made easier. Once you find out you are positive, take a moment and decide who you feel will be supportive and who won't. You don't need to go through the process alone. Parents, spouses, partners, or families may be good sources of support. Councelors or social workers can also be very helpful in this adjustment time. Don't feel you need to tell everyone about your HIV right away. Only do so when you feel the time is right.
Knowledge is Power - Learn All You Can About HIV
The next step in managing this diagnosis, is getting to know the disease. Learn as much as you can about HIV. It is said that knowledge is power. HIV is the perfect example of how knowing your illness, and knowing your body can help manage the disease process.
Choose a Doctor that's Right for You
Another important step in dealing with your HIV is choosing a doctor to manage your care. While some decide to continue their care with their family physician, experts universally agree that in order to get the best HIV care, you should emply the services of an HIV specialist. HIV is a rapidly changing medical field that requires a doctor to be aware of the latest medical facts. Family physicians are just not able to keep up with the rapidly changing field and do not see a large enough number of HIV patients to remain current. In order to get the best HIV care, see an HIV specialist.
Some people choose to use both an HIV specialist and their family doctor. They continue with their family physician for routine matters, such as colds, routine illnesses, and regular yearly physicals. The specialist is left to regulate the HIV medications and to monitor the health of the immune system. If this method is your choice, make sure both physicians communicate with one another. This is imperative to assure continuity in your health care plan.
Staying Healthy
One last important step in dealing with your disease is keeping yourself as healthy as possible. While your physicians can help, it is up to you to optimize your health in order to feel good and to live a productive life. It is important to eat healthy, exercise regularly, and to see your doctor and dentist regularly. If one can avoid smoking, drinking too much alcohol , and using recreational drugs, HIV can be managed more effectively. And always practice safe sex to avoid infecting others and acquiring sexually transmitted diseases that complicate your medical care.
Friday, January 18, 2008
The History of HIV
An HIV Timeline
In July 1981, the New York Times reported an outbreak of a rare form of cancer among gay men in New York and California, first referred to as the "gay cancer"; but medically know as Kaposi Sarcoma. About the same time, Emergency Rooms in New York City began to see a rash of seemingly healthy young men presenting with fevers, flu like symptoms, and a pneumonia called Pneumocystis. About a year later, the CDC (Centers for Disease Control) link the illness to blood and coins the term AIDS (Acquired Immune Deficiency Syndrome). In that first year over 1600 cases are diagnosed with close to 700 deaths.
As the number of deaths soared, medical experts scrambled to find a cause and more importantly a cure.
In 1984, Institut Pasteur of France discovered what they called the HIV virus, but it wasn't until a year later a US scientist, Dr. Robert Gallo confirmed that HIV was the cause of AIDS.
Following this discovery, the first test for HIV was approved in 1985. Over the next several years medications to combat the virus were developed as well as medicines to prevent infections that flourish when the immune system is damaged by HIV and AIDS. By the end of 1987, there were 71,000 confirmed cases of AIDS, resulting in over 40,000 deaths.
So where are we today? Thanks to an ever-changing array of new anti-retroviral drugs and improved funding for early medical care, AIDS related deaths in the US are declining. People are healthier and living longer. Some estimate that 40 percent of persons in the sub-Sahara region of Africa are HIV infected. Many of these people don't realize they are infected, resulting in the infection of others, adding to the spread of the disease. Another grim reminder of the epidemic is the number of African children orphaned by AIDS. Streets are clogged with children who have lost their parents to AIDS, have no food, and no place to go. And with no money available for expensive HIV drugs, the epidemic is expected to get much worse, with estimates of 20,000,000 infected over the next 5 years.
Could anyone have foreseen that the mysterious illness affecting a few gay men in 1981, would become the epidemic of the 20th. century? We have made much progress, but still so much needs to be learned. Until then the epidemic continues.
In July 1981, the New York Times reported an outbreak of a rare form of cancer among gay men in New York and California, first referred to as the "gay cancer"; but medically know as Kaposi Sarcoma. About the same time, Emergency Rooms in New York City began to see a rash of seemingly healthy young men presenting with fevers, flu like symptoms, and a pneumonia called Pneumocystis. About a year later, the CDC (Centers for Disease Control) link the illness to blood and coins the term AIDS (Acquired Immune Deficiency Syndrome). In that first year over 1600 cases are diagnosed with close to 700 deaths.
As the number of deaths soared, medical experts scrambled to find a cause and more importantly a cure.
In 1984, Institut Pasteur of France discovered what they called the HIV virus, but it wasn't until a year later a US scientist, Dr. Robert Gallo confirmed that HIV was the cause of AIDS.
Following this discovery, the first test for HIV was approved in 1985. Over the next several years medications to combat the virus were developed as well as medicines to prevent infections that flourish when the immune system is damaged by HIV and AIDS. By the end of 1987, there were 71,000 confirmed cases of AIDS, resulting in over 40,000 deaths.
So where are we today? Thanks to an ever-changing array of new anti-retroviral drugs and improved funding for early medical care, AIDS related deaths in the US are declining. People are healthier and living longer. Some estimate that 40 percent of persons in the sub-Sahara region of Africa are HIV infected. Many of these people don't realize they are infected, resulting in the infection of others, adding to the spread of the disease. Another grim reminder of the epidemic is the number of African children orphaned by AIDS. Streets are clogged with children who have lost their parents to AIDS, have no food, and no place to go. And with no money available for expensive HIV drugs, the epidemic is expected to get much worse, with estimates of 20,000,000 infected over the next 5 years.
Could anyone have foreseen that the mysterious illness affecting a few gay men in 1981, would become the epidemic of the 20th. century? We have made much progress, but still so much needs to be learned. Until then the epidemic continues.
What's Being Done About Needlesticks?
When one thinks of dangerous professions, being a policeman or fireman comes to mind immediately. Construction workers negotiating the narrows walkways of steel beams sends shivers up the spines of many. Or window washers dangling from their ropes several stories up make us all cringe. But few realize the danger associated with being a healthcare worker.
What is the major source of danger in the healthcare setting? Needlestick injuries. Nurses, sanitation workers and lab technicians are just a few of the people affected by this problem everyday. In fact the Centers for Disease Control estimate that approximately 600,000 needlestick injuries occur each year. And with each needlestick comes the risk of transmitting infections such as hepatitis B, hepatitis C, and HIV.
Sadly, approximately 1000 such infections occur each year from needlesticks.
Because of the widespread problem, syringe manufacturers have developed about fifty different products that when used, significantly decrease the risk of needlestick injuries. There are reports that about 80% of needlestick injuries could be eliminated if only the safer syringes and needle systems were used.
So if this is the case, why are needlestick injuries still a problem? Unfortunately, many institutions across the country opt not to utilize the safer products due to their increased cost. Some experts estimate that only about 15% of hospitals use the safer products.
The Government is now stepping in to to help persuade hospitals to utilize safer equipment. In fact, several states now having pending legislation requiring institutions to use the safer products when available.
As HIV continues its attack, and hepatitis C emerges as the new epidemic, eliminating transmission sources becomes more important. The use of safer syringe and needle systems has been proven to be an excellent way to do just that. Lets hope that hospitals across the country begin to realize that the safety of their staff should always be more important than their bottom line.
What is the major source of danger in the healthcare setting? Needlestick injuries. Nurses, sanitation workers and lab technicians are just a few of the people affected by this problem everyday. In fact the Centers for Disease Control estimate that approximately 600,000 needlestick injuries occur each year. And with each needlestick comes the risk of transmitting infections such as hepatitis B, hepatitis C, and HIV.
Sadly, approximately 1000 such infections occur each year from needlesticks.
Because of the widespread problem, syringe manufacturers have developed about fifty different products that when used, significantly decrease the risk of needlestick injuries. There are reports that about 80% of needlestick injuries could be eliminated if only the safer syringes and needle systems were used.
So if this is the case, why are needlestick injuries still a problem? Unfortunately, many institutions across the country opt not to utilize the safer products due to their increased cost. Some experts estimate that only about 15% of hospitals use the safer products.
The Government is now stepping in to to help persuade hospitals to utilize safer equipment. In fact, several states now having pending legislation requiring institutions to use the safer products when available.
As HIV continues its attack, and hepatitis C emerges as the new epidemic, eliminating transmission sources becomes more important. The use of safer syringe and needle systems has been proven to be an excellent way to do just that. Lets hope that hospitals across the country begin to realize that the safety of their staff should always be more important than their bottom line.
HIV Complacency
The advent of protease inhibitors and other anti-retroviral (ARVs) medications has certainly been great news for those people infected and living with HIV. People are now living longer and AIDS diagnoses and deaths are down. But with every bit of good news there seems to be some bad news as well.
Due to prevention efforts, the number of new HIV infections is down from a peak of about 100,000 / year to a current figure of about 40,000 / year. While this is a significant decline, why are there still so many infections occurring each year? In fact, while new infections have gone down, HIV and AIDS among Africans is at a record pace.
These facts have health officials concerned about a growing complacency about HIV, especially among groups most at risk.
Research among gay and bisexual men suggest there is a growing lack of concern about becoming infected, and in turn more risks are being taken. This may be true in other high risk groups as well who believe that safer sex is not as important since the advent of HIV medicines. Myths abound among some high risk groups regarding the need for continued prevention efforts. Lets take a look at some.
"We have defeated HIV with ARVs."
While it is true, AIDS cases are declining, the number of people living with HIV is on the rise. In addition, new HIV infections have remained stable and in some parts of the world are on the increase. In Africa rates are approaching record rates. All these things point to the continued need for prevention efforts.
"Prevention efforts have not worked."
Past prevention efforts have been effective in changing behaviors that in turn have slowed the epidemic overall. However, some high-risk behaviors such as unprotected sex continue at far too high a rate among those not infected as well as those infected.
"If I become infected, I can just take the pills and I will be fine"
While HAART therapy has been proven to decrease progression to AIDS and results in living longer, the long-term effects of the drugs are just now beginning to become evident. While vast improvements have been made, the pills still can be difficult to take and even more difficult to tolerate. Side effects such as diarrhea, nausea and fatigue among others make therapy less than a walk in the park. Even the slightest diversion from prescribed regimens can result in resistant virus, which makes treatment even more difficult. And resistance is not limited to those who have problems staying on schedule. Even patients who take their medicines exactly as prescribed can develop resistant virus. Like any other illness, the fact is that treatments are not perfect and may not be effective in some people. The best solution is not to get infected at all.
"We can track the epidemic and monitor how bad it really is."
In the past, AIDS rates have been a reliable indicator of HIV infection trends. That is no longer true. With the decline in progression to AIDS diagnosis, we are now finding it difficult to monitor where and how new infections are occurring, making prevention and treatment issues even more difficult. Some believe we have never been so close to losing our ability to monitor the epidemic.
So while funding for treatment is on the rise, prevention dollars are slowing fading away. One can't forget the importance of prevention in beating this disease. Without continued prevention efforts, the fight is only going to get tougher.
Due to prevention efforts, the number of new HIV infections is down from a peak of about 100,000 / year to a current figure of about 40,000 / year. While this is a significant decline, why are there still so many infections occurring each year? In fact, while new infections have gone down, HIV and AIDS among Africans is at a record pace.
These facts have health officials concerned about a growing complacency about HIV, especially among groups most at risk.
Research among gay and bisexual men suggest there is a growing lack of concern about becoming infected, and in turn more risks are being taken. This may be true in other high risk groups as well who believe that safer sex is not as important since the advent of HIV medicines. Myths abound among some high risk groups regarding the need for continued prevention efforts. Lets take a look at some.
"We have defeated HIV with ARVs."
While it is true, AIDS cases are declining, the number of people living with HIV is on the rise. In addition, new HIV infections have remained stable and in some parts of the world are on the increase. In Africa rates are approaching record rates. All these things point to the continued need for prevention efforts.
"Prevention efforts have not worked."
Past prevention efforts have been effective in changing behaviors that in turn have slowed the epidemic overall. However, some high-risk behaviors such as unprotected sex continue at far too high a rate among those not infected as well as those infected.
"If I become infected, I can just take the pills and I will be fine"
While HAART therapy has been proven to decrease progression to AIDS and results in living longer, the long-term effects of the drugs are just now beginning to become evident. While vast improvements have been made, the pills still can be difficult to take and even more difficult to tolerate. Side effects such as diarrhea, nausea and fatigue among others make therapy less than a walk in the park. Even the slightest diversion from prescribed regimens can result in resistant virus, which makes treatment even more difficult. And resistance is not limited to those who have problems staying on schedule. Even patients who take their medicines exactly as prescribed can develop resistant virus. Like any other illness, the fact is that treatments are not perfect and may not be effective in some people. The best solution is not to get infected at all.
"We can track the epidemic and monitor how bad it really is."
In the past, AIDS rates have been a reliable indicator of HIV infection trends. That is no longer true. With the decline in progression to AIDS diagnosis, we are now finding it difficult to monitor where and how new infections are occurring, making prevention and treatment issues even more difficult. Some believe we have never been so close to losing our ability to monitor the epidemic.
So while funding for treatment is on the rise, prevention dollars are slowing fading away. One can't forget the importance of prevention in beating this disease. Without continued prevention efforts, the fight is only going to get tougher.
How Much Is Too Much?
As health care providers, its our job and second nature to assist our patients in every way possible. We call in prescriptions, we set-up appointments, and we check on them when they are sick. We will do anything that we feels helps them get better. But when does caring go too far? In other words how much is too much?
HIV is not only a physical illness but an emotional one as well. Regardless of how good or bad one feels physically, once diagnosed, their life has changed. Some are able to take such change in stride, carrying on with life, making adjustments as needed but doing what needs to be done to go on. But others find it very difficult to continue. The shock of learning they are HIV positive often leads to drugs, alcohol and depression. For obvious reasons, it's these patients that test our abilities.
We as caregivers are challenged to walk the fine line between giving appropriate care and assuming all responsibility for our patients health. At what point does our caring effect the patient's ability to care for themselves?
Studies show that patients who are invested in their own care do much better. If by doing too much, caregivers remove the need for that patient involvement their health will ultimately suffer. How can we expect patients to adhere to drug therapies on their own, when we have illustrated to them that we will do everything for them, from making appointments, to calling employers, to filling out forms. Instead, caregivers and patients should work together, each with their own set of responsibilities and expectations. This way, the patient stays invested in their own care. Obviously, how involved a patient is depends greatly on a patient's health, knowledge base, and available resources. Some patients are not well enough to care for themselves or to maintain their activities of daily living, leaving it up to the caregiver to meet those needs until the patients are able to meet them without assistance. For patients who are feeling well and are able, they should be encouraged to take control of their healthcare. And we as caregivers must be aware that sometimes a little goes a long way. Too much help can be a true disservice to our patients.
So what do we do?
First assess our patients needs and abilities.
Like the old saying goes..."too much of a good thing...."
HIV is not only a physical illness but an emotional one as well. Regardless of how good or bad one feels physically, once diagnosed, their life has changed. Some are able to take such change in stride, carrying on with life, making adjustments as needed but doing what needs to be done to go on. But others find it very difficult to continue. The shock of learning they are HIV positive often leads to drugs, alcohol and depression. For obvious reasons, it's these patients that test our abilities.
We as caregivers are challenged to walk the fine line between giving appropriate care and assuming all responsibility for our patients health. At what point does our caring effect the patient's ability to care for themselves?
Studies show that patients who are invested in their own care do much better. If by doing too much, caregivers remove the need for that patient involvement their health will ultimately suffer. How can we expect patients to adhere to drug therapies on their own, when we have illustrated to them that we will do everything for them, from making appointments, to calling employers, to filling out forms. Instead, caregivers and patients should work together, each with their own set of responsibilities and expectations. This way, the patient stays invested in their own care. Obviously, how involved a patient is depends greatly on a patient's health, knowledge base, and available resources. Some patients are not well enough to care for themselves or to maintain their activities of daily living, leaving it up to the caregiver to meet those needs until the patients are able to meet them without assistance. For patients who are feeling well and are able, they should be encouraged to take control of their healthcare. And we as caregivers must be aware that sometimes a little goes a long way. Too much help can be a true disservice to our patients.
So what do we do?
First assess our patients needs and abilities.
- Structure our care plans to maximize the patient's abilities and optimize their health.
- Involve patients in care planning.
- Allow patients do what they are able, keeping them invested in their own care and health.
- Promote patient education by providing HIV educational material to patients and loved ones as well as taking time during their visits to answer their questions.
Like the old saying goes..."too much of a good thing...."
Monday, December 10, 2007
Walk in my shoes...living with HIV
Walk in my shoes...living with HIV
I have worked in HIV for many years. I have seen hundreds of people infected with HIV, many of them suffering from AIDS. My role in the HIV community is to provide medical care, to educate patients and families, and to offer support. But what I have found out quite unexpectedly, is that my patients have become my teachers in many ways. Their daily struggle goes unnoticed by most but deserves to be told. Walk in their shoes now if only for a moment.
Getting the news
The words echo in my head like a gunshot in the night. Panic begins to swell inside, my heart races and my chest pounds in fear. The sky, so blue and bright just a short time ago, now looks dull and gray. The people around me continue about their daily lives. Don't they what has happened? I have just been told I am HIV positive, and realize my life will never be the same.
It's been a week now, and I can't stop thinking about it. It's the first thing I think about each morning and the thing that keeps me up all night. What I dread the most, is the fact that this feeling of fear and isolation may never go away. I feel that I will never be able to escape the realization that I am sick and too frightened to tell anyone.
How do I tell? Who do I tell?
I have never felt so alone. I have to tell someone what has happened but who should I tell. Nobody will understand. I fear telling my family most of all. They will never forgive me. They won't understand. I'm afraid to tell anyone because of what they may think, what they may do. But I feel so alone. I'm not going to tell a soul. People seem to look at me differently now. Maybe they already know what has happened. I have to tell someone. My family will have to understand...or will they? What's worse, I may have infected the one I love most, but how do I break the news. Our relationship will never be the same...how could it. If I passed this on to someone else, I will never forgive myself. I have to tell...but if I do I may lose the one I love so much. I don't know what to do. I'm so tired.
I'm so tired
It's ten o'clock in the morning, I have to get out of this bed. Another work day missed. How do I explain my absence to the boss? I can't tell him the truth. I'm exhausted. Seems like I can never get enough sleep. The bed is soaked again. The night sweats make it so hard to rest. I have my first doctor's appointment in the morning. I am afraid of what I may hear. Am I going to die? Will I have to take a bunch of pills? How am I ever going to pay for all of this. I am so tired.
So much to learn
I am still so tired. My doctor seems very nice but I didn't understand most of what was said. There's just too much information to remember. CD4, T-cells, viral loads...what does it all mean? The nurse is going to come in and tell me about the medicines I am going to take. I've heard some real horror stories about HIV meds. Do I really need them so soon? Other than being tired, I really don't feel that bad. But, I agreed to give it a try. I hope I made the right decision. Take with food...take on an empty stomach...three pills twice a day...or is it two pills three times a day. How am I ever going to remember all this? And so many side effects to worry about. I wonder if I will have any problems? I hope I made the right decision.
There is no way I can take these meds with food. I feel like I am going to throw-up. I always feel like I'm going to throw-up. The pills are helping...my counts are better. So why do I feel so bad? I felt better when I wasn't taking anything. My pills cause diarrhea. So I will take these other pills to stop the diarrhea. That makes an even dozen now. Damn! I forgot another dose. Well that's OK. It's only one dose. What can it hurt? Plus I feel pretty good today. I don't want to throw-up again. I saw my doctor today. My counts are better. The drugs seem to be working. But my insurance doesn't want to cover the cost. How am I going to pay for them. I missed another day of work today. Just too tired to get out of bed.
A Course in the Biology of HIV
A Course in the Biology of HIV
Two decades ago, an AIDS diagnosis usually meant death would soon follow. But today, thanks to the development of HIV medications, people are no longer dying from AIDS they are living with HIV. To live a productive, healthy life with HIV, one must learn as much as possible about the disease; they must at least understand HIV basics or as some call it HIV 101. Knowledge is power, and never has that been more true than when dealing with HIV. Here are some common questions about the biology of HIV with easy to understand answers.
What is HIV?
In 1985, scientists discovered the HIV virus and concluded that it was the cause of AIDS. Human Immunodeficiency Virus (HIV) is a virus that is transmitted from person to person through the exchange of body fluids such as blood, semen, vaginal secretions or breast milk.
The most common way exposure to bodily fluids occur is through sexual contact but HIV can also be transmitted by exposure to infected blood through transfusions, sharing needles to inject drugs, or from mother to child during pregnancy, childbirth, or while breast feeding.
Is HIV and AIDS the same?
HIV and AIDS are not the same. HIV damages the the immune system making a person at risk for infections and illnesses considered AIDS defining. People who have HIV and contract one of the AIDS defining illnesses is said to have AIDS. A person can be infected for years without having AIDS. Having HIV infection does not mean you have AIDS.
How does HIV multiply?
Once inside the body the virus attacks specialized cells of the immune system called T-cells. The virus attaches to these T-cells and begins infecting them by injecting HIV proteins (DNA and RNA) in order to reproduce. New HIV virus then infects other T-cells as the cycle repeats itself.
How does HIV harm the body?
As HIV reproduces, the T-cells are damaged and become unable to perform their role as protectors as part of the immune system. As this process continues, the body's immune system weakens and the HIV infected person becomes ever more susceptible to a score of different infections, all capable of making the person sick and in extreme cases can lead to death. These opportunistic infections take advantage of a weakened immune system, thus the name opportunistic.
Can the Virus Be Stopped?
While there is no cure for HIV, medications are available that interferes with virus replication, which in turn helps preserve the health and function of the immune system. A healthy immune system is able to fight off those opportunistic infections and AIDS defining illnesses.
Important Warning!
HIV medications can't rid the body entirely of HIV. People can still infect others even when they are taking HIV medications so safer sex precautions in the form of condoms are a must with each anal, vaginal, or oral sexual contact.
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