Patient Education for HIV and AIDS Nenette Dusal, RN
• Indicate that patient could be a source of infection to others and should take actions to prevent transmission – no exchange of blood or body fluids• Encourage patient to disclose HIV status to: – sex partners – needle-sharing partners
• Emphasize to HIV-positive woman that children should be tested for HIV• Discuss family planning with HIV- positive woman – the rate of transmission from mother to newborn is approximately 20% – can be decreased to less than 2% when antiviral therapy is provided during pregnancy
– If she does not want more children, discuss birth control options• Establish both a primary care and HIV provider for the patient and encourage regular follow-up care. – For primary care: yearly Papanicolaou smears for women and routine dental and eye examinations.
– For HIV: follow-up visits every 3 months with laboratory assessment of CD4+, HIV RNA viral load, CBC with differential, and comprehensive metabolic panel.• Teach patient to recognize and report important symptoms: – Change in pattern or magnitude of temperature elevation
– Development of a new focal complaint: • skin spots, sore mouth, and diarrhea• Emphasize to injection drug users that continued use may expose them to additional infection, and such infections may accelerate disease progression. – Assist them in finding drug treatment.
• Encourage patient to modify sexual behaviors for safer sex. – Use latex male condoms. – If a man will not use a condom, the woman can use a female condom. – Encourage patient to read literature from various AIDS action groups on safer sex techniques.
• If the patient abuses substances (drugs, alcohol): – Encourage enrollment in a treatment program. – Caution patient not to share needles and to join needle-exchange program, if available. – If unused needles are not available, advise cleaning needles before using with a bleach/water solution.
• Teach patient to optimize immune system function through: – sound dietary practices, exercise, regular sleep – Promote changes in the direction of more healthful living• Some patients may use complementary or alternative therapies, such as vitamins, herbs, and teas.
– Caution the patient to share these additional therapies with the primary provider.• Refer patient to resources such as: – Patient-oriented site with many resources including a list of hotlines for HIV consumers, www.thebody.com.
– Consumer oriented magazine, which is available online and by mail, www.poz.com.– 100 Question and Answers about HIV and AIDS by Joel Gallant (paperback available at bookstores). Excellent resource for patients in easy-to-understand language.– “100 Questions and Answers about HIV and AIDS” by the New York State Health Department, www. health.state.ny.us/diseases/aids/facts/quest ions/index.htm or 518-474-3459.
• References for health care professionals: – U.S. Public Health Service, www.aidsinfo.nih.gov. Comprehensive Web site with links to a variety of information sources, including a list of resources for consumers. – Centers for Disease Control and Prevention with general AIDS information, publications, resources, statistics, www.cdc.gov/hiv.
– Johns Hopkins University AIDS Service, www. hopkinshivguide.org/. General AIDS information, content review of recent AIDS conferences, e- mail HIV consult service for providers and patients.– International resources, www.unaids.org/en/. Provides international view of AIDS epidemic with links for other international resources.
DRUG ALERT• Oral contraceptives interact with many protease inhibitors and NNRTI medications• Encourage the patient to discuss this with her obstetrician/gynecologist because she may need alternative contraception• Perform careful medication reconciliation after the visit• Consult with the pharmacist if there is a question.
DRUG ALERT• Protease inhibitor levels can be affected by St. Johns wort, an herbal treatment for depression• Discourage patients taking protease inhibitors from using this over-the-counter herbal remedy.