Despite the advent of highly effective, lifesaving antiretroviral therapy and other advances, people today face many of the same psychological burdens as people diagnosed years ago. In my 10 years of HIV nursing I don’t think the issue of stigma has changed very much. When I am with the doctor disclosing to someone that he or she are HIV positive, the reaction of the patient is the same now as it was 10 years ago, and it usually covers three different issues. First is “I’m going to die.” The second is “I cannot tell anyone,” and the third is “I will not be able to have a family.” If they are a woman they will say “I can not have a child,” and if they are a gay man, they will say, “no one will ever love me,” or “I will never have sex again,” or “I will not have a child or family.” Intellectually, many people know much more information. These patients need to be reminded that they are not going to die and that this is not the uniformly fatal disease it was 30 years ago. Emotionally it is still there and that has to do with stigma. The stigma is still alive and well. In some cases I have patients who need a tremendous amount of support to disclose to their partner or partners that they have HIV and in other cases I have patients who have said to me that coming to their first appointment in
￼the clinic was harder for them than when they were first told that they were HIV positive. That it was emotionally, a more difficult thing because it represented a lifelong identification with this virus, and this infection. They find the clinic waiting room to be extremely frightening place. In some cases these patients will wait until the last few minutes before the clinic closes just so that they will not have to wait in the waiting room and have other people see them. There is no doubt that overcoming that degree of stigma is really essential when facing a lifelong adherence to treatment with medication. The psychological and emotional impact of living with this type of secret, and the fear that this secret will be uncovered and that everyone will know can be devastating.
Centers for Disease Control HIV/AIDS Population Demographics: (1)
• More than 1.1 million people in the United States are living with HIV infection, and almost one in five (18.1%) are unaware of their infection. (1)
• Gay, bisexual, and other men who have sex with men (MSM), particularly young Black/African American men who have sex with men, are most seriously affected by HIV. (1)
• By race, Blacks/African Americans face the most severe burden of HIV. Centers for Disease Control and Prevention estimates that 1,148,200 persons aged 13 years and older are living with HIV infection, including 207,600 (18.1%) who are unaware of their infection. (1)
￼Estimated New HIV Infections in the United States, 2010, for the Most Affected Subpopulations.(1)
I work at the AIDS Health Foundation and our policy is to offer antiretroviral therapy to everyone regardless of CD4 count and most people who we offer it to, want it. This includes people who have just discovered that they are HIV positive and their immune system may still be intact with a high T-cell count. It is very easy for them to understand the value of going on medication immediately. Between 80% - 90%