THE GLOBAL IMPACT OF HIV AND AIDS

Tomorrow (Friday, December 1, 2006) is designated as the 18th annual World AIDS Day. The goals of this international effort are to increase awareness about HIV and AIDS, encourage support and understanding for people living with HIV and AIDS, and reinforce the need for continued education about the disease and the development of new and more effective prevention initiatives that can be used in the developed as well as the developing areas of the world.

My postings on this blog have centered mostly around the issues and treatment of HIV infected persons living in the United States, or other medically advanced societies. This is not to ignore the worldwide pandemic. I am very much aware of the devastation that this disease is causing worldwide, and of the seemingly insurmountable obstacles to education, prevention, diagnosis, and adequate treatment that exist in other parts of the world. I want to share some facts about the global impact of HIV and AIDS.

HIV and AIDS has been reported in all regions of the world, but most of the people infected with the virus are living in lower income (developing) countries. The pandemic is growing at alarming rates; It is estimated that AIDS has already claimed over 25 million lives, and that close to 40 million people worldwide are currently living with HIV and AIDS, although these numbers are not precise because many areas of the world lack the sophistication to develop accurate surveillance and reporting systems.

In the United States, HIV and AIDS prevalence continues to be high among certain sub-populations, such as African American and Hispanic women. However, certain regions of the world have been particularly hard hit by the pandemic; the most affected regions of the world are: Sub-Saharan Africa, Latin America and the Caribbean, Eastern Europe, and Asia. Heterosexual transmission is the most common method if infection in these areas.

The United Nations and many international donors, as well as the governments of affected nations have made great efforts at fund raising to develop prevention and treatment initiatives that will be effective in these hard hit areas, but much work remains to be done. I also want to mention that, as a consultant and advisor for several major pharmaceutical companies who do research, development, and marketing of drugs used to treat HIV and AIDS, I know that the pharmaceutical companies themselves have become very much involved in manufacturing their drugs and distributing them at cost (with no profit to the company) in many of these regions.

HIV and AIDS is clearly not going away anytime soon. In a sense, we are all living with HIV. We need to promote education and understanding in our communities that these issues affect everyone. World AIDS Day is a start; don't forget to wear a red ribbon to show your support.

DO SMOKERS HAVE THE RIGHT TO SMOKE?

Some businesses provide an area where their employees can smoke. This businessman got very creative when painting the ceiling in his company's smoking room. How could anyone "enjoy" a smoke while looking up at a simulation of their own funeral? What better incentive could there be to quit!

Read my previous post on "Smoking and HIV". It contains some very compelling reasons why you should continue to make serious attempts to quit until you are successful, as well as some great links to help you out.

ROUTINE HIV SCREENING RECOMMENDATIONS

Based on the lack of progress in preventing the transmission of HIV infection and the fact that early recognition and treatment of HIV disease keeps people healthy longer, slows the progression to AIDS, and may prevent the unknown transmission of the virus to others, the Centers for Disease Control (CDC) issued revised guidelines for routine screening for HIV infection in September, 2006. The new guidelines state that all patients ages 13-64 who present in any health care setting should have a baseline HIV test done as a part of normal preventive medical care. Testing should be voluntary; patients should be informed about HIV testing and given the choice to opt-out of it.

Repeat screening for persons determined not to be at high risk should be done based on clinical judgment, making it essential that healthcare providers incorporate a thorough assessment of lifestyle and sexual practices into annual healthcare for all patients in order to identify risk factors. Healthcare providers should encourage patients and any new prospective sexual partners to have HIV testing done prior to initiating a sexual relationship.

Persons considered to be at high risk should be screened at least annually; these people include injection drug users and their sexual partners, sexual partners of someone who is known to be HIV positive, persons who exchange sex for drugs or money, any male who has had sex with another male, anyone treated for a sexually transmitted disease, and anyone who has had unprotected sex or sex with more than one person since their last test.

Pregnant women should be tested during their first prenatal visit and then re-tested during the third trimester of pregnancy. This testing is voluntary, but if the woman refuses testing and her HIV status is unknown at the time of labor, the newborn should be screened immediately after birth; in the United States, screening of the newborn can be done without parental consent.

It goes without saying, of course, that prevention counselling and discussion of safe sexual practices should also be a part of the routine care of all patients, regardless of whether or not they admit to being sexually active. The hope is that this more aggressive approach to prevention of new HIV infections and early diagnosis will positively impact the transmission of HIV, thus decreasing the number of new infections.

REMEMBERING TO TAKE HIV MEDICATIONS

It is well known and understood by everyone who treats HIV and by those who are taking medications for HIV that excellent adherence to the medication regimen is required in order for the medications to work and to prevent the virus from becoming resistant to the medications that are prescribed, as well as to other medications that may be needed in the future. The development of drug resistance is a very complicated issue. The bottom line is that many well-executed clinical trials have proven that these medications must be taken exactly as prescribed, following instructions for taking them with or without food, at the proper times and intervals. Adherence to these medications needs to be at least 95%, which doesn't leave much room for error, complacency, or "forgetting".

HIV treaters and the adherence counselors and nurses working with them spend many hours educating patients and assessing their adherence to medications. This issue is addressed intensively when a patient starts medications, and on all followup office visits. Most AIDS Service Organizations and HIV providers have a formal Adherence Program, which evaluates a patient's knowledge of HIV and his or her readiness to start medications and helps to identify any potential barriers to their success in being able to take the medications consistently. Drug and alcohol abuse and mental illness issues need to be addressed at this point, although in many cases patients with these issues are able to take the medications as prescribed. Close one-on-one counseling and support is provided, and the patient is empowered to incorporate the medication regimen into his or her daily life by examining daily routines and ways to be reminded to take the medication as well as how to prepare for unforeseen circumstances (such as working an extra shift at work). Education itself is the best tool for adherence; if patients know why medications are prescribed, believes that they will benefit from them and be healthier, and understands the implications of not taking them consistently, they will be more likely to be adherent. In addition to education, other tools to assist with adherence are the involvement of family or friends to provide reminders, charts with medication times to post in conspicuous areas of the home, organization of pills into weekly pillboxes, keeping an extra dose of medications at work, in the car, or in a purse, and electronic medication reminders.

So, what do we do when all of this fails, and a patient keeps "forgetting" to take their medications? It's back to square-one. The first thing is to re-assess the person's understanding of the importance of taking the medications as prescribed and the implications of missing doses. Next, reassess what is going on in his or her life; unusual or new stress, the breakup of a relationship, recent relapse or increase in drug or alcohol use, and transportation problems to get to the pharmacy are just a few of the many things that could result in someone becoming careless with their regimen. It might be that the patient needs to be referred for substance abuse or short-term mental health counseling.

If the patient convinces us that he or she is committed to taking the medications, but just keeps "forgetting" them, it may be helpful to get the patient to identify a reliable friend or family member who will be willing to commit to making a reminder phone call for each dose. The problem with this is that people get busy in their own lives and may forget to make the phone calls. Still, the idea of phone calls is a great one; most of us won't go anywhere without a cell phone anymore, so it makes sense that phone reminders would work. I did an Internet search for "telephone reminder calls" and "telephone wake-up calls" on Google, and came up with many services that could be utilized for this purpose. There are many different options and rates; the best I found was a place called "MyCalls". Pricing is by the minute or by the month (both are very reasonable), depending on the plan selected. The patient can choose the exact time of the calls, and can change these times online or over the phone if needed. The patient can set the ring-tone on his or her phone specifically for these calls, so that they are not ignored.

I realize that most people don't want another bill to pay each month, especially if they are not working. But the price paid for non-adherence to these medications is much higher than what one of these plans would be. Realistically, if someone can afford a cell phone, there is most likely a way to fit a reminder call service into their budget. A referral for Case Management services or Financial Planning may be beneficial.

WORLD AIDS DAY - DECEMBER 1, 2006

Approximately 40 million people throughout the world are living with HIV and AIDS, and that number is increasing daily.
December 1 is recognized internationally as World AIDS Day. The aim of the campaign is to encourage people worldwide to unite in the fight against HIV and AIDS to stop the spread of this preventable disease and to end the ignorance and prejudice against those who are infected or affected.

There are campaigns worldwide to raise community awareness of the impact of HIV and AIDS on the population, the issues faced by those who are HIV positive, including their need for support and understanding, and the need for the development of more comprehensive worldwide prevention and education initiatives.

You can support World AIDS Day in many ways:
The Red Ribbon is an international symbol of AIDS awareness. Wear one on December 1 to show your support and to remind others of the need for their support and commitment. Get involved with local community events at AIDS treatment centers in your area. Help to educate people about HIV and AIDS and to raise awareness - get people talking and thinking! Promote education and understanding instead of stigma and discrimination. Encourage safe sex and HIV testing... Use your imagination!

AIDS is not over- in fact, the epidemic is going strong. It is up to all of us to make a difference and to work together towards an AIDS-free world.

FACTS ABOUT INFLUENZA (FLU) AND INFLUENZA VACCINE - Special Considerations for the HIV Positive Person

When encouraging patients to receive the flu vaccine every fall, I always find it amazing that so many people have misconceptions about the flu and the flu shot. If I were to ask a group of patients what the flu is, I would get many different answers, including descriptions of symptoms of a viral gastrointestinal syndrome (nausea, vomiting, diarrhea), a sinus infection, the common cold, or of true influenza (flu) infection.

Influenza (referred to as flu in this article) is a serious and extremely contagious viral respiratory illness. Complications of the flu can lead to hospitalization and death. According to the Centers for Disease Control (CDC): Every year in the United States, 5% - 20% of the population gets the flu, approximately 200,000 people are hospitalized from flu complications, and approximately 36,000 people die from the flu.

The symptoms of the flu include fever (usually >102F), headache, extreme fatigue, sore throat, dry cough, runny or stuffy nose, and muscle aches. Nausea, vomiting, and diarrhea are uncommon with the flu. Although some flu symptoms resemble those of the common cold, flu symptoms have a much more abrupt onset and are more severe than those of a cold. Possible complications of the flu include bacterial or viral pneumonia, sinus infections, ear infections, dehydration, and worsening of other medical conditions such as diabetes, asthma, or chronic lung disease. These complications can prolong the illness and may lead to hospitalization.

The flu virus spreads from person to person through coughing or sneezing. You may get infected by touching something (such as a doorknob or telephone) that has flu virus on it and then touching your mouth or nose. The best way to prevent the flu is to get a flu vaccination each year between October and December. The flu shot can be offered to all healthy people who want to decrease their risk of getting the flu. Certain people are at high risk for flu complications and should be strongly encouraged to receive the vaccine. These groups are: children (6 months-5 years old), pregnant women, people over age 50, people with chronic medical conditions such as diabetes, asthma, emphysema, HIV infection, AIDS, heart disease), and people living in long term care facilities such as nursing homes and prisons. In addition, all healthcare workers and household contacts of people in the high risk groups, as well as household contacts of infants less than 6 months of age, should be vaccinated to prevent the spread of the virus to those people.

Let's clear up another very common misconception: The flu shot does not give you the flu, and does not make you sick! I can't even count the number of times that patients have told me that they received the shot and got the flu. The vaccine consists of killed influenza virus (killed virus is not capable of causing illness), which causes the body to respond by developing antibodies to protect against the flu. It is this response that causes common side effects of the vaccine, such as a slight fever, chills, headache, and fatigue, for the first 24 hours after the vaccine is given. Remember, this is not the flu.

Some people should not be vaccinated; they include: people with a severe allergy to eggs, people who have had a severe reaction to the flu shot in the past, children less than 6 months of age, and people with a history of Guillain-Barre syndrome (a paralyzing neuromuscular disorder). If you have a moderate or severe illness with a fever, you should wait until those symptoms resolve before getting vaccinated.

If you are HIV positive, most healthcare providers will recommend that you receive the flu vaccine each year. Although there has been some debate and controversy over this issue, it is generally thought that vaccination offers significant benefits to the HIV positive person, including the prevention of serious complications of the flu such as bacterial pneumonia and activation of HIV replication (leading to an increase in HIV viral load and a decrease in the CD4 cell count). In addition, the flu may resemble symptoms of an HIV or AIDS related opportunistic infection; thus, avoiding the flu will avoid an unnecessary workup. The vaccine itself is well tolerated by most people, including those who are HIV infected. There may be a very slight and temporary rise in the HIV viral load, but this will quickly resolve after vaccination. Studies have shown that the body's ability to respond to any vaccine and to build up protective antibodies may be decreased when the CD4 cell count is below 2oo, but it is still recommended to vaccinate these people, as there may still be some protective benefit.

You may hear about the Nasal-Spray Flu Vaccine, and think that this would be a great alternative to getting another injection. Sorry, but if you are HIV positive you cannot receive this vaccine. The nasal spray vaccine is a live vaccine, which contains weakened live virus (instead of killed virus in the injection), and is capable of producing severe illness in anyone with a weakened immune system. If you are HIV positive, you should never receive any live vaccines for this reason.

In conclusion, the flu vaccine is the best protection against getting the flu. However, you may still get other viral respiratory illnesses or even a strain of the flu that was not included in the flu shot. Besides vaccination, the next best defense against viral illness is frequent and thorough hand-washing and the use of antibacterial hand gels which can easily be carried in your pocket, purse, or car. This will help to prevent you from transferring virus you come into contact with to your mouth and nose.

HOME FOR THE HOLIDAYS - Traveling With Your HIV Medications

Believe it or not, it's that time of year already! As you are busy preparing for the holiday season and making plans to visit with family and friends, you will need to add one more thing to your already long list of things to do. Anyone with a chronic disease has to consider their health when traveling, and HIV is no exception. You must give some thought to your HIV treatment and the medications that you are taking before you pack up and leave.

This article will focus mainly on travel within the United States, although I will briefly touch on a few special considerations regarding international travel. If you will be traveling internationally, you should find out in advance if the country you are planning to travel to has any restrictions on entry for people who are HIV positive; many countries, including the United States, ban people with HIV from entering. Discuss your travel plans with your doctor to determine if any special precautions or vaccinations will be necessary. You should be up to date with your influenza, pneumonia, tetanus, diphtheria, and hepatitis A and B vaccines. If you are traveling across international time zones, you may want to ask your healthcare provider, adherence counselor, or pharmacist to help you work out a plan for adjusting the times of your dosages to avoid long intervals between doses. Find out in advance where you would go if you were to require medical care, and check into getting travel insurance that does not exclude emergency treatment for HIV related illnesses. If you are fortunate enough to be going to a warm and sunny place, check with your pharmacist if any of your medications cause an increased sensitivity to the sun, and bring lots of sunscreen with you.

Discuss your plans to travel with your healthcare provider, and ask for a brief medical letter to carry with you. At the very least, you should have a copy of your latest blood work results, including your CD4 cell count and HIV viral load. Do not start any new medications within 4 weeks prior to traveling in case you should have an allergic reaction.

It is important to remember that taking a vacation does not mean that you take a "vacation" from your medications. As you have undoubtedly heard many times from your healthcare provider, anything less than 95% - 100% adherence to your medications may result in your HIV becoming resistant to your medications, which will cause them to stop working. Whenever your usual schedule and routine is changed, it will take a little bit of extra thought and planning to ensure that you are able to stay on track with your medications.

Whenever you travel, be sure to bring enough of all of your medications with you, as it may be impossible to get these medications when you are away from home. Count out your doses, and take several days worth of extra medications with you in case you get delayed or decide to lengthen your trip. Pack your medications in your carry-on luggage to avoid losing it. You should also carry a letter from your doctor listing your medications and stating that they are being taken for a chronic medical condition.

You may want to invest in some pillboxes to help you to stay on track. Consider prefilling a 7-day pillbox for each week that you will be away, and take along a few tiny single dose pillboxes that you can discreetly carry in your pocket or purse; this will be especially helpful if you will be spending time with people who are unaware of your HIV status.

Do a little bit of planning in advance, and then enjoy your vacation.

Here are a few options for pillboxes that you might want to check out. Once getting to Amazon.com, you can search the site for "pillbox" to view the complete selection and find the items which will meet your needs.

THE GREAT AMERICAN SMOKEOUT

Meet Joe Chemo, a camel who wishes he'd never smoked cigarettes. Joe Chemo was developed as an anti smoking character by Scott Plous, a psychology professor at Wesleyan University, after his father nearly died from smoking. The idea was to present a more honest image of smoking than the Joe Camel character used by R. J. Reynolds.

Now, for the purpose of this post... The 30th annual Great American Smokeout!! The Smokeout takes place every year on the 3rd Thursday in November (1 week before Thanksgiving). This year's event is on Thursday, November 16, 2006. The Great American Smokeout, sponsored by the American Cancer Society, encourages all Americans to quit smoking for 24 hours- and hopefully longer (forever!!).

Click here for a list of resources and local events for each state. If you commit to quitting for 24 hours, you will not be alone!! This could be the first day of the rest of your (smoke-free) life!!
The best way to quit is one day at a time. Once you make it through the first 24 hours, the hope is that you go to bed at night and say to yourself "Well, I made it today. There's no reason that I can't make it for another 24 hours".

There are so many resources and tools to help you quit smoking - Try a Google Search for "smoking cessation", and see what you get.

A few really good resources are:
http://www.cancer.org/docroot/SPC/SPC_0.1.asp

www.quitsmokingonline.com

http://whyquit.com/

http://whyquit.com/whyquit/A_Symptoms.html

http://quitsmoking.about.com/od/forumgems/

You will also benefit from Allen Carr's book "The Easy Way to Quit Smoking"- I wrote about this book in an earlier post, so you might want to check it out. This book is fantastic; I highly recommend it. "Out of the Ashes", by Peter & Peggy Holmes, is an inspirational handbook designed to help ex-smokers on an ongoing basis.

You can also download an excellent free e-book about the cognitive-behavioural aspects of smoking cessation by clicking here.

Check out the following books at Amazon and Barnes & Noble:






The Easy Way to Stop Smoking

0925190578:Product Link on Barnes & Noble.com.

THE EASY WAY TO STOP SMOKING

Quitting smoking may perhaps be the most difficult fight of your life. I have had many drug and alcohol addicted patients who are living successfully in recovery from their addictions tell me that quitting smoking will be much harder than abstaining from drug or alcohol use. Who knew, when they started smoking as teenagers, that the cigarette that made them look so "cool" was actually more addicting than heroin... Don't be discouraged. Just as you "learned to smoke", you can "learn to live again without smoking". Read on to discover one of the many tools that you can use as a weapon in your fight to become a non-smoker.

Allen Carr's book "The Easy Way to Stop Smoking" is a must read for anyone who is considering quitting smoking. In this international bestseller (over 6 million copies sold worldwide), Allen Carr teaches the method that he developed in 1983 to help himself quit a 3 pack per day cigarette habit. Since then, he has helped millions of people around the world to finally be free of smoking for good.

When following Allen Carr's method, you will continue to smoke while you study the book and focus on removing your psychological need to smoke. By the time you finish the book, you will have developed the skills to enjoy your life as a non-smoker, and can set a quit date with the confidence that you are prepared to handle any physical withdrawal pangs and tempting situations that occur.

People who have quit with the help of this book attest that they did not suffer from anxiety, depression, serious withdrawal pangs, weight gain, or feelings of deprivation. After hearing about this book, I picked up a copy and read through it myself. I was quite impressed with it; it really made sense.

Quitting smoking is sometimes the hardest thing that someone has to do. Why not pick up a copy. You can continue to smoke while you're reading the book and developing the skills needed to become a successful quitter. You have nothing to lose, except for the unhealthy, costly habit of cigarette smoking. Link to Amazon.com or Barnes & Noble through this site to view the book and purchase online (new and used copies are available).




The Easy Way to Stop Smoking

SMOKING AND HIV

We all know that smoking is an unhealthy habit for anyone. Tobacco is an addictive and lethal drug, and there is no doubt that it causes many serious health conditions and even early death. Despite all that we know about the dangers of smoking and all of the warnings that are constantly in the media, tobacco is still a widely used drug. As HIV infected individuals are now living longer, we need to take a serious look at the long term health implications of smoking in this patient population.

I won't try to go into all of the health problems caused by smoking or discuss smoking cessation methods in detail here, but I'll provide some great links at the end of this article to get you all thinking about quitting. My objective today is to get HIV positive people thinking about the increased dangers of health problems associated with the combination of smoking and chronic HIV infection. You can get information regarding medical terms and opportunistic infections at TheBody.com.

The only "good" news is that most studies have shown that smoking, in itself, has not been shown to affect HIV infection itself. Smoking does not affect the rate at which the CD4 cell counts drop or how rapidly HIV progresses to AIDS. Antiretroviral medications used to treat HIV are just as effective in smokers as they are in nonsmokers. If you can even consider this to be "good" news, read on to learn about the specific risks associated with HIV and smoking.

1. Opportunistic Infections and AIDS-defining Illness: Smoking weakens the immune system and interferes with lung functioning. This leads to a decreased ability to fight off infections, making HIV positive smokers more likely to develop certain infections and AIDS-defining illnesses, particularly those related to the lungs (such as PCP pneumonia and MAC). Oral thrush, oral hairy leukoplakia, and bacterial pneumonia also occur much more frequently in HIV positive smokers. In women, smoking can increase the severity of human papilloma virus (HPV), leading to the increased risk of aggressive cervical cancers.
2. Chronic Lung Disease and Emphysema: Smoking causes a constant inflammatory state in all smokers, and this effect is greatly increased in HIV positive smokers. The lung destruction and emphysema that occurs as a result of this chronic inflammation is greatly accelerated in HIV positive smokers; emphysema will develop more frequently, at an earlier age and tends to be more aggressive and disabling.
3. Cancer: Smoking has been strongly linked to many types of cancer, including lung, throat and mouth, bladder, and pancreas. Cancers in general seem to occur more frequently in HIV positive people. Similar to chronic lung disease, these cancers tend to occur at an earlier age and be more aggressive in HIV infected people. This is true even in those who are taking HIV medications and have a well-controlled viral load.
4. Heart Disease: It has been well-established that cigarette smoking is the #1 modifiable risk factor for heart disease. Smoking also increases the risk for high blood pressure and stroke. It is likely that HIV infection itself can increase the risk of heart disease. It is known that certain HIV medications can raise the levels of cholesterol and other fats in your blood, and lower the "good cholesterol", (HDL) and cause certain metabolic changes such as diabetes and high blood sugar, which further increases the risk of heart disease.
5. Liver Disease: Nicotine is a drug, and it needs to be processed by the liver. When combined with the side effects of toxic HIV medications, liver problems may occur, and any pre-existing chronic hepatitis infections may worsen as a result of the stress on the liver. Smoking has also been shown to interfere with the liver's ability to process certain medications properly.
6. Osteoporosis (weak, brittle bones): This can be a result of chronic HIV infection itself or the long-term side effects of HIV medications. Smoking has been shown to increase the risk of osteoporosis in all people. As people are living longer with HIV, the risk of disabling bone fractures impacts on quality of life.

The bottom line is that stopping smoking (or not starting if you are a non-smoker) will greatly improve your health and decrease your risks for many serious health problems. Check some of the links below for information on smoking cessation.

http://www.thebody.com/index.html

http://www.quitnet.com/

http://www.quitsmokingonline.com/

http://www.joechemo.org/index.html

http://unr.edu/homepage/shubinsk/smoke.html

http://whyquit.com/

http://www.americanheart.org/presenter.jhtml?identifier=3038016

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22937

MORE ON CHOOSING AND TALKING WITH YOUR HIV PROVIDER

There is much more to your relationship with your HIV specialist than medical appointments, discussing lab results, and medication prescriptions. Your partnership with your provider is your #1 "weapon" in your fight with HIV. In order to remain healthy, you will need to have trust and confidence in your provider. The decisions that you make about your care are very important ones.

Approach your initial meeting with the provider as if you are "interviewing" him or her for the position. Ask questions about his or her background, experience, and approach to treatment (conservative, "canned" approach vs. willingness to make a "custom" treatment plan with you). You should feel that the provider is non-judgemental and willing to listen to and discuss your treatment ideas and goals with you. The provider's role is to educate you so that together you can make informed and knowledgeable decisions, and he or she should be flexible enough to listen to and adjust to your needs. If your questions are met with resistance or hostility, this is a sign that you need to be wary and seriously consider if you will be able to establish a trusting, therapeutic relationship with this person.

Be honest with the provider. In HIV care, the provider needs to really know you as a person. All aspects of your lifestyle are important to your care. Be honest about sexual practices, the use of alcohol and recreational drugs, daily habits, your support system (family, friends, domestic partners), how you feel about having HIV and taking medications, and about any other treatments that you are using or are considering (such as vitamins, herbs, supplements, acupuncture, massage, etc.). If you feel that the provider is judgemental and that you have to hold back certain information or "tell them what they want to hear", then you need to continue searching for the right provider. You need to be totally honest with your provider and be comfortable asking him or her questions, even if they are personal and embarrassing to you.

Consider a situation where you might be having trouble taking your HIV medications (maybe you are having side effects, have a new work schedule, or are dealing with stressful events in your life). You need to be able to openly and honestly discuss these issues with your provider, instead of saying what you think they want to hear. In reality, a good HIV specialist wants to hear what is really going on with you so that they can help you to stick to your treatment plan or develop a new plan, remain health, and prevent complications.

Do not be afraid to ask questions and take notes. Before your appointments, write down your questions and concerns, and take notes so that you can remember what you are told. It is OK to ask for clarification of unclear or confusing explanations or medical terms - Keep asking until you understand. The same thing goes for a provider who speaks with an accent; ask for clarification until you understand what is being said. The provider should be willing and able to explain things so that you can understand them. If you have questions about something that you have heard from a friend, read, seen on the Internet or TV, ask your provider about them. It may also help you to bring a friend, family member, or partner with you to your appointments to help you remember what was discussed.

In my own practice with HIV positive patients, I have had many, many patients approach the first several visits as a "trial". I do not consider this to be threatening or insulting in any way. In fact, it is to be commended, because it shows that the patient is very willing to be an active part of his healthcare. I feel that my willingness to spend extra time with patients and really get to know them as people, and get to know what is going on in their lives, has helped me to provide better care to them. I remember one young man who was moving to my city from the west coast. He came in with his mother and sister for a "tour" of the office. It was clear from the beginning that he was considering 3 different sites for his HIV care, and that he was "interviewing" me. The meeting lasted for over an hour, and he asked most of the questions that I have brought up in this post. My willingness to listen to him and to discuss what was important to him is what won him over, and he initiated and continued his care with me. It turns out that he had a bad experience with a provider in the past regarding starting HIV medications. His CD4 cell count (T-Cells) had been in the 190-250 range for several years, and his provider was insisting that he must start medications. The patient tried to express his concerns, and was pretty much told what he "had to to". The provider did not listen to the patient... My approach was different. I discussed the progression of HIV disease with him, the current Department of Health and Human Services, and gave him the information that he needed to make an informed decision. He discussed his feelings and opinions with me. He felt well, led an active life (work, volunteer activities, social life), was in a monogamous, stable relationship with his domestic partner, ate right, exercised regularly, got plenty of sleep, and did not smoke, drink alcohol, or use recreational drugs. He was very knowledgeable about the side effects and long-term toxicities of the medications, and did not want to take them. We agreed that he was making a reasonable, informed choice, and that we would briefly discuss the issue on every visit, and that he would consider taking medications only if he became symptomatic of HIV disease (began not to feel well). This approach encouraged total honesty from the patient, and it helped me to provide the best care for him. The bottom line is that you and your HIV provider must work together as a team to fight your HIV. You need to be comfortable with each other and with each other's approach
to dealing with your treatment. This is a decision that you are making for life - so make it a good one!

CHOOSING A HEALTHCARE PROVIDER FOR YOUR HIV TREATMENT

There are a number of things that you must consider when searching for the right healthcare provider for your HIV treatment. "Healthcare Provider" can mean a physician, a Nurse Practitioner, or a Physician's Assistant (Nurse Practitioners and Physician's Assistants are not doctors, but they have received extensive education and training and in most states they are allowed to treat patients with only a minimum amount of physician supervision). You and your provider must work together as a team- and remember, you are the most important member of that team. Take an active role in planning your healthcare, read and learn all that you can about the disease - The Body is a great informational website to explore. Work in partnership with your provider to make decisions about you health care. This will make it much easier for you to stick to your treatment plan and to remain healthy.

If you are newly diagnosed with HIV, you are most likely feeling overwhelmed, and may tend to avoid and procrastinate when it comes to seeking treatment. These behaviours are understandable, but may also be detrimental to your health. Early treatment will help you to understand what is going on in your body, and will also allow your provider to assess whether or not you need life-saving medications immediately. It can prevent or delay the progression of your disease to AIDS and prevent you from getting sick. You will also need a place to turn for emotional support, information, and education. Early in treatment, you will receive information regarding preventing the spread of HIV infection, safer sexual practices, and needle exchange programs if you are an intravenous drug user. You will also be directed to a counsellor or your local Health Department to discuss notification of any sexual or needle-sharing partners of their possible exposure to HIV.

If you are relocating to a new city, you will want to research the available healthcare options in your new location, and make the best decision for continuing your care in a timely manner.

You may also want to change providers as time goes on. You always have the right to stop seeing a provider and change to another at any time, for any reason. If you don't like your provider or you feel uncomfortable with him or her, or if you feel that your health care needs are not being addressed or your ideas about your treatment are now different from your provider's, then it is time to search for another provider.

Following are some important things to consider when choosing a provider:

1. Training and Experience: HIV treatment is very complicated and changes quickly, and there are many things to consider at all stages of the disease. It is essential that you see an HIV specialist (someone who treats a significant number of HIV infected patients and who is certified as a specialist by the American Academy of HIV Medicine. Your provider must be committed to staying current and up-to-date with the field. Ask how many HIV patients the provider has treated, and how many they currently see. Ask if he or she has experience treating patients at all stages of the disease.
2. Availability: Ask the office staff how long it usually takes to get an appointment, or to reschedule an appointment if you have to cancel. Also inquire about being able to get an appointment quickly if you are sick or are having a problem. You can see a general internist for other primary care needs, but I would recommend that you search for an HIV specialist who is also willing to provide primary care services. Every time another provider treats you, there is the potential for a possible HIV-related problem to be overlooked, or for a medication to be prescribed that has interactions with your HIV medications. You also need to find out how easy it is to have your provider return phone calls to you when you have questions that cannot be answered by the nursing staff.
3. Office Staff and Environment: You will most likely have complex problems and issues that will require expert assistance from support staff such as nurses, insurance and billing specialists, mental health and substance abuse counsellors, social workers, and case managers. The support staff is there to assist you in obtaining the benefits and help that you need. Although your initial visit to the office will be frightening and intimidating, you should be able to come out of the visit with a feel for whether or not the office and the provider will be a good fit for you and will provide you with the services that you need .
4. The Patient-Provider Relationship: Your relationship with your provider is perhaps the most important aspect of your care. During the initial visit with the provider, you will be able to assess if you will be able to develop trust and confidence in the provider. Most people do not want a "canned" approach to their healthcare, where every patient must do the same thing. Remember, this is a partnership, not a dictatorship. Discuss your goals and ideas about treatment to make sure that the provider is willing to be somewhat flexible and adjust to your needs, while still providing you with high-quality care. You will get a feel for the provider's overall outlook and approach during this initial visit - is it optimistic and hopeful? In order for you to get the best care, you must be comfortable discussing anything with your provider. He/she must be comfortable and non-judgemental about sensitive lifestyle issues such as sexual practices and drug use, to name just a few.

These are just a few things to consider when making this all-important decision. Take your time, and do your research. Choose a provider who is well-qualified, but who will also respect and listen to you. Remember, this is all about YOU!!!!!

INTRODUCTION TO FOCUS ON LIVING WELL WITH HIV/AIDS

I am a Nurse Practitioner with many years of experience caring for and about patients. I have spent the past 6 years treating patients infected with the HIV virus. Due to funding cuts at the Not-for-Profit agency where I was working, I was recently laid-off. While I am looking for work in the HIV field, I have been busy keeping up with the developments in the field of HIV treatment by reading, attending conferences and continuing education programs, and networking with other providers in the field. I am now in the process of developing an informational website for HIV infected individuals and anyone else who wants to learn about all aspects of this chronic disease.

Over the years, I have attended many continuing education conferences, read extensively about HIV disease, and have become certified as an HIV Specialist by the American Academy of HIV Medicine. Although this knowledge is what makes me competent to care for patients, the fact that I truly care about each and every one of my patients and have been able to gain their trust and confidence by getting to know them as people is what makes me good at what I do. I love this specialty, and feel that I have truly found my "niche" in the treatment of HIV.

This blog will emphasize living with HIV, and living well. This is a chronic disease which can be treated, managed, and controlled. It is not a death sentence. In fact, it can be compared to living with any serious chronic medical condition, such as Diabetes. If an HIV positive person is diligent about staying in medical care, follows the directions of his/her health-care provider, and lives an overall healthy lifestyle, then he/she can expect to live a normal life, with the goal of a normal life expectancy. My goal is to help people to do that, through education and information about HIV disease and treatment, as well as maintaining good overall health.

I will post on many topics, including: HIV testing, prevention of HIV infection, STD's (sexually transmitted diseases), dealing with the social stigma of being HIV positive, sexual diversity, disclosing HIV status to friends, family, and new sexual partners, HIV treatment, medications, side effects, and complications, family planning (including decisions to have children), social support, mental health, drug and alcohol abuse, healthy diet, exercise, vitamin and herbal supplements, the global HIV and AIDS pandemic ... the list goes on & on. I will provide links to excellent web resources, as well as include experiences that I have encountered with patients over the years.

I am new to this, and this is my first attempt at blogging and developing a website, so it will surely be a "work in progress".