Choosing a Healthcare Provider for HIV Treatment

by Brian A. Boyle, MD

Introduction

If you are newly diagnosed with HIV infection, this may be a very difficult time for you. Many newly diagnosed HIV patients have severe bouts of depression and anxiety. They simply don’t know where to turn or what they should do. This may lead to denial, procrastination, and avoidance. If you feel like this and have not taken steps to seek treatment, this understandable, but unfortunate behavior may be not only detrimental to your health and well being, but also may deny others the opportunity to be tested and treated or may lead to further spread of HIV through continuation of unsafe sex practices or needle sharing.

The Decisions

There are several decisions you have to make in order to be sure that you are doing what you can to:

• prevent the spread of HIV
• prevent the progression of your HIV disease to AIDS
• avoid getting sick or perhaps even dying

If you are engaging in high-risk behaviors, the first decision you need to make is to stop engaging in these behaviors, as they may endanger others and cause them to become infected. This means that you must not have unprotected sex (a condom or dental dam are required at all times to prevent direct contact) and, if you use intravenous drugs, you must not share needles with other people. The people with whom you have had sex or shared needles in the past may or may not already be infected. You should consider informing them yourself of their exposure to HIV, but if you are unable to do so, you should contact your doctor or the health department so that the people with whom you have had sex or shared needles can be informed anonymously and then get tested. If you have children, they may also need to be tested, but you can discuss this with your doctor as well.

Choosing a Healthcare Provider

This decision involves first assessing your healthcare options, gathering some information about providers, making a choice, and scheduling an appointment. Keep in mind that your contact with the healthcare provider you choose will be confidential and that your provider will not release information about you unless you tell him or her that it is all right. Remember, just because you visit one healthcare provider doesn’t mean you have to stay with him or her. If you don’t feel comfortable with that provider or you don’t like him or her, then you should continue your search and go see another provider. If you are a part of an HMO, you may need to pick a doctor from the list of providers in your HMO or you may be referred to an HIV specialist by a primary-care doctor. Someone at your health plan should be able to provide you with information about how to find an HIV specialist so that you are able to have several choices.

The medical qualifications
Healthcare providers include physicians, physician’s assistants, and nurse practitioners. Physicians have been to medical school, followed by a residency in internal medicine or family medicine, and in some cases, a fellowship in a subspecialty such as infectious disease. Nurse practitioners and physician’s assistants have not been to medical school nor have they done a residency or fellowship, but they have received a substantial amount of education and training and in some states, they are allowed to treat patients without physician supervision.

Some people feel more comfortable with a doctor, while others feel more comfortable with a nurse practitioner or physician’s assistant. You can receive excellent care from any of these healthcare providers so long as he or she is well versed in treating HIV disease and has adequate experience. This is an important attribute to remember, as several studies have shown that physician experience plays a major role in how well a person with HIV disease does, including whether they get sick and how well they take their medications.

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Support staff
Also, it is important to keep in mind that when you choose a healthcare provider you are also choosing that person’s support staff and system. Since there are a number of social issues and questions associated with HIV disease, you want to make sure that the doctor has someone on staff or someone to whom he or she can easily refer you who can help you take care of insurance and billing issues, drug or alcohol problems, disclosure issues, and other concerns that patients with HIV disease frequently must confront. These issues are complex and frequently require expert assistance from a very knowledgeable person. You are going to have enough to deal with. You should not have to be constantly struggling to get the benefits and help that you need.

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Last updated: 10/05

Brian Boyle, MD, JD, is an Attending Physician at the New York Presbyterian Hospital-Weill Cornell Medical Center and Assistant Professor of Medicine in the Department of International Medicine and Infectious Diseases at Weill Medical College of Cornell University.

Last updated: 10/05

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