Communication Is the Key

It is not just doctors but HIV patients too who should be active participants in their health care management, says Eric Daar, chief of the division of HIV medicine at Harbor-University of California, Los Angeles, Medical Center. But instead of immediately getting bogged down in the specific medical tests and exams that will be conducted over time, health care providers recommend that HIV-positive patients first address a few key general issues and take simple steps to ensure that they receive quality medical care. ' Ask about your doctor's experience with HIV treatment and HIV-positive patients, says Michael Allerton, HIV operations policy leader for Northern California's Kaiser Permanente Medical Care Program. 'People are often afraid to ask that for fear that the doctor might be put off, but it's a critical question,' Allerton says. 'In all areas of chronic-disease management, experience breeds a better outcome.' If your doctor has had few HIV-positive patients or little background in treating the disease, switch to an HIV specialist or a general practitioner with a large HIV patient population. Check with local AIDS service organizations for physician recommendations. Another good source for locating an HIV doctor is the American Academy of HIV Medicine, which has more than 1,600 members. You can reach the group by telephone at (866) 241-9601 or link to its Web site at www.aahivm.org. ' Determine your comfort level'and your doctor's'in addressing sexual health issues, Allerton advises. This is important because patients engaging in high-risk activities may be exposing themselves to other sexually transmitted diseases. Excessive risk taking also can be a sign of untreated mental or emotional problems. If sexual health issues are avoided or either party is uncomfortable discussing them, look for a new health care provider. 'Patients must be willing and free to talk to their doctors about what they're doing sexually, and doctors need to respond nonjudgmentally,' Allerton explains. ' If you do not know what your CD4 count, viral load, and drug resistance tests results mean, ask your physician. Because these tests are indicators of your HIV disease progression and treatment success, it is imperative to understand how they work, Allerton says: 'It also lets the patients help decide when to begin medications or make changes. It becomes more of a partnership.' ' Prepare and carry a complete and regularly updated list of all the medications you are taking, including those not related to your HIV and all over-the-counter drugs, supplements, and vitamins you use, says Judith Feinberg, MD, board chair of the American Academy of HIV Medicine. 'People get hospitalized, go to emergency rooms, and end up getting treated by someone other than their primary caregivers,' she says. 'This list is important in those situations.' ' Before each office visit, write a list of questions and concerns you want to discuss with your doctor and take the list to your appointment, Feinberg notes. 'This will help make your visit as productive as possible for you,' she explains.