Living with HIV: Guidelines for your antiretroviral treatment programme.

If you or a loved one has recently been diagnosed with HIV, we have created this series of articles to help you along the way.

This article focuses on integrating HIV treatment with the rest of your life. If you have any more questions, we encourage you to speak to your doctor, nurse or clinic team for more information and recommendations. Remember that your body is unique. Your experience with ARVs won’t always be the same as for other HIV-positive people.

When to start HIV treatment

When ARVs were first rolled out in South Africa, the National Department of Health set a treatment criterion: an HIV-positive person would only be prescribed ARVs if his/her CD4 cell count dropped to a level below 350cells/mm³. Nowadays, however, the medical protocol has changed. Today, immediately upon being diagnosed as HIV-positive, you will be prescribed ARVs.

Many HIV-positive people, upon receiving their diagnoses, enter a state of shock and/or denial. Many people will collect the ARVs and not take them as instructed, for up to four weeks thereafter, and others will keep the script aside and delay even collecting the medication. .

HIV Treatment Guidelines

When is the best time to take your ARVs?

ARVs need to be taken exactly as your doctor, nurse or clinic team instructs you to do so. This includes the time of day, the relation to meals, alongside the prescribed nutritional plan you may be referred to, and an exercise plan.

How do your ARVs affect your life insurance policy?

AllLife helps HIV-positive people get up to R10million life insurance. One of the qualifying criteria for specialised HIV life cover relates to your CD4 cell count, which can be determined through a single simple blood test. In order to maintain your own health, and the validity of your life insurance policy, your regular blood tests need to reflect a healthy CD4 cell count. This is primarily achieved by adhering to your HIV treatment plan.

What support is available for HIV treatment adherence?

Dr. Avron Urison says that the prescription of medicine is an essential component of the delivery of health care, as it not only relieves symptoms or cures conditions but, also prevents poor health in the future. There is a need for thorough ARV adherence counselling, to guide people living with HIV, particularly in South Africa, on how they can keep HIV under control and lower the risk of developing viral resistance.

Dr. Urison also stated that incorporating a behavioural element to adherence interventions can increase effectiveness. Educational efforts alone are not enough to promote adherence to medication, especially with HIV-positive people stuck in denial, or closing themselves off to learning opportunities.

“In the case of people living with HIV, they need to be helped to understand that missing medication doses regularly, or changing the time medication is taken, enables the virus to defeat the ARVs sooner,” Dr. Urison said.

What happens when you don’t take your ARVs regularly?

Dr. Urison stated that non-adherence to HIV treatment plans becomes a challenge when people hesitate to talk about their doubts or concerns. There’s a desire to ‘please’ medical practitioners at times, through wanting to look as if medical concepts are clearly understood. People are afraid to feel inferior or stupid, and it affects their health.

South African medical practitioners are encouraged to approach HIV treatment from all angles, and encourage conversation with patients or coax information from them by using effective communication skills.

How can HIV-positive people get the support they need?

Everyone in South Africa, but especially HIV-positive people, is strongly encouraged to let their medical practitioners know if speech, learning and physical impairments may be a factor in understanding HIV and what’s required to treat it. Additionally, language barriers in South Africa are being actively addressed, as medical doctors are requested to now learn at least 2 national languages.

Don’t be afraid to talk about what you need, or prefer, to help you understand your own health, and how to look after it.

Intentional and unintentional non-adherence to HIV treatment

Dr. Urison states that there are two categories of non-adherence to HIV treatment: intentional and unintentional.

Intentional non-adherence occurs when an HIV-positive person decides, with full knowledge and awareness of what he/she is doing, not to follow the treatment recommendations.

Unintentional non-adherence occurs when someone intends to follow the prescribed dosage and schedule, but is delayed or prevented by uncontrollable circumstances. Related situations include poor understanding of prescription instructions due to a language barrier, or impairment as we have mentioned above. Equally so, forgetting to take your ARVs counts as a form of unintentional non-adherence.

Sources:
AIDSTruth. 2020. [online] Available at: <http://aidstruth.org/> [Accessed 14 August 2020].

Southern African HIV Clinicians Society. 2020.[online] Available at: <https://sahivsoc.org/> [Accessed 14 August 2020].

The South Africa Health News Service. 2020. [online] Available at: <https://www.health-e.org.za/> [Accessed 14 August 2020].

World Health Organization. 2020. [online] Available at: <https://www.who.int/> [Accessed 14 August 2020].

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