Considering Treatment and Your Health Care (Additional PLUS Reading Materials)


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Considering Treatment and Your Health Care (Additional PLUS Reading Materials)

  1. 1. BOOKLET 2 OF 3 HIV HEALTH & WELLNESSConsidering treatmentand your health care JANUARY 2013 your life matters
  2. 2. Table of contentsUsing this booklet ... 2How is today different from earlier in the epidemic? 3KNOWLEDGE: Understanding the details of treatment Why take HIV medications? 4–5 Choosing the best time to start 6–7 When to start: CD4 count ranges 8 Classes of HIV meds 9 Recommended regimens for first line treatment 10 A few things about your first regimen 11 Understanding test results 12 Resistance testing before starting 13HEALTH: Your ability to start and maintain Women and HIV infection 14–15 Are you ready to start? 16 Side effects from HIV meds 17 Drug interactions 18SELF-ADVOCACY: Getting ready to start Getting your health care covered 19–21 Is your doctor experienced in treating HIV? 22 Important questions to ask others 2RESOURCES: Checklist for getting started 24 HIV Health & Wellness: Considering treatment and your health care 1
  3. 3. Using this booklet ... The main focus of this booklet is to get you thinking about HIV and your health. Because treating HIV can be complex and because only you can take the medicines your body needs, your ability to commit to the meds are a critical part of your health decisions. Getting the earliest treatment is generally recommended for most illnesses. HIV may not be any different; except that once it’s started, treatment is for life. On one hand, deciding the best time to start HIV meds is a matter of personal choice. On the other, study results increasingly lean toward starting earlier. Some experts believe that starting meds is appropriate immediately after finding out your diagnosis. Waiting might allow HIV to progress further and do more damage to your immune system and to other body systems and organs such as your heart, blood vessels and kidneys. At a minimum, most doctors would agree that it’s neces- sary to start meds when HIV symptoms are present, your CD4 count is falling, or your viral load is high and rising. HELPFUL RESOURCES Just Diagnosed Resource Center HIV Health & Wellness: Considering treatment and your health care
  4. 4. How is today differentfrom earlier in the epidemic?Treating HIV is very different todaythan what it was earlier in the epi-demic. People are now healthier andliving longer on HIV meds, andmany can start with a full regimenof just one or two pills taken onceor twice a day. There are fewer foodrestrictions, and drugs are generallyeasier to take and tolerate. Perhaps some of the things you believe about today’smedicines are not — or are no longer — true. Concernsstill linger in the community about severe side effects andhow someone might look after being on meds for awhile.Newer regimens generally have fewer and more manage-able side effects. The drugs that caused the most problemsare rarely used for people starting treatment in the US. Over the years, public health care programs as well asprivate health insurance have greatly improved their HIVcare, allowing more people to find and pay for stable medi-cal care. The medical community also has a great deal moreexperience treating HIV today. HIV Health & Wellness: Considering treatment and your health care 3
  5. 5. Why take HIV medications? Although most people don’t have outward symptoms of HIV for many years without being on treatment, it’s extremely rare that the immune system can fully sup- press HIV on its own. The longer you have untreated HIV the more damage it can do, making you more susceptible to infections and other health problems. IMPROVING QUALITY OF LIFE Being on HIV treatment should interfere as little as possible with your quality of life. It should be easy enough to use so you can take every dose as prescribed. For most people, it’s possible to find a regimen that works well with mini- mal side effects or drug interactions. If you cannot tolerate a drug or the regimen isn’t working for you, it’s possible to switch to other options. IMPROVING IMMUNE FUNCTION Taking HIV treatment normally produces a higher CD4 count. Some people experience a rapid rise in their CD4s after starting treatment, but for others the increase may take more time. This is especially true if you wait to start treatment until your CD4 counts are very low, such as below 100.4 HIV Health & Wellness: Considering treatment and your health care
  6. 6. REDUCING VIRAL LOADHIV treatment makes it easier for the immune system tocontrol HIV. The goal is to keep HIV levels as low aspossible for as long as possible, preferably below 50 copies(called undetectable). The minimum change that showstreatment is working is lowering your virus level by 90%,or a 1 log decrease (such as 10,000 down to 1,000).REDUCING DRUG RESISTANCEWhen HIV is fully suppressed by HIV meds, it’s lesslikely to change and become resistant to the drugs.Taking every dose as prescribed and staying undetect-able can help prevent resistance. Most commonlyused HIV meds are so good now that they’re able toovercome drug resistance for many years even withone or two doses missed every once in a while.HELPING PREVENT TRANSMISSIONPeople who take HIV meds and stay undetectable areless likely to transmit HIV. However, even with goodadherence to an HIV regimen, there’s still some risk intransmitting HIV — forexample, active sexuallytransmitted diseases(herpes, syphilis, etc.)can increase the risk. It’simportant to continueengaging in safer sex. HIV Health & Wellness: Considering treatment and your health care 5
  7. 7. Choosing the best time to start The following factors can help you and your provider choose the best time to start treatment. YOUR CD4 COUNT TREND A trend is when you look at two or more CD4 count results to see how much they change. Over time, falling CD4s indicate declining immune health. A loss of 100 CD4s or more each year shows a weakening immune system. Don’t panic about a single lower test result, but consult with your doctor and consider another test to determine your trend. (Read more on page 8.) YOUR VIRAL LOAD TREND Increasing HIV levels over time indicate that the virus is reproducing and can infect more CD4s. Again, the trend is important: consider two or more test results to inform a treatment decision. Experts generally agree that viral load rising above 100,000 is a sign to start.6 HIV Health & Wellness: Considering treatment and your health care
  8. 8. YOUR GENERAL HEALTHIf your health is good and stable, then starting treat-ment right away may not be necessary. But if youhave some symptoms of HIV disease, despite a goodCD4 count, starting is usually the right decision. Onthe other hand, if you have an illness that may makeit difficult to take HIV meds, it may be better to waituntil that illness has resolved. Your doctor can helpyou make this decision.ARE YOU READY TO START?You should begin treatment when you feel you’re ready,but you shouldn’t put it off until all your fear is gone.Being ready includes being emotionally ready to com-mit over the long-term, as well as being able to takepills every day, manage possible side effects, and makesure you have ongoing health care. It might also meandealing first with other issues such as finding stablehousing or mental health or substance use services.THESE CONDITIONS INCREASE THE URGENCY TO START: HIV Health & Wellness: Considering treatment and your health care 7
  9. 9. When to start: CD4 count ranges STARTING TREATMENT BETWEEN 0–350 CD4 CELLS Waiting to start until a CD4 count drops below 350 puts you at much higher risk of developing many health problems. These can include conditions related to HIV (pneumonia, certain cancers, etc.) and other conditions (heart attacks, kidney disease, etc.). Almost all doctors would agree that people with low CD4 counts should start treatment as soon as possible. STARTING TREATMENT BETWEEN 350–500 CD4 CELLS The risk of getting sick isn’t quite as high in this range. Fewer studies confirm the benefits of starting in this range compared to lower CD4s. For this reason, you may have more time to get ready to start. However, it’s important to under- stand that some studies suggest your risk of getting sick is higher if you don’t start in this range. Longer-term damage to your body is occurring as long as HIV is not kept low. STARTING TREATMENT ABOVE 500 CD4 CELLS A couple of studies show a lower risk for getting sick in people who start this early. Many other studies show that early damage to your immune system and other parts of the body happen when HIV isn’t well controlled — no mat- ter the CD4 count. As well, people who are on treatment with undetectable HIV are much less likely to pass on HIV to their sex partners. However, even though the risk of side effects is much lower with modern treatment, taking meds longer could increase your chance of developing certain side effects. It’s reasonable for someone to start above 500, but the pros and cons should be carefully considered.8 HIV Health & Wellness: Considering treatment and your health care
  10. 10. Classes of HIV medsYour first regimen will probably include three drugs fromtwo different classes. These classes work against differentsteps in the life cycle of HIV. Using at least two classes to-gether provides better and longer-lasting health. Below is the current list of HIV meds, organized by classand then listed by brand name, generic name and year of FDAapproval. Some drugs are no longer used or not used oftenin the US, while others are used only in special situations.NRTIs (nucleoside/nucleotide NNRTIs (non-nucleosidereverse transcriptase inhibitors) reverse transcriptase inhibitors) Emtriva (FTC, emtricitabine, 2003) Edurant (RPV, rilpivirine, 2011) Epivir (3TC, lamivudine, 1995) Intelence (etravirine, 2008) Retrovir (AZT, zidovudine, 1987) Rescriptor (delavirdine, 1997) Videx EC (ddI, didanosine, 2004) Sustiva (EFV, efavirenz, 1998) Viread (TDF, tenofovir, 2001) Viramune (nevirapine, 1996) Zerit (d4T, stavudine, 1994) ENTRY INHIBITORS Ziagen (ABV, abacavir, 1998) Fuzeon (T20, enfuvirtide,PIs (protease inhibitors) injectable, 2003) Aptivus (tipranavir, 2005) Selzentry (maraviroc, 2007 Crixivan (indinavir, 1996) FIXED DOSE COMBINATIONS Invirase (saquinavir, 2003) Atripla (TDF+FTC+EFV, 2006) Kaletra (lopinavir/r, 2000) Combivir (AZT+3TC, 1997) Lexiva (fosamprenavir, 2003) Complera (RPV+TDF+FTC, 2011) Norvir (ritonavir, 1996) Epzicom (3TC+ABV, 2004) Prezista (darunavir, 2006) Stribild (ELV+TDF+FTC, 2012) Reyataz (atazanavir, 2003) Trizivir (AZT+3TC+ABV, 2000) Viracept (nelfinavir, 1997) Truvada (FTC+TDF, 2004)INI (integrase inhibitor) elvitegravir (ELV, 2012) Isentress (raltegravir, 2007) HELPFUL RESOURCES HIV Health & Wellness: Considering treatment and your health care 9
  11. 11. Recommended regimens for first line treatment (updated March 2012) The Guidelines list “preferred” and “alternative” HIV regi- mens. Research shows that “preferred” regimens are potent, better tolerated and easier to take. These are listed below. “Alternative” regimens are second choices but may work just as well. These can be found in the Guidelines. PREFERRED REGIMENS NNRTI: Atripla (1x/day), 1 pill Women should get a pregnancy test done before start- ing this pill. One of the drugs in it, Sustiva (efavirenz), can cause birth defects. PI: Prezista/Norvir + Truvada (all 1x/day), 4 pills PI: Reyataz/Norvir + Truvada (all 1x/day), 3 pills People who are taking more than 20mg of omeprazole (an antibiotic) should not start Reyataz. INI: Isentress (2x/day) + Truvada (1x/day), 3 pills This regimen is a little unusual in that one pill is taken once a day while the other is taken twice a day. People should not take both pills of Isentress 1x/day because it does not control HIV as well as taking one pill 2x/day. Pregnancy: Kaletra + Combivir (all 2x/day), 4 pills HELPFUL RESOURCES Guidelines for Treating HIV in Adults   more  recent  updates  to  the  Guidelines  for  preferred  regimens.10 HIV Health & Wellness: Considering treatment and your health care
  12. 12. A few things about your first regimenThe most powerful and long-lasting control of HIV comesfrom a person’s first regimenif taken properly. The longera person can stay on it with-out major side effects or drugresistance, the better. To tell if your regimen isworking, you should see a90% drop in your viral loadwithin a month or two. (Seepage 5.) Most people can reach an undetectable level withinsix months, although it may take up to a year if you’re over 50or have another condition like hepatitis C. When a person’s viral load remains undetectable for atleast one year on treatment, it usually remains that way forat least another two years, assuming they take their meds asprescribed. Some people have been able to stay on their firstregimen for up to eight years without having to switch. Thisis true for almost any regimen. _______ MAIN POINTS TO REMEMBER _______ control of HIV. should drop by at least 90%. months. HIV Health & Wellness: Considering treatment and your health care 11
  13. 13. Understanding basic test results VIRAL LOAD TEST A viral load test is used to check how well treatment is con- trolling HIV. It measures the number of copies of HIV in a small amount of blood. People starting treatment for the first time usually see their viral load fall to an undetectable level within 12–24 weeks. Several things can influence this, including taking the meds as prescribed and the potency of the regimen. Higher viral loads may take longer to respond. CD4 CELL COUNT HIV treatment helps to preserve and increase your CD4 count, which means the immune system is getting better at controlling HIV and other infections. The actual increase will vary from person to person. If you start treatment with a lower CD4 (below 200) it usually takes more time to reach higher counts, or you may not see a large gain. Older people and those with hepatitis C may also have smaller gains. CD4 PERCENTAGE The CD4 percentage shows the proportion of all white blood cells that are CD4s, which in people living with HIV averages about 25% or more. This marker tends to change less often be- tween tests than the CD4 count, and it may be more reliable. A decreasing CD4% over time shows a weakening immune system, and one that falls below 14% is an AIDS diagnosis. HELPFUL RESOURCES Blood Work Understanding Lab Results HIV Health & Wellness: Considering treatment and your health care
  14. 14. Resistance testing before startingDrug resistance occurs when HIV mutates,or changes enough so that a drug orregimen doesn’t fully control it any-more. Resistance usually occurs whendrugs are not taken as prescribed andconsistently on schedule. Some people(about 1 out of 9 per year in the US) geta strain of HIV with some level of resis-tance. However, HIV is rarely resistantto all HIV meds, so learning ahead of time which drugs it isresistant to (if any) can help you choose the best regimen. The US Guidelines recommend that people get a geno-typic resistance test before they start or change treatment.People who choose HIV meds guided by resistance testresults have better control of HIV over time. To run a resis-tance test, you must have a viral load above 1,000. The testcannot be done accurately if viral load is below 50 copies. _______ MAIN POINTS TO REMEMBER _______ your doctor make better treatment decisions. done when viral load is above 1,000. HELPFUL RESOURCES HIV Drug Resistance Tests HIV Drug Resistance Mutations HIV Drug Resistance Database HIV Health & Wellness: Considering treatment and your health care 13
  15. 15. Women and HIV infection HIV meds have not been studied as much in women. Some questions remain about the doses given to women. Female hormones may also affect HIV meds. However, the recommendations for when to start and what to choose are generally the same for both sexes. Women who are not pregnant, planning to become pregnant, breast-feeding or taking hormonal birth control can follow the same guidelines as men. Women sometimes experience both a higher rate and different types of side effects from HIV meds than men, likely due to differences in their weight and body size. In some cases side effects can persist longer for women than for men, but usually decline over time. Oral contraceptives can interact with some HIV meds. It’s not clear whether this actually raises the risk of unintentional pregnancy, but some experts recommend that prescriptions should be changed or other forms of birth control should be used.14 HIV Health & Wellness: Considering treatment and your health care
  16. 16. With careful planning and ongoing care, pregnantwomen can expect to have a safe pregnancy and to givebirth to an HIV-negative baby. Although HIV medshave not been well studied in preg-nant women, the US Guidelines rec-ommend that all pregnant women beon treatment to protect themselvesand their unborn babies. Some medsappear to be safer, some can be moreproblematic, and a few others shouldnot be used at all. When makingdecisions around pregnancy, deliveryand nursing, it’s wise to consult anHIV-experienced doctor, such asan OB-GYN who has treated HIV-positive women. _______ MAIN POINTS TO REMEMBER _______ for women and men. effects than men. as birth control pills, pregnancy, delivery and nursing. HIV Health & Wellness: Considering treatment and your health care 15
  17. 17. Are you ready to start? It can be hard to take medicines and stay on them when you’re feeling well. It’s easier to remember and take them when you feel sick because you want to feel better. But HIV meds are taken every day — whether you feel good or feel bad. It’s difficult to fully grasp the meaning of “lifelong” treat- ment, but once you start HIV meds you need to stay on them. How do you feel about taking pills every day? Have you taken other medicines or vitamins long-term? How about family or friends? What were their experiences? Adjusting to several changes in your life at once can be hard. You may want to avoid starting meds before disrupt- ing life experiences like going on vacation, moving or start- ing a new job. What flexibility do you have with commit- ments like caring for children or volunteering? How will you carry your meds? It’s generally better to not start until you’re ready rather than to start and stop. You’re the expert on when you can start in a way that helps ensure your quality of life. STIGMA For many, privacy is an important consideration when taking HIV medicines. Taking them on time every day or going to regular doctor visits may raise suspicions of some people in your life. Discrimination or disapproval from others can make it challenging to take care of your- self. When possible, discretely telling people who sup- port you may help you stay healthier.16 HIV Health & Wellness: Considering treatment and your health care
  18. 18. Side effects from HIV medsModern HIV regimens generally havefewer and more manageable side effects,and many people tolerate them quitewell. Although most people wonder orworry about side effects, it’s impossibleto predict who will have them. Somepeople have few or no side effects, whileothers have ones that are more troublesome for them. Theside effects one person has from a particular medicine doesnot mean everyone else will have the same ones. Short-term side effects (headache, fever, nausea, etc.) nor-mally appear during the first few weeks of taking a new drug.They often get better or disappear as your body gets used tothe meds. They can reappear due to stress or other infections. People with better overall health usually experiencefewer short-term side effects. If you start later when you’reless healthy, you may experience more side effects. How-ever, if your regimen interrupts your quality of life, you canprobably switch to another one that you can tolerate better. You and your doctor will keep track of long-term sideeffects with routine blood tests. These can include changesin blood fats or in certain blood proteins (such as ALT,AST, amylase and creatinine) that point to possible problemswith certain organs, including the liver and kidneys. Overtime, these changes can progress to other conditions likemore fragile bones or kidney and liver disease. HELPFUL RESOURCES Dealing with Drug Side Effects HIV Health & Wellness: Considering treatment and your health care 17
  19. 19. Drug interactions Drug interactions are possible whenever you take two or more drugs together, whether they’re prescriptions, over- the-counter drugs like cold medicine, recreational drugs or even herbal products. Even food can interact with drugs. The more meds you take, such as meds for high blood pres- sure or even erectile dysfunction, the more likely you could experience an interaction. This is also true about taking HIV meds with some herbal products, especially St. John’s Wort. Not only does each drug or herb have its own possible side effects, they may also increase or decrease the effec- tiveness of other drugs. Drug interactions are not always considered when making treatment decisions, but they can certainly play a major role in its success. Make sure your doctor knows about all the drugs and supplements you take, including over-the-counter products and recreational drugs. Your pharmacist can also be a good resource. Drug interaction tools are also available online. _______ MAIN POINTS TO REMEMBER _______ drugs or herbal products. meds to avoid or correct drug interactions. HELPFUL RESOURCES HIV Drug Interactions Medwatch HIV Health & Wellness: Considering treatment and your health care
  20. 20. Getting your health care coveredYou may never need to file for disability, but for simplicity wepresent these options in terms of pre- and post-disability.Disability is a formal claim that must be made with yourdoctor and approved by Social Security. To find programs youmay be eligible for, it’s important to consult local resourcessuch as benefits counselors, case managers, social workersor attorneys as programs differ greatly from state to state. IF YOU HAVEN’T FILED FOR DISABILITY …GROUP INSURANCE THROUGH YOUR EMPLOYERIf your employer covers health care, the insurance companymust cover you even if you have a pre-existing condition likeHIV. There are three types of plans: fee-for-service, preferredprovider organizations (PPOs), and health maintenanceorganizations (HMOs). Plans vary in what they offer, theirfees and your choice of doctors. Choose a plan that is bestfor you, and check your plan for HIV-experienced doctors.COBRAIf you leave work due to a layoff and had insurance, thenyou should be offered a continuation policy called COBRA,which is meant to sustain you until you get other insurance.INDIVIDUAL PRIVATE INSURANCEIndividual plans are an option, but few people with HIVcan purchase them due to high cost and restrictions on pre-existing conditions. If you had coverage before your HIVdiagnosis, it’s likely most or everything you need will becovered. However, out-of-pocket expenses may be high. HIV Health & Wellness: Considering treatment and your health care 19
  21. 21. Getting your health care covered, cont. HIGH RISK INSURANCE POOLS This program covers people who can’t get insurance due to pre-existing conditions and operates in 36 states. In addi- tion, under health care reform each state has a Pre-existing Condition Insurance Program (PCIP) in place until 2014 when the large coverage expansions will occur. FEDERAL RYAN WHITE PROGRAM Ryan White funds a broad range of HIV services in states and localities, depending on their unique needs. It’s intended to help under- or uninsured people. If you have insurance, you may get help with premiums or other out-of-pocket costs. If you don’t have insurance, your state program may help you purchase it. You may also get free or very low cost care through HIV clinics and the AIDS Drug Assistance Program (ADAP). Ryan White may also fund dental and vision care. Check with your state AIDS program or ASO to see if a Ryan White program can help you. IF YOU HAVE AN APPROVED DISABILITY CLAIM … COBRA If you leave work due to disability and had insurance, you’ll be offered COBRA until you can get other insurance like Medicare. Coverage is often expensive. Check with a local ASO or state AIDS office for programs to help with out-of- pocket costs. MEDICAID Most people with HIV qualify for Medicaid through its disability category, although some women with children can qualify through a different program. Nearly all states20 HIV Health & Wellness: Considering treatment and your health care
  22. 22. Getting your health care covered, cont.require a disability claim, income and assets below a certainlevel to qualify. Several states offer Medicaid to all childlessadults (AZ, DE, HI, MA, NY and VT), while several othersoffer some benefits. States vary greatly in what they coverand who qualifies.MEDICARE ( you have held a job, you’ll likely qualify for Medicare.However, you must wait 29 months after your disabilityclaim, during which you may be able to get your health carethrough COBRA, Ryan White or Medicaid. OTHER POSSIBLE SOURCES OF HELPPATIENT ASSISTANCE PROGRAMS (PAPs)PAPs are run by HIV drug makers to supply meds topeople who are under- or uninsured. They differ widelyin eligibility. These are not ideal for the long-term but canhelp in the short-term or in an emergency.VETERANS ADMINISTRATION ( you’re a veteran or family member, you’re eligible for carethrough the VA. VA sites are only found in some areas andvary in their ability to provide HIV care. As a veteran, you canaccess Ryan White programs, but if your VA facility is acces-sible and offers quality HIV care, it may be a good option. HELPFUL RESOURCES Welvista (access HIV meds for those on ADAP wait lists) Federal resource on health care Pre-existing Conditions Insurance Plans, List of PAPs for HIV meds Social Security Administration HIV Health & Wellness: Considering treatment and your health care 21
  23. 23. Is your doctor experienced in treating HIV? You will need to find a doctor who’s able and willing to treat HIV, ideally one who already has experience with HIV. Depending on how and where you get health care, you may not have many choices. Experienced doctors usually keep up with recent develop- ments in treating HIV. They also have a better sense of preventive health care. If you can, it’s also important to find other doctors like gynecologists, eye doctors and dentists who have HIV experience. Doctors with less or no HIV experience may need to consult resources that can help them provide the best medical care for you. Resources are available that can help you and your doctor make informed decisions. The WarmLine (National HIV/AIDS Clinicians’ Consul- tation Center) provides expert clinical advice to medical professionals. It’s available Monday–Friday, 8am–8pm, Eastern Time. (See below.) HELPFUL RESOURCES WarmLine 800-933-3413 (for doctors only), AIDS Education Training Centers Clinical Care Options GLMA’s Find a Provider, click FIND A PROVIDER HIVMA’s Find a Provider, click FIND AN HIV PROVIDER AAHIVM’s Find a Provider, use REFERRALLINK at right22 HIV Health & Wellness: Considering treatment and your health care
  24. 24. Important questionsFOR YOUR DOCTOR: FOR OTHERS: Do you start every Have you started on HIV patient on treatment at meds? Why or why not? the same time, or on the What was important same regimen? Why or for you to understand why not? to help you make a Should I be concerned decision about starting about HIV meds inter- meds? acting with other drugs When did you know it or herbs that I’m taking? was the right time to Should I be concerned start? about drug resistance, What other ways do you and how do I keep keep yourself healthy? ahead of it? Do you know of support What tests or prescrip- groups or agencies that tions are covered by my help people talk about insurance (public or these decisions? private)? How do you make sure How do blood tests you take every dose of inform my decision to your meds every day? start treatment? How did your blood What vaccines do you work inform your deci- recommend I get? Why? sion to start? What if I’m not ready to Did other things affect start treatment? your treatment decision? Are there are any other tests that I should take What HIV treatment before starting an HIV information do you rely regimen? on? Why? HIV Health & Wellness: Considering treatment and your health care 23
  25. 25. Checklist for getting started I am (am not) ready to start taking HIV meds, and under- stand the reasons why I want (don’t want) to start. My CD4 count is _______. The trend is stable, increasing, decreasing. My viral load is _______. The trend is stable; increasing; decreasing. I have a good understanding of the risks and benefits of starting treatment according to my individual needs. I have thought about how HIV treatment may impact my life. I’ve considered the issues around taking HIV meds and oral birth control, or HIV meds and pregnancy. I have private or public insurance or another way to cover the cost of my doctor visits, medicines and blood work. I know where to go to get other types of support, like mental health or housing services, that will help me stay healthy. I will ask how to properly take my medicines. I understand how my doctor and I will check to see if my regimen is working. I know what side effects may give me the most problems, like nausea or diarrhea, and which likely get better over time. I’m aware of what I can do to help avoid or lessen side effects. If I want privacy when taking my meds, I’ve thought about how to ensure that. If I have questions and my doctor is not available, I can call _________________ or __________________.24 HIV Health & Wellness: Considering treatment and your health care
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