Concerns About HIV/AIDS
At one time, AIDS was a quick death sentence. Then there was a time
when it was a rapidly progressive chronic disease with various difficult
pathways through the end of life. Recently, the course of AIDS has
changed again. With new drug regimens, many people are living for
much longer, and how the usual person will die is again unclear. It
still seems likely that persons with AIDS will probably die of AIDS,
but often this will happen only after many years of living with the
HIV infection. The very last phase is likely to include infections,
tumors, or mental confusion. If you want, you can take a strong hand
in shaping what treatments will and will not be used when AIDS becomes
far advanced.
AIDS has become a "high-tech" disease. The medication
regimes and machinery involved are difficult even for experienced
health care professionals to man-age. You will be well-served to
seek out doctors and teams who have lots of experience with AIDS
patients, since they will be right up to date on the best information
as it becomes available. They also will be familiar with your needs
and the challenges you face. Even if you are in a rural area or
otherwise can't have an experienced team as your primary source
of care, you might well find an experienced team in a nearby city
to consult occasionally.
Because HIV infection is (incorrectly) thought of as being dangerous
to people nearby, because people with advanced AIDS are often remarkably
ill in appearance, and because many people with AIDS have few anchors
in social and family life, you may have to rely on paid caregivers
and non-family volunteers more than most people affected by chronic
disease in old age. You would do well to connect with family, even
if they have been distant. Often, "buddy" programs in
the community can really help. Most people with AIDS will live a
long time, but you will probably be very sick from time to time,
and will have long periods when you have limited energy. You will
do better if you have some connections to friends and family.
AIDS has affected mostly people who are relatively young. Thus,
you are not as likely as retired persons to have substantial financial
resources and permanent housing. Yet, you may still have young children
and family caregivers who are younger, too, and must work. And treating
AIDS is very expensive. Almost every-one with AIDS needs to consult
knowledgeable and experienced social workers who can help to secure
qualified support services for you and your family. Likewise, plans
must be made for the care of any dependent children, some of whom
may have been infected as well. Social workers are helpful, too.
The situation may seem quite overwhelming. Caregivers often doubt
their ability to meet the physical and psychological needs of AIDS
patients. Yet, astonishing networks commonly are created, and caregivers
ordinarily feel useful and positive about their work.
Caregivers may worry about becoming infected. This is really exceedingly
unlikely if everyone learns a system called universal precautions
and uses it consistently, even when it seems a little silly or a
little troublesome.
Bereavement seems harder for AIDS patients and their families.
Many victims (and their caregivers) are younger and frequently must
deal with the losses of friends and family members who have also
died of AIDS. Caregivers who are HIV-positive are being asked to
confront their own futures every time they care for a loved one
with advanced AIDS. For them, anticipatory grieving may be much
more intense.
Not many years ago, it was very awkward to deal with death certificates
with "AIDS" as the cause of death, and it was often even
difficult to get funeral services. Now, you and your family are
much less likely to run into these problems, but you still would
do well to inquire and plan ahead. Preplanning funerals and handling
of the body, and arranging things having to do with the care of
dependent children and financial estates, is especially important
for many people with AIDS. Many of these things are much easier
to do when the person dying can still sign legal papers and make
decisions. It is often a great burden to family and friends to have
to handle everything through the courts and official channels.
Remember, you often can't avoid feeling angry, and you will need
to grieve. The situation is tragic. The intensity of your feelings
is a reflection of the intensity of the situation. Just be sure
to reach out for support, and to try to express your appreciation
when support is offered.
Patients with AIDS frequently take many medications. These regimes
can themselves cause symptoms. Because of the unpredictable nature
of the disease, it is sometimes hard to know which medications provide
comfort or suppress the illness and which ones are ineffective and
cause problems. Active aggressive treatment often continues right
up until death. When you can't keep track of why you are taking
certain medicines, you may need to review them all with your doctor
or nurse and see if some can be stopped or their timing can be simplified.
Depression or depressive symptoms are very common among people
with AIDS. You should know the warning signs of these disorders
and seek help if they occur. The desire to commit suicide can itself
be a symptom of depression. So, any decisions about euthanasia or
assisted suicide should be delayed until a physician can make an
evaluation and treat underlying psychiatric disorders.
HIV/AIDS sometimes causes dementia or confusion. Again, it is important
to use health care providers who are familiar with the management
of AIDS and with these psychiatric disorders.
Physicians try to evaluate symptoms and treatments by keeping in
mind "the big picture." You should do the same. Will the
medication or test significantly enhance your quality of life or
enable you to do something important? Is the treatment or test being
used to prevent a symptom or to extend life? How does the medication
make you feel? Remember, how you live is more important than the
numbers on the laboratory reports. And how you die is less important
than how you live right up to the end.
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