Counseling Patients with HIV/AIDS
Noble, Sara L., Tatum, Nancy O., Replogle, William H., Drug Topics
People infected with the human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), are a rapidly expanding group with numerous concerns and needs. The uninfected public also has concerns about the disease. Pharmacists, readily accessible, are in an ideal position to provide counseling for many or these concerns.
Since passage of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), state laws and court cases have recognized the responsibility of the pharmacist not only to dispense medication but to monitor drug therapy, counsel patients, and document that care. In this lesson, we will attempt to define the role of the pharmacist as an HIV/AIDS counselor. We will present specific HIV prevention strategies and discuss current antiretroviral agents, opportunistic infection treatment, and prophylaxis protocols. Finally, we will attempt to equip the pharmacist with the tools necessary to become an effective HIV/AIDS counselor.
The pharmacist as HIV/AIDS counselor
Counseling of HIV-infected patients is difficult. Many different issues need to be addressed. They include knowledge of disease transmission and prevention, confidentiality, treatment initiation, drug therapy resistance, complex therapeutic regimens, adverse drug effects, drug-drug interactions, common opportunistic infections associated with the disease, AIDS-related weight loss, current clinical research trials, and HIV resource information. The pharmacist's role may vary with the site of service and the facility resources available to the pharmacist.
Barriers facing the pharmacist counselor
The pharmacist's role as HIV/AIDS counselor may be hampered by the complexity of the disease and the difficulty in maintaining current information. Many pharmacists may have been trained prior to the AIDS epidemic and might not feel comfortable with current multiple drug regimens.
To be effective as counselors, pharmacists must be able to manage the sometimes unique and uncomfortable situations associated with this disease. They must be able to address patients' perceptions of their individual needs and be able to discuss issues such as adverse drug effects, drug interactions, dosage information, and mechanism of action of drugs.
Concerns about confidentiality and privacy may be difficult to address in a busy pharmacy setting. While patients may not always desire empathy and compassion from the pharmacist, they do expect understanding of their condition and the unique problems they may face.
Prevention remains the key to halting the HIV/AIDS epidemic. The disease is spread through three known routes: It is spread by contact with infected blood and blood products via contaminated needles and syringes or through transfusion; it can be passed from an infected mother to infant during pregnancy, at delivery, or through breast feeding; most commonly, it is spread by sexual contact through the exchange of infected semen or cervical secretions.
Infection through contaminated blood and blood products has been significantly reduced since the mandatory testing of donor blood and blood products began in 1985. Exposure to contaminated needles and syringes remains a concern because of the continued epidemic of intravenous drug abuse and the potential exposure to contaminated instruments and body fluids by health-care workers. However, the main source of exposure is through sexual contact, and the major efforts at prophylaxis should be placed on the prevention of sexual spread of HIV.
Prevention of exposure to any sexually transmitted disease including HIV/AIDS is through abstinence of sexual activity or through the effective use of barrier methods. The most effective barrier method is the condom used consistently for anal or vaginal intercourse. Tests have shown that the latex condom is the only condom effective in reducing the spread of HIV. …