many people living with hiv have unmet treatment needs – open conversations with their health-care providers can uncover them

as treatment for hiv has evolved over the past two decades, so have the needs and goals of people living with hiv. antiretroviral therapy is available to help suppress the virus, and although hiv infection is still incurable, it can be treated. today, the unmet treatment needs of people living with hiv (plhiv) are changing, as are the conversations they want to have with their communities and health-care professionals.  

dr. jonathan angel, h ead of infectious diseases at the ottawa hospital and associate professor of medicine at the university of ottawa, has seen first-hand how treatment discussions have evolved.   

“there have been huge advances in medical therapies for hiv,” says dr. angel, who has been involved in hiv care for about 25 years. “when i began, therapies were relatively restrictive around dosing schedules, and many of us remember ads or stories of patients expressing struggles with their treatment regimens. of course, patients today still struggle, but the actual administration has generally become simpler. now, virtually all new, and most historic, patients can be treated with one pill a day. there are lots of exceptions, but that’s become the standard.”  

however, other unmet needs still weigh on the minds of some patients. a review of a survey assessing the emerging needs of people living with hiv has revealed just how prevalent these needs are. for example, 37.9 percent had concerns that a daily pill creates a greater chance of revealing their hiv status to others.   

“everyone is going to have their own view,” says dr. angel. “for a gay man living in a community where he has lots of friends and acquaintances with hiv, having hiv is less of an issue. but if you’re someone from a community where you’re ostracized if you have hiv, it can be a daily reminder and can perhaps make it very hard to live in privacy from others.”  

on the other hand, daily pills can actually be empowering to some people living with hiv. the same survey found that some were empowered by daily dosing, as it reminded them their hiv was under control.    

this contrast shows how a regimen can have very different psychosocial implications, depending on the individual. particularly with hiv, for which community and individual lived experience can so strongly influence perception of the condition.   

what does this mean for people living with hiv and health-care professionals? it underscores the importance of open dialogue in discussing hiv care.  

“i think we are very bad at predicting what a patient’s personal preferences might be,” says dr. angel. “for example, i’ve had patients where i’m almost reluctant to open a dialogue and bring up switching to an injectable treatment because they’re doing so well with their treatment. only to find they’re very interested in switching,” dr. angel says. “conversely, i’ve had patients who complain about pills – and when i bring up injectable therapy, they tell me they’re fine with what they’re on,” he adds. “you have absolutely no idea until you ask a patient. and i’ve been surprised in many ways.”  

dr. angel says it’s particularly important to acknowledge these differences, as community and individual lived experience can so strongly influence perception of the condition. “every person living with hiv is unique in that regard,” he says, “and as a physician, you really have to leave your assumptions at the door.”   

nearly two-thirds of people living with hiv would like to be more involved in decisions about their hiv treatment. given how greatly their needs can vary – and how difficult those needs can be for health-care professionals to guess – proactive conversations about treatment options and patient preferences are critically important to navigating today’s hiv care.  

furthermore, a collaborative and holistic approach to hiv care that facilitates ongoing communication between plhiv and health-care providers can help improve health outcomes and quality of life.  

is it time to think beyond viral suppression? ask your doctor about your hiv treatment options. visit : myhivtreatmentoptions.ca for more information and questions you can use for your next discussion.  

this story was created by content works , postmedia’s commercial content division, on behalf of a canadian health-care company.