Management of HIV Infection

General considerations

In general, the needs of HIV-infected clients and their families can be categorized into four overlapping areas:

1. Medical needs, including treatment information and treatment
2. Psychological needs, including emotional support
3. Socioeconomic needs, including orphan support and medical and transport expenses
4. Human rights and legal needs, including access to care and protection against violence and discrimination

Because HIV infection is both chronic and progressive, most medical management is provided by the client’s primary care physician on an outpatient basis, particularly during the long asymptomatic stage of the infection.

In addition to any available drug therapies, clients living with HIV/AIDS need a host of clinical services. For example, children with HIV/AIDS require routine medical care and immunizations, and women with HIV/AIDS may require specialized contraceptive and prenatal counseling and services.

Range of services needed

Aside from clinical care, though, health care workers should be aware that clients living with HIV require a wide range of services, and that infected clients also often face difficult psychosocial issues, including a high incidence of depression. Health care providers need an understanding of the social, economic, psychological, behavioral, and philosophic factors that affect management of the infection and should consider all aspects of a client’s life when making management and drug recommendations.

Because clients often need assistance in terms of housing, food, child care, and other social services, optimal management of the infection should include thoughtful counseling, close cooperation with family members and friends, and referral for additional medical and nonmedical services, as available.

The most urgent management goal for health care providers working with HIV-infected clients is counseling to prevent further transmission of the infection, treatment of any conditions that require immediate attention, and the use of a nonjudgmental approach to encourage clients to remain within the health care system for follow-up.

Clients with HIV infection often experience shame or social stigma either because of the infection itself or because of risk behaviors leading to infection. In addition, some clients may have experienced biases or had negative interactions within the health care system.

Health care programs need to address such stigma and discrimination against people with HIV/AIDS. Staff in health care facilities can benefit from training that addresses the needs and human rights of those affected by HIV and that emphasizes clients’ rights to privacy, confidentiality, dignity, and services free of discrimination and judgment. Staff can also have their fears about occupational exposure to HIV addressed through training in standard precautions. Procedures can also be put in place to ensure clients’ rights and confidentiality.

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