A doctor’s role in creating hope for people living with HIV
Q. How often do you work with PLHIV ie, daily, weekly, occasionally?
A: I work with PLHIV on a daily to weekly basis. PLHIV face the same chronic conditions such as hypertension and high cholesterol like most people. They also face the same anxieties and mental health challenges as any other person. I treat my PLHIV patients as I do any other normal patient and during their follow-ups with me, it has become second nature for me to not just focus on their condition but also the big picture of their overall health.
Q: How do you initiate conversation with those suspected of being HIV positive?
A: One of the core strengths we believe at my place of practice is for anonymous rapid HIV testing. This allows the person to get checked without the fear of and stigma of the diagnosis. If a diagnosis is picked up through a rapid test, we would then counsel the patient on the benefits of getting treatment and getting it early. In terms of how to initiate a conversation, I will share more below of a recent conversation I had with a patient who was newly diagnosed with HIV.
Q. What are the first and main concerns of those diagnosed with HIV?
A: When I look after my patients, it is not just the HIV component I am most concerned about but rather treating them as a complete individual and addressing every aspect of their lives including the physical (HIV), emotional and mental (how they are feeling and coping with the diagnosis and the journey ahead).
My biggest concern is whether patients have support and whether they have someone close to them that they can share this news with. Or if they are concerned about their loved ones not accepting this too well, I often ask them to bring their loved ones together on their next consult, so I can debunk and address the concerns their loved ones may have.
Ultimately with the advancement of medical treatments, HIV is almost seen as a chronic disease where treatment allows for PLHIV to live normal healthy lives, grow old and some even have children.
Q.:Have you seen any improvement or change in acceptance of PLHIV?
A:Unfortunately, stigma is a real concern. A report by the UNAIDS on PLHIV in Malaysia showed almost half of PLHIV who took part in the study were gossiped about in the last 12 months either because of their HIV status or for other reasons (in particular, sexual orientation). [Available at: http://www.stigmaindex.org/sites/default/files/reports/StigmaIndexMalaysia_LowRes.pdf]
Changing the acceptance of PLHIV requires addressing the myths and conceptions people have about HIV. More people need to know that undetectable viral load (after treatment) equals untransmissible. Furthermore, HIV requires a medium to transmit and myths such as sharing food, hugging, sharing the same toilet, gym and touching the same door handle can transmit HIV, need to be debunked with facts.
No one with HIV chooses to have the condition, and stigma affects the way they find support and lead normal lives. By choosing to learn more about and understanding the condition, and knowing that with good treatment PLHIV lead normal lives, one would be less worried about their interactions with PLHIV. Ultimately, just as I did, one will learn to treat them as any other normal person.
Q: Could you bring us through a typical counselling session for someone newly diagnosed with HIV?
A: When I see a patient in the clinic, I often share with them the timeline of what happens next—in the next 1 week, 1 month, 3 months and at 1 year.
I will request that they bring along their loved ones for the 1-week meeting to share more about the condition with them, of course with the patient’s permission. This way, they can debunk any myths and find that they can support the journey with the PLHIV.
Having bite-sized checkpoints helps the newly diagnosed person process what to do next and, in a way, feel empowered rather than let the situation overwhelm him or her.
Ultimately, the important part I focus on when I counsel a newly diagnosed patient is hope. Hope that he or she will live a normal life as much as possible with good medication control. Hope that as people become more aware and educated about the topic on HIV, this stigma can be overcome. Hope not in vain but hope in vicissitude.