Dear Dr Joel, how do you advise your patients to deal with stigma, even in a health care setting?
That’s a big question. One of the things I discuss early in my book is the issue of who to disclose to. There are few people who need to know your HIV status, other than your doctor and your sex partner(s). You should also seek out someone who can provide emotional support: a close friend, family member, or therapist. But it’s not necessary to tell anyone else—your boss, your parents, your coworkers, your plumber.—and you shouldn’t disclose to people who are more likely to stigmatize you than support you.
Of course, there are many people who are open and “out” about their HIV status, and I applaud them. They help to reduce stigma for everyone else. But getting there takes time. Before you appear on the cover of POZ magazine, get comfortable with your status, and work on addressing whatever stigma you may carry in your own mind. That can take time, education, and sometimes counseling.
Hello Dr. Joel, I was wondering exactly what an opportunistic infection is and what classifies it as such. Can people without HIV/AIDS develop these infections? Also, are people with HIV/AIDS more susceptible to other infections, as well? Thanks!
Here’s an excellent question that I somehow ignored. I’ll answer it with an excerpt from my book:
An “opportunist” is a person who takes advantage of opportunities, usually at the expense of others, for his own benefit. Similarly, an opportunistic infection (OI) is one in which a pathogen (a bacterium, virus, fungus, or parasite) takes advantage of a weakness in the body’s defense mechanisms to cause disease. In the case of HIV infection, an OI is usually an infection caused by an organism that is normally kept in check by the cellular immune system, the part of the immune system that is most damaged by the HIV virus.
Some pathogens are exclusively opportunistic, meaning that they almost never cause problems in people with normal immune systems. Examples include many of the common HIV-related OIs, including Pneumocystis, Cryptococcus, Mycobacterium avium complex (MAC), and Toxoplasma. Other pathogens take advantage of immunosuppressed patients but can cause disease in anyone. Examples include herpes simplex virus (HSV), human papilloma virus (HPV), and the bacterium that causes tuberculosis, each of which causes more frequent or severe disease in people with low CD4 counts. As a general rule, “exclusive opportunists” cause disease in people with lower CD4 counts than “optional opportunists.”
In some cases, OIs can be prevented by avoiding exposure to the pathogen itself. For example, we lower the risk of spreading TB by isolating those who are actively infected; you can avoid toxoplasmosis by cooking meat properly; you can avoid syphilis by wearing condoms. However, many opportunistic pathogens are “ubiquitous”—they’re found everywhere and can’t be avoided. Examples include Pneumocystis, MAC, and Cryptococcus. Prevention of infections caused by these organisms requires either prophylaxis(medical treatment that prevents disease) or better yet, ART, which keeps the CD4 count above the danger zone.
Much has been written about the growing number of older people in this country, as well as the incremental shift in favorable policies and attitudes toward certain segments of the LGBT population.
Important: 2. LGBT older people report fearing that if their sexual orientations and gender identities become known by healthcare or long-term care providers, as two examples, they will experience judgment, discrimination and inferior care.
NBC News: The widening Ebola epidemic is reminiscent of the health threat caused by AIDS, the director of the Centers for Disease Control and Prevention said Thursday, urging action so Ebola “is not the world’s next AIDS.”