A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 2: Approach to the Patient
Chapter 2:
Approach to the Patient
John V. L. Sheffield, MD
Gloria A. Casale, MD, MSPH
BASIC ELEMENTS OF CARE
STIGMA AND DISCRIMINATION
CONFIDENTIALITY AND DISCLOSURE
PATIENT EDUCATION
RISK ASSESSMENT AND COUNSELING
KEY POINTS
SUGGESTED RESOURCES
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BASIC ELEMENTS OF CARE
What are the special challenges of caring
for patients with HIV/AIDS?
Providers need to be mindful of several special issues:
• Patients infected with HIV face a complex array of
medical, psychological, and social challenges. A strong
provider-patient relationship, the assistance of a
multidisciplinary care team, and frequent office visits
are usually required to provide excellent care.
• The stigma associated with HIV/AIDS places a major
psychological burden on patients. Confidentiality is
critical, as is a careful assessment of each patient’s
emotional support system.
• Ethnic minorities are over-represented among people
with HIV. Efforts to understand and acknowledge
the beliefs of patients from a variety of cultural
backgrounds are necessary to establish trust between
providers and patients.
• Providers play a key role in the public health system’s
HIV prevention strategy. Disease reporting, partner
notification, and risk assessment are important
aspects of care.
• Many patients have inaccurate AIDS information that
can heighten their anxiety, sabotaging treatment
adherence and appropriate prevention behaviors.
They need assurance that HIV is a treatable disease
and that with successful treatment, patients may live
indefinitely. They also need to hear explicitly that HIV
is transmitted through sexual contact, intravenous
drug use, and blood contact (perinatal or other) and
how they can prevent transmission to others.
What are the important components
of good HIV care?
The elements that ensure good care for people with
HIV/AIDS include mechanisms for coordination and
communication of care:
• Clinics must offer a nonjudgmental and supportive
environment because of the sensitive nature of issues
that must be discussed.
• A multidisciplinary approach, utilizing the special
skills of nurses, pharmacists, nutritionists, social
workers, and case managers is highly desirable to help
physicians address patients’ needs regarding housing,
medical insurance, emotional support, financial
benefits, substance abuse counseling, and legal issues.
• Providers and other clinic staff should be prepared to
conduct appropriate interventions and make timely
referrals to community resources and institutions.
• The primary provider should coordinate care, with close
communication among providers across disciplines.
• Individual office visits should be long enough to allow
a thorough evaluation.
• Providers must be able to see patients frequently for
good continuity of care, and clinic scheduling should
be flexible so that patients with acute problems can
be seen quickly.
• A range of medical resources, including providers with
subspecialties and laboratory expertise, must be in
place (see Chapter 16: Clinic Management).
• Patient education is a vital aspect of care that begins
during the initial evaluation and continues throughout the
course of care (see section on Patient Education below).
What steps can providers take to
enhance care?
Providing comprehensive care for patients infected
with HIV requires a lot of time, attention to detail, and
a strong patient-provider relationship. Specifically, the
provider should do the following:
• Discuss issues in a straightforward fashion to foster
trust and openness.
• Be realistic about the seriousness of HIV disease and
yet, to instill hope, be optimistic about the potential to
restore health and to provide comfort. Give accurate
information regarding prognosis and the real hope
that antiretrovirals provide.
• Encourage patients to learn all they can about
their condition and take an active role in decisions
regarding their care.
U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
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