Other Management Issues

Counseling

Counseling is an essential component of the continuum of care for HIV/AIDS. Counseling can help infected individuals better cope with the infection, avoid transmission to others, obtain early medical attention, make decisions about family planning, and make other important decisions about life and family that will be affected by illness and death. Community-based and group counseling may help clients better deal with their infection and increase community acceptance and care for people with HIV/AIDS. Although this course focuses primarily on provision of counseling in health care facilities, it is important to recognize that counseling should be provided on the community level as well, and that linkages between the community and the clinical settings are an essential aspect of a good continuum of care. Making It Work provides links to organizations that actively provide community-based counseling and care.

Nutrition

Nutrition is an important issue for HIV-infected persons, who are particularly vulnerable to malnutrition and weight loss. Infected individuals may require an extremely high caloric intake to maintain weight, and drugs and conditions affecting the gastrointestinal tract can result in severe weight loss due to nausea, vomiting, or malabsorption. In addition, HIV-infected clients may experience loss of appetite or may be too sick or lack adequate income or resources to obtain food.

Those at risk for opportunistic infections should avoid eating raw foods, which might contain bacteria or other microbes that could make them sick. However, there is little evidence that highly specialized diets, such as a macrobiotic diet, have any beneficial effect.

Alternative therapies

Many people with HIV use some kind of alternative or complementary therapy, such as herbs, acupuncture, megavitamins, or other therapies that are purported to strengthen the immune system. Some alternative therapies may be beneficial, some can be dangerous, and others may be safe but ineffective.

It is important to take a nonjudgmental approach to the use of these types of treatments, so long as they are not harmful to clients. Knowing about nonprescription treatments enables providers to assess the possibility of side effects from these treatments and potential drug interactions. 

End-of-life issues

Clients often wish to discuss issues regarding death and dying after diagnosis with HIV infection or during management and treatment. Although these topics might be difficult for health care providers to discuss, it is important to listen and respond to clients honestly.

Because of the progressive and terminal nature of HIV infection, clients should be encouraged to consider issues regarding loss of income, the likelihood of increased incapacitation, care of children and other dependents, and decisions regarding the level of care they would want to receive in case of terminal illness or respiratory arrest.

Although health care providers should be realistic and not overly optimistic when discussing a client’s probable life span, it is equally important and reasonable to hope that research findings, new developments, improved access to treatment, and other factors will enable some currently infected people to live out their normal life spans.

Stress Reduction and Coping Skills for Providers

It is important for providers to acknowledge that working on issues related to HIV with clients can be very stressful. Providers must develop their own coping skills for dealing with issues of death and loss, as well as feelings of powerlessness to protect or save clients. For example, providers can benefit from peer support and relaxation techniques to reduce stress.

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