America Living With AIDS

AM E R I C A Living With A ID S

There is a re
of burnout on the pa
we physicians and the
ng staffs.... We hav
or problem as treate
ýgarding how to take
Sour own psyches as
maintain the psyche.
tients and their fam
addition to that, nev
cians are not going i
)S treatment. They a
ding hemophiliac cai
They are avoiding
|ing that has to do w
AIDS care.

ing unnecessary hospitalization by
moving treatment to less intensive and
more familiar settings. Many procedures formerly requiring hospitalizations, such as lumbar puncture,
chemotherapy, and transfusions, are
increasingly performed in outpatient
settings in the context of HIV care.
The ability to receive care outside of
the hospital can enhance quality of
life, foster autonomy, improve outlook
and attitudes, and allow people with
HIV disease to spend
more time with, and
sometimes be cared for
al by, their loved ones.
irt The desire of people,ir living with HIV disease to
'e a remain at home and be
rs cared for at home has
coincided with fiscal
well pressures to reduce health
s of care costs and shorten the
ilies. length of hospital stays,
v fostering the growth of
nto the home health care
re industry. Scores of comre. panies now offer intravenous, intramuscular,,ith and aerosolized home
therapy. AIDS care constitutes a significant portion of this rapidly growing sector of the health
care system. Rules and
regulations for thirdparty payment must be
adjusted to meet new realities and
opportunities for home health care.
As home health care efforts grow,
increasing attention will be necessary
to the quality and cost of such care.

LINKING HI\ PRE\ ENTION
WITH PRIMARY CARE
Behavioral change will continue to be
the greatest hope for altering the
course of the epidemic. Prevention
and education programs will continue
to be of paramount importance in
encouraging such change. Of particular interest in the health care context
are programs of HIV antibody testing
and counseling. There is a longstanding consensus that HIV antibody testing alone will not suffice in creating
and sustaining behavioral change.
Nevertheless, when testing is accompanied by supportive pre- and posttest counseling, knowledge of HIV
antibody status can help some individuals make the changes necessary to
prevent the further spread of HIV.
Beyond its function as an adjunct
to behavioral change, HIV antibody
testing now has a role to play in the
context of early intervention. Discovery that one is HIV positive early in
the course of HIV disease can provide
hope of a longer life of better quality
when diagnosis, monitoring, and
treatment begin early in the course of
HIV disease. Individuals at risk of
HIV infection need ready access to
voluntary testing and counseling services in order to find out their HIV
status. For many impoverished individuals, gaining entry into a health
care and social services system by
means of a passport stamped "HIV
antibody positive" is a cruel hoax.

SSLER, M.D.
zber 1989

54