As I look back over the recent past in HIV research, I am impressed at what advancements we have made, yet disturbed at what little we know and have done regarding HIV prevention and treatment in women.
Both apply to certain patients in whom we might consider waiting to start treatment -- but both these studies suggest we do otherwise.
We marked U.S. National Women and Girls HIV/AIDS Awareness Day on March 10. The theme this year was "Now it's time for you to decide: What can you do?" Although the day is meant to raise awareness among the general population, and although it passed weeks ago, in my opinion we need to have that awareness every day as health care providers. We regularly see people in our HIV agencies/organizations that, if health education had reached them the way it should, would have never walked through the door in the first place.
When I was going through clinical supervision before licensure, my mentor pointed out that one's particular therapeutic modality, be it cognitive, behavioral, psychodynamic, Gestalt or whatever, is often not as important for good clinical results as simply being present with the patient. Because at that time I was very focused on mastery of particular skills, I was somewhat incredulous. But I have since come to understand that beneath good technique there is indeed a realm of energetic exchange with a patient that is often non-verbal and that has great power for healing. I call it being present at both physical and emotional levels.
Hat tip to the inimitable Rochelle Walensky for the video!
We live in parallel worlds rife with contradictions. As we fear more and more budget cuts; AIDS Drug Assistance Program (ADAP) problems; slow, or lack of, global access to HIV medications; and other concerns that keep popping up when attempting to control this epidemic, there are rays of hope that emerge, and motivate many of us working in treatment and research advocacy to keep moving forward.
It is one of the great ironies of a sex-drenched culture that sex, if it is spoken of at all, is too often described with code words and cute metaphors or, in health care settings, sometimes barely mentioned. Both practitioners and patients can be reluctant to speak frankly and this can impact both the quality of health information, as well as good decisions about healthy sexual practices. Health care providers need to take an honest look at their ability to be comfortable with sexuality and discussions of sex.
As a result, we've posted a case on the Journal Watch/AIDS Clinical Care site, describing someone who requests intermittent pre-exposure prophylaxis to prevent HIV.
Bethsheba Johnson (in green) at a meet-and-greet with former President Bill Clinton for Clinton HIV/AIDS Initiative volunteers; Addis Ababa, Ethiopia, 2006.
"Smile, it can't be that bad!" My client Sam had just arrived in my office and was angry and upset that a total stranger had approached him with these words while he was shopping for groceries. "Can you believe that?" he asked before adding, "And that's not the first time that's happened." He was embarrassed that his mood was so obvious to everyone he encountered, yet defiant at his right not to mask his feelings from anyone.