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- Managing your health: a guide for people living with HIV
The guide covers the totality of HIV care, including voluntary counseling and testing VCT ; HIV prevention; antiretroviral therapy ART ; and diagnosis and treatment of opportunistic and other related infections, with particular emphasis on tuberculosis TB co-infection and sexually transmitted infections STIs. Information is presented in a practical fashion, making it useful in diverse settings. Thus, recommendations for initiating and changing HIV therapy are made for settings ranging from those in which laboratory testing is limited to places where a total lymphocyte count can be obtained, to those with access to viral load analysis.
A section on data management is also included.
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The guidelines for HIV treatment are — appropriately -- based largely on World Health Organization WHO guidelines; recommendations for treating opportunistic infections OIs and other complications of HIV infection make use of drugs and diagnostics available in those areas of the world where the guide is intended for use. Most importantly, many algorithms protocols that care providers will find extremely useful have also been included. I found these algorithms to be logical, easy to follow, and reflective of best practices. Most importantly, positive living for PLHIV also involves playing an active role in preventing the spread of HIV, and you should stress the importance of safer sex practises in this context.
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In this way, you will also be able to provide information to patients who have misconceptions about HIV, its transmission and treatment. In addition, you may consider referring patients to the nearest health centre if you determine that they should receive additional clinical services and psychosocial support. In brief, by helping PLHIV to adopt positive living practises, you will be able to encourage them to live a healthy and good quality life.
SAQ SAQs Positive living is a lifestyle adopted by an HIV-infected person in order to live life as fully as possible while slowing progression to AIDS. In doing so, you will maintain the continuity of care patients receive from the health centres and hospitals at the level of their own community. The points listed in Box In the following sections we will be discussing these specific issues in more detail.
In Study Session 25, you learnt about preventative measures that individuals — whether they know their HIV status or not — may take into consideration in order to reduce risks of HIV infection via the sexual route, and by direct contact with objects contaminated with infected blood. In this section, we are going to discuss specific issues that relate to sexual transmission of HIV, and to a lesser extent transmission by contact with infected blood, in the context of HIV treatment, care and support provided to PLHIV.
Patients who are on antiretroviral therapy ART should be informed that HIV transmission to other people is still possible, even if treatment has been effective and they are informed by health workers that they have undetectable levels of HIV in their blood. Re-infection can accelerate progression to AIDS in two ways. First, re-infection can increase the viral load i. This will result in further damage to the immune system, making the person with a re-infection more vulnerable to opportunistic infections.
What are the most widely known strategies for prevention of HIV transmission through the sexual route? In general, maintaining faithful relationships is an effective measure for individuals to reduce the risk of HIV infection. Remember the linear relationship between HIV transmission and the number of sexual partners that is; the higher the number of partners, the higher the risk of HIV transmission Study Session In this context, it is critical that you stress the importance of consistent and correct safer sex practises to PLHIV whether they have opted for faithful relationships or for multiple sex partners.
Refer to Study Session 25 for information on the correct use of condoms. In this context, safer sexual practises are also beneficial in the prevention of other sexually transmitted infections STIs , a topic that will be further discussed in Study Session When providing information to PLHIV about general and specific issues on prevention of HIV transmission via the sexual route, it is also important to engage their partner s in the discussion, whether they know their HIV status or not.
This is important so that all partners involved play an active role in the prevention of HIV transmission or re-infection. Biruk and Hiwot are a young married couple in your community. They now want to have a baby. What issues would you discuss with them? You should make sure that they understand that unprotected penetrative sex will greatly increase the risk of HIV infection for Hiwot.
This may have consequences for the health of Hiwot and for the health of the child, should she become pregnant. If they are still intent on having a baby, refer them to the nearest health centre for further care and support. Finally, you should also advise PLHIV and their partner s and close family on issues related to HIV transmission via contact with blood-contaminated objects.
PLHIV and their close family should be particularly attentive to sharing common objects that may have been contaminated with blood. These include utensils such as needles, razor blades and toothbrushes Figure It is also important to emphasise that PLHIV should never give blood for transfusion, as this could result in HIV transmission to other patients that receive their blood or blood-related products. Informing the PLHIV in your care about their health status builds up their confidence, thereby encouraging their active involvement in improving their own health.
At each visit, you should inform patients about how they are progressing health-wise, and provide them with health information materials that are available from your health post to build their ability to manage their own health issues. It is advisable to encourage PLHIV to attend their visits accompanied by members of their family or treatment supporters, especially if this helps them express any concerns they may have about their health status Figure Knowing more about HIV may also help your patients remember to take their medications correctly and at the prescribed times, hence promoting good adherence to ART.
Poor adherence may lead to drug resistance, increased viral load, decreased levels of CD4 lymphocytes, higher incidence of opportunistic infections and faster progression to AIDS, and increased possibility of sickness and death. Therefore, educating patients about essential points of good adherence to treatment at regular visits is essential to promote health for PLHIV, and to strengthen positive living.
For example, you should make sure that HIV-positive patients understand that HIV has no cure, that HIV infection is at present a lifelong condition, but also that medications can help a patient live a healthier and longer life. Adherence is not restricted to ARV drugs, and should include medication such as cotrimoxazole for prevention of opportunistic infections.
The message given to patients should be concise and clear. Here is an example:. In addition, medications may be available to help manage some side-effects of ART, such as pain, vomiting and diarrhoea.
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Lifestyle and unprescribed medications may influence the outcome of ART. Thus, patients should not take any medication without first consulting their respective health worker. In addition, these lifestyle choices will have a negative effect on the overall health in particular, the function of the immune system of the patient, who will then become more susceptible to opportunistic infections.
When discussing positive living practises with PLHIV, you should emphasise that work provides income, stability, satisfaction, friendships and fulfilment to many people, and may therefore promote their psychological and physical wellbeing. You should encourage your patients to continue working for as long as they are able to reasonably manage their workloads.
In the event of episodes of ill health, it may be quite difficult to continue regular work, and PLHIV should determine whether they are fit enough for work. However, they should keep in mind that returning to work after illness may help improve their quality of life. Avoiding stress and dealing with worries in a positive manner is also important for PLHIV to maintain their health. Specific strategies on how to deal with stress, anxiety and depression are discussed in detail in the Module on Non-Communicable Diseases, Emergency Care and Mental Health.
For example, they may need to find positive ways to deal with stress such as talking with friends or family members, and avoid negative ways of dealing with stress such as abusing alcohol, chewing khat or taking other recreational drugs. It is important to emphasise that alcohol or chewing khat may make them forget their problems for a short while, but may lead them to be involved in risky behaviours such as unsafe sex. Maintaining a good nutritional status is essential for improving the quality of health of people presenting with any disease, including HIV and AIDS, as sick people have more nutritional needs than healthy ones.
Poor nutrition in PLHIV may lead to further impairment in the function of an already damaged immune system and favour an increased incidence of opportunistic infections.http://kick-cocoa.info/components/kezeluxal/pepej-app-microspia.php
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Other contributing factors to weight loss are the presence of diarrhoea and vomiting common in patients with AIDS , which impair nutrient absorption through the gut, and loss of appetite, sometimes related to difficulties in eating. You should advise PLHIV in your community to adhere to the following recommendations if they feel nauseated or they lose their appetite — eat small frequent meals, eat bland foods e. Also remember that the nutritional requirement of people who are sick is greater than that of healthy people.
This is because additional energy is needed to compensate for the increased energy needs of the body due to illness.
Managing your health: a guide for people living with HIV
PLHIV who are also coping with opportunistic or other infections will need to eat more nutritious food in order to help their immune system fight the infectious agents. Meals should include protein, fat, carbohydrates and vitamins in the recommended proportions, as described in the Nutrition Module, and illustrated in Figure In addition, a well-balanced diet involves drinking plenty of clean water, up to two litres per day.
You should discuss with patients about how to incorporate a well-balanced diet into their life routines, and about factors such as lifestyle and economic status that may negatively affect it. If needed, suggest they ask for help when preparing meals and cooking. You may also need to refer patients to food support services at your nearest health centre. As you already know, since HIV affects the function of the immune system, a person with HIV is more susceptible to opportunistic infections.
People with HIV should take effective actions to prevent communicable diseases which may have important consequences for their health. Here, we will briefly discuss some preventative measures to reduce the risks of some common infections, but you should refer to the more detailed discussion of prevention in other study sessions in this Communicable Diseases Module when giving advice to PLHIV. Can you give any examples of common infectious diseases that PLHIV may contract due to improper handling of food and unclean water?
You may have thought of giardiasis, amoebiasis and diarrhoeal diseases caused by bacteria or viruses. To prevent the occurrence of f a eco-oral diseases , caused by transmission of infectious agents from the faeces to the mouth usually on the hands or in food and water , your advice should include instructions on clean preparation of food and water before consumption. For example, vegetables and fruits should be washed with clean water.
Drinking water should be cleaned by boiling it vigorously for a few seconds, then cooling it.
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Advise your patients to eat only well-cooked food. For example, cooked meat should be brown and have no traces of blood in it, and soups should always be boiled before being eaten. Another very important hygienic measure used to prevent faeco-oral diseases includes frequently washing hands with soap, in particular after using the toilet and before preparing food or eating. Prevention of sexual transmission of HIV Section Abstaining from sex, being faithful to a long-term partner, and adopting safer sex practices, such as the use of condoms.
If your community is in a malaria-endemic area, you should educate PLHIV to use bed nets regularly at night, to prevent being bitten by mosquitoes Study Session 9. Finally, common hygienic measures to reduce the risk of infections from minor injuries or wounds include thorough cleaning and wound care. You should actively encourage PLHIV to attend the nearest health post or health centre as soon as possible in the event of a minor injury or wound.
Exercise is a good and low-cost way of maintaining the health of your clients. You should encourage PLHIV to practice regular exercise and to find time for adequate rest to improve and maintain their health.
Regular exercise includes any sort of activities that fits into the daily routine life of your clients.