Starting HIV Treatment
By David Fawcett, Ph.D., L.C.S.W.
From TheBody.com
To keep the immune system as robust as possible, it is now
recommended that HIV medication be initiated immediately after testing
positive. Many of my clients, adjusting to the shock of being HIV
positive, find the rush to medicate daunting. While HIV meds are easier
to take than ever before (most newly diagnosed people take just one pill
a day), starting treatment is a major and, for some, difficult step.
Starting HIV medications is both a big step and a lifelong
commitment. Here are seven things to consider as you begin your journey
toward a healthy life with HIV.
1. Accept a New Way of Life
Most people have many strong emotions such as anger, fear and sadness
after testing positive. Each of these feelings is entirely normal, yet
all of them can easily be projected onto one little pill. HIV
medications, even if taken only once a day, are a constant reminder of
your serostatus, and they leave little room for denial or avoidance. The
road to acceptance of living with HIV can be long and difficult.
Resisting this process can mean delaying the start of a regimen, or
taking medications inconsistently or not at all. It is essential to work
with your support system (friends, family and health care providers) to
identify and express any negative feelings you are experiencing about
being HIV positive so that you are ready to commit to this new daily
routine.
2. Prepare for Physical Side Effects
Tremendous strides have been made toward improving the effectiveness
of HIV medications with as few side effects as possible. Nevertheless,
some people do experience physical complications as a result of taking
meds. These are mostly gastrointestinal and often subside after a few
weeks. However, some medications can create additional symptoms or cause
vivid dreams or disturbing thoughts. Most people report having no
persistent difficulty tolerating their medications and, if problems do
occur, there are many alternative medications available.
3. Address Mental Health and Substance Abuse Issues
Consistent
adherence to medication is essential because the HIV virus can quickly mutate if unsuppressed, resulting in
drug resistance.
In my experience, mental health problems and substance abuse are among
the most significant barriers to adherence. Methamphetamine, a drug that
is once again popular among gay men (a high-risk community), often
results in drug runs that last several days during which no one is
concerned about his medications. The same is true for other
recreational drugs.
People under the influence, despite their best efforts, will frequently
miss doses. Therefore, anyone starting meds should be mindful of
substance abuse issues. The same is true for mental health concerns.
During the manic phase of a bipolar episode, for example, people rarely
take their medications (or even feel the need for them). Likewise,
someone experiencing
depression
may not care enough to worry about his or her meds. Anyone starting
medications should work with health care providers to ensure that any
mood disorders or substance abuse issues are as stable as possible.
4. Understand Access and Cost
It is important to review the options for obtaining one's HIV meds.
Insurance often covers the cost of medications, although copayments can
be high. Pharmaceutical companies have patient assistance programs that
may defray the cost of such copays. State and local health departments
have various programs to help those with limited incomes have access to
HIV medications. However, this often involves many bureaucratic hurdles
that can be frustrating and sometimes overwhelming. It is helpful for
anyone who is newly diagnosed to work with case manager assistance when
maneuvering the administrative details to ensure access to care.
5. Fight Shame and Stigma
While we have made tremendous progress fighting HIV-related stigma,
it continues to impact anyone living with the virus. I have had clients
who skipped their evening dose of medications because they were at a
business conference and constantly around colleagues. Another refused to
take his medications on weekends when he had custody of his children
for fear they would ask about his pill bottles. Yet another refused meds
all together because she lived with her mother and hadn't disclosed her
status. In each case, stigma from external sources and internal shame
about HIV impacted medication adherence. It is important for people
starting meds to prepare themselves to experience stigma and work with
their support system and health care providers to eradicate any shame
they feel that affects their own sense of worthiness.
6. Become Proactive
Steve, a client of mine, arrived for his therapy session one day and
announced that he had begun taking HIV meds two weeks earlier without
any problems. When asked what medications he was taking, Steve responded
that he had no idea -- he just took what the doctor told him to take.
Successfully living with HIV requires becoming proactive regarding one's
own health care. Relationships with providers should be collaborative
and the medical decision-making process should be interactive. It is
important to have an understanding of all medications you are taking,
their potential side effects and any drug-drug interactions (including
with recreational drugs). Don't be passive about decisions that affect
your health.
7. Maintain a Healthy Support System
Medications alone are inadequate to live a healthy life with HIV. It
is essential that a support system be developed that complements medical
interventions. Being connected to others at various levels of intimacy,
including one's spouse or partner, family, friends and community, is
vital to help you maneuver through the various emotions, frustrations
and victories that are experienced by someone living with HIV. Work to
maintain that social connectedness and eradicate any shame or stigma
that separates you from others. Share your experience and volunteer your
time. Both you and your community will benefit.
The Next Step
It may help to keep in mind that taking HIV medications won't just
save your own life; it will save others' lives as well. While
antiretroviral medications are obviously essential to halt an
individual's progression to AIDS, keeping one's
viral load
undetectable will also slow the epidemic. Because many people are
inconsistent with their medications, or are totally unaware of their
status, the viral load within some communities remains high. This
significantly increases the chance of someone else becoming infected.
Many experts believe that the next few years represent a time-limited
window during which we can get the virus under control. Several
strategies have been implemented to achieve this, many focused on
suppressing the virus of every individual living with HIV. That, of
course, requires HIV medications to be taken consistently.
A New Day, A Remarkable Opportunity
Starting HIV medications can be frightening, but it need not be
overwhelming. It is a significant moment in our lives, and most of us
clearly remember the day we took our first HIV medications. It is also a
chance to be grateful for the opportunity these remarkable drugs give
us for a long, healthy and happy life.
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