HIV counselling and combination antiretroviral therapy
Significant developments in combination antiretroviral therapy have led to a surge of optimism about long-term medical management of HIV infection and people are now living much longer with HIV.
Patient adherence is an important factor in the efficacy of drug regimens. However, taking a complicated drug regimen — often taking large numbers of tablets several times a day — is a constant reminder of HIV infection. The presence of side-effects can often make patients feel more unwell than did the HIV and some may be unable to cope with the side-effects. Counselling may be an important tool in determining a realistic assessment of individual adherence and in supporting the complex adjustment to a daily routine of medication.Discussions on safer sex are important, as drug-resistant HIV strains are emerging which limit treatment options for those acquiring such strains. Many patients diagnosed with HIV some years ago are now feeling well enough to return to work, to study and are, paradoxically, learning to readjust to living as they had formerly adjusted to the possibility of dying. Patients also have to deal with the uncertainty which remains about long-term efficacy of current medical treatment, and there are some who will fail on combination therapy. Even with the significant medical advances in patient management, counselling remains an integral part of the management of patients with HIV, their partners and family.
Box 13.10 Coping strategies
• Using counselling
• Problem solving
• Participation in discussions about treatment
• Using social and family networks
• Use of alternative therapies, for example relaxation techniques, massage
• Exploring individual potential for control over manageable issues
• Disclosure of HIV status and using support options
Box 13.11 Who is HIV and AIDS Counselling for?
• People worried that they might have HIV
• People considering being tested for HIV
• People who have been tested for HIV (both negative and positive)
• People unaware of the risks involved in behaviours that they are, or have been, engaged in
• People with HIV infection and disease, including AIDS
• People needing support with antiretroviral therapies
• People experiencing practical and emotional difficulties as a result of HIV infection
• FamilyZPartnersZFriends of people with HIV/AIDS
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