After you ve tested positive

Transcription

1 Booklet 1 of 3 ATTAINING HIV Health & Wellness: After you ve tested positive get informed ask questions live well AUGUST 2010

2 Attaining HIV Health & Wellness Project Inform created this series of three publications to address commonly asked questions and issues that people face as they come to terms with their HIV status and begin addressing their health care needs. After you ve tested positive (booklet 1 of 3) This booklet helps guide individuals on basic things to do after finding out they re HIV-positive, with an emphasis on understanding HIV infection, getting into care, and finding a support network. Considering treatment & your health care (booklet 2 of 3) This booklet explores decision making about HIV health, from considering treatment to talking things out with a support network and doctors to thinking more broadly about personal health needs. What you should know about when to start & what to use (booklet 3 of 3) This booklet focuses on the issues related to taking HIV medications, including deciding when to start and what to use, planning ahead, considering how treatment may affect one s life, and finding an HIV-experienced doctor. To order copies of this booklet, Project Inform at questions@projectinform.org.

3 Table of contents Using this booklet... 3 How is today different from earlier in the epidemic? 4 What should you do now? 5 KNOWLEDGE: Getting informed about HIV What is HIV disease? 8 Your immune system 9 Do you have to start meds right away? 10 HIV treatment guidelines 11 Two common blood tests: CD4 count and viral load 12 HEALTH: Getting involved in your well-being Getting into care as soon as possible 14 Finding and developing relationships with doctors 15 Your first few doctor visits Consider your general health 18 Ways to improve your health 19 SELF-ADVOCACY: Learning to support yourself Getting into health care 22 Telling others about your status 23 Lining up support Laws regarding disclosure and discrimination 26 Important questions 27 RESOURCES: Checklist for getting started 28 Online resources that may help 29 Personal tracking charts Attaining HIV, Health & Wellness: After you ve tested positive 1

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5 Using this booklet... The main focus of this booklet is to let you know that you can live well with HIV. It may take some time for that message to sink in, because adjusting to this new life may be an emotional road for you on top of it being a physical one. But this information has been written to answer questions that many people have after testing positive. You re not alone, and with resources and effort you can live healthfully with HIV, just as you did before your diagnosis. In the following pages, you ll find topics that will help you understand more about your diagnosis. You ll notice we highlight three key areas: knowledge (what can help to know), health (what can help to do), and self-advocacy (how to get what you need). When these three areas work well together, you get better outcomes. We believe that getting informed about HIV, being actively involved in your health, and talking things out with your doctor and support network can result in a longer, healthier life. Although medical care, support groups or referrals to housing and other services exist for people with HIV, it s up to you to engage with them and decide how well they suit your life. Sometimes the first referral may not be the right fit, so you may have to work at it for a time until you find what works best for you. You don t have to figure all of this out at once. Read at your own pace and revisit it from time to time as you feel ready for more. If you have any questions, call Project Inform s HIV Health InfoLine. We offer this information to help support, but not replace, the relationship with your doctor(s). HELPFUL RESOURCES HIV Health InfoLine , 10a 4pm, M F, PST Just Diagnosed Resource Center Attaining HIV, Health & Wellness: After you ve tested positive 3

6 How is today different from earlier in the epidemic? Living with HIV today is very different than what it was like in the 80s or 90s. You may have some very real fears about HIV such as telling others, starting medicines or the prospect of a life with HIV. These fears are normal, but some of them may be influenced by old ideas about HIV. Many people used to experience advanced disease well before knowing they were HIV-positive. They often found themselves going to an emergency room to treat very obvious opportunistic infections like PCP or KS. This is not the case for most people today, although it does still happen. Today, many consider HIV a chronic disease, like diabetes or heart disease. This means it s something to be aware of and treat each day of your life, once you start taking HIV meds. You will need to see a doctor about every 3 to 6 months to keep on top of it and attend to your overall health. But many aspects of HIV could make it more than a chronic disease for you, such as not being able to be open about it to your friends or family. Stigma and discrimination and even domestic violence related to HIV are real concerns for many, and these social aspects can sometimes make it difficult for individuals to take care of themselves. Finding a support network or contacting social services can help you address these issues. By getting tested, you may have found out your status much sooner than most people did earlier in the epidemic, giving you more time to make informed decisions. HIV is certainly not a walk in the park, but many more support systems exist today and much more is known about how to treat it. HIV meds have improved and extended the lives of people living with the virus, and today s meds are generally safer and easier to take. There are other steps you can take that can prolong your life, improve your health, and help you prevent other conditions. 4 Attaining HIV, Health & Wellness: After you ve tested positive

7 What should you do now? You ve already done a lot by knowing your status and beginning to adjust your life to living healthfully with HIV. Your diagnosis can be a wake-up call to be more proactive with your health, develop a healthier life style, and take full advantage of the options you have available. You likely have time to consider the many aspects to this new development in your life. This includes lining up various types of support, finding a doctor experienced in treating HIV, making decisions about HIV treatment, and getting linked into local resources that could help you maximize your well-being. Finding others who live with HIV and case managers or social workers can go a long way to support you in living well with HIV. Chances are if you re reading this booklet, you re already on your way. Hopefully you ve contacted an organization close to you or you ve talked to someone who gave this to you. If you haven t, we suggest you find local resources, with people who can give you referrals to services that suit you best. Project Inform can also help connect you to local resources at Attaining HIV, Health & Wellness: After you ve tested positive 5

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9 KNOWLEDGE: Getting informed about HIV

10 What is HIV disease? Simply put, HIV disease is a disease of the immune system, although it can infect other cells in the body like nerve cells. HIV (human immunodeficiency virus) causes disease because, after it gets into immune cells, it uses them to reproduce over and over. As a result, these cells function poorly or die early. Left untreated over time, your body will lose its ability to fight off other illnesses that are called opportunistic infections, or OIs. This gradual damage doesn t happen the same way in everyone, or even at the same pace. In some it may not happen at all, while in a few people HIV weakens their immune systems very rapidly, in just a few years. On average, without HIV treatment, it takes about 8 10 years before most people would face their first serious symptoms. With treatment, studies suggest that many people can live another 40 years with HIV. However, it s important to start treatment before these symptoms appear. Without treatment, the body will eventually lose its ability to fight infections. Most everyone will need to start treatment at some point to control their HIV. Even though you probably feel well, HIV is still considered a disease. The word disease makes it seem like you should feel sick, when in fact you can feel quite well a lot of the time. Some people don t think of it that way; instead they say they live with HIV or are HIV-positive. It s really the same thing. However, the term AIDS is different. In this case, a person with AIDS not only has HIV but has developed certain conditions. These include a CD4 count below 200, a CD4 percentage below 14%, and/or one of 26 AIDS-defining conditions. (More on CD4s is found on page 12.) Many people wonder if they have to start HIV meds right away. (See page 10.) In some cases, HIV disease can be treated with minimal impact on a person s life. For others, it may be more difficult. But treating HIV is becoming more manageable with each passing year. It s very possible that you can live well with HIV, and a full consultation with a doctor can help you devise the best treatment for you. 8 Attaining HIV, Health & Wellness: After you ve tested positive

11 Your immune system Next to the nervous system, your immune system is the most complex system in your body. It s made of many parts: cells, tissues, organs, fluid and vessels. Some of these include your skin, appendix, tonsils, spleen, thymus and lymph glands. Scientists know a lot about the immune system, but there s a great deal more to learn. Your immune system is constantly on alert to find microorganisms like viruses, bacteria, fungi and parasites. These are also called pathogens, which means they can cause disease. When one of these pathogens is found, your immune system goes into action to stop it from reproducing, destroy it and rid it from your body, which it does in many complex ways. As a result, you can feel various symptoms like headache, fever or aches and pains. During early infection with HIV, the immune system responds to get this new infection under control, which is why many people felt like they had the flu. And even though the immune system gets HIV under control to some degree in most people, the virus can push the immune system out of balance, cause inflammation, and destroy immune cells that may not be so easily replaced. This is one significant way it gets damaged. Research is looking at ways to replenish these lost immune cells. However, some ways to improve your chances of a healthy immune system are by getting into care as early as possible to keep track of your health, keeping your immune organs healthy, engaging in habits that promote health like proper diet and exer cise, preventing infections, and starting HIV treatment when it s appropriate for you. Using HIV medicines is the only way we know how to control the virus over time, and they have improved and extended the lives of people living with HIV. Attaining HIV, Health & Wellness: After you ve tested positive 9

12 Do you have to start meds right away? The answer depends on your situation, but many newly diagnosed people don t have to start treatment right away. You likely have time to get used to your diagnosis, learn more about HIV, and get your ducks in a row. This includes getting ready for treatment, fully understanding the benefits and risks of starting HIV treatment (or even not starting), and knowing how and where to access your medications. However, some people should start right away. A panel of HIV experts revises HIV treatment Guidelines to help with making decisions on when to start meds, as new information becomes available. (See next page.) If your blood tests show that your immune system is not controlling HIV or you have other illnesses that make you less healthy, you may need to start. Pregnant HIV-positive women are also recommended to start. Still others will start right away because they believe starting sooner will be better for them over time, which is something to discuss more in depth with your doctor or other people you trust. Some argue that starting as soon as possible may help prevent immune system damage, while others feel that it s better to wait due to possible long-term side effects. HELPFUL RESOURCES HIV, Health & Wellness: Considering treatment and your health care HIV, Health & Wellness: What you should know about when to start and what meds to use PI s position paper: When to Start Treatment 10 Attaining HIV, Health & Wellness: After you ve tested positive

13 HIV treatment guidelines The US Guidelines for treating HIV infection in adults were updated December 1, Updates are based on the latest understanding of current HIV research as recommended by a panel of more than 30 HIV-experienced doctors, researchers and community representatives. The panel culls through and considers a broad range of study results and makes recommendations based on these data along with their expert opinions and interpretation of those results. As of December 2009, the panel recommends everyone start treatment who has a CD4 count below 500. Pregnant women, people with an AIDS-defining illness, people with HIV-related kidney disease, and people living with hepatitis B disease who need to be treated for HIV should start treatment regardless of their CD4 count. These Guidelines are recommendations, not strict rules, and are one significant source of information for you and your doctor. Since treating HIV is best done considering the many needs of the individual, you and your doctor will likely use the Guidelines as one factor to consider, along with your own health and lifestyle considerations and ability to start and stay on your regimen. Other people may make different decisions about their treatment. HELPFUL RESOURCES US Guidelines for Treating HIV Infection in Adults HIV, Health & Wellness: What you should know about when to start and what meds to use Attaining HIV, Health & Wellness: After you ve tested positive 11

14 Two common blood tests: CD4 count and viral load As you keep up with your doctor visits, two blood tests are often used to keep track of the health of your immune system, as well as for making decisions about starting or changing therapy. The first, the CD4 count, shows how many of these important immune cells are found in a sample of blood, which represents the total amount in your body. The CD4 is usually looked at as the general of the immune system coordinating the immune response by telling other cells what to do. The goal is to keep your CD4s as high as possible for as long as possible. CD4 range What it GENERALLY means Below 200 Should be on treatment. Constitutes an AIDS diagnosis Should be on treatment. Some disease symptoms likely Recommend treatment.* Symptoms less likely, but possible. Above 500 Normal range. Could be on treatment.* Symptoms even less likely. * From US Guidelines for treating HIV. For more information, read Project Inform s publication, HIV, Health & Wellness: What you should know about when to start and what meds to use. The other test, the viral load, shows the amount of HIV that s found in a sample of blood, which represents the total amount in your body. An undetectable viral load (below 50 copies) is one main goal in treating HIV disease. This means that HIV is under control by your immune system or by the medicines you re on. A low viral load is generally considered below 55,000, and a high viral load is generally considered above 100,000. HELPFUL RESOURCES Blood Work: Two Common Tests 12 Attaining HIV, Health & Wellness: After you ve tested positive

15 HEALTH: Getting involved in your health care

16 Getting into care as soon as possible It s very important to get into care as soon as possible after your diagnosis. This is not because you should start taking medicine right away, but because you and your doctor will need to assess your health and begin planning for the future. Getting into care can improve your quality of life even before you start treatment. Some issues in your life may make it hard for you to see a doctor regularly, such as lack of stable housing, active drug and/ or alcohol use, or lack of insurance and other resources. These can and should be addressed as you establish your HIV care, and many resources are available. Your doctor may be able to help you with this or refer you to a case manager or social worker. For more information, read Lining up support on pages Many people develop a more assertive attitude about their well-being when they find out they have HIV. Because treating HIV disease can be complicated, making decisions about when, how and whether to start treatment isn t always easy. One of the first positive steps is to actively participate in your health care and help make treatment decisions. This means that both you and your doctor(s) should learn how to work and communicate thoughtfully with each other. Seeing a doctor on the first visit after your diagnosis can be an emotional time. Most doctors are sensitive and caring, and can respond well to your needs. However, they have time constraints and are there to provide medical help for your HIV, not necessarily emotional support. Friends, family, support groups, social workers and therapists are ways to find emotional support. HELPFUL RESOURCES AAHIVM Directory (click MEMBERS at top) GLMA Directory (click RESOURCES >> FOR PATIENT at top) HIVMA Directory (click DIRECTORIES at top) 14 Attaining HIV, Health & Wellness: After you ve tested positive

17 Developing a relationship with your doctor(s) Most of us simply do what we re told to do when it comes to our health. So, participating with your doctor in choosing treatment and talking about side effects and effectiveness of a regimen is a new experience for most people. You may not feel relaxed with it at first, and some doctors are unfamiliar with patients asking questions and can be uncomfortable with this type of relationship as well. However, people who help make their own health care decisions tend to have better health, which simply means to take a more active role in your health and treatments. You may also find that developing a closer relationship with other staff in your doctor s office, like a nurse practitioner or physician s assistant, can help as they often have more time to spend with you during an appointment. Other medical professionals can also be resources for you, such as a pharmacist you trust or even getting second opinions from doctors who your friends or family see. HELPFUL RESOURCES Building a Cooperative Patient/Doctor Relationship Attaining HIV, Health & Wellness: After you ve tested positive 15

18 Your first few doctor visits The first few appointments are important visits for you and your doctor. They will become the basis for what you learn about HIV and how you and your doctor will work together to treat it. You can interview doctor(s) before you make a final decision on who you want to see. You have the right to make sure you re comfortable with your doctor and to change them if the relationship isn t working for you. It s important to get a thorough exam and medical history done and to be open and honest about what you know about your health. Some conditions such as diabetes or hepatitis C can complicate treating HIV, so knowing these things as early as possible is one way to ensure your continued health. Writing questions down before your appointments can help you make the most of your visits. You may also want to consider finding a friend or an advocate to go with you to make sure everything gets covered. If you start seeing a new doctor, make sure you have your medical records transferred. 16 Attaining HIV, Health & Wellness: After you ve tested positive

19 Below is a list of common tests your doctor will probably run to assess your health. It s a good idea to check in with him/her about these to make sure the right tests and screenings are done to give you the most accurate information possible. You will need a couple of visits to cover all the bases. Complete medical history, if this is a new doctor Full physical exam Blood pressure reading Temperature Two sets of CD4 counts and viral load tests, taken about 2 weeks apart Genotypic resistance test, if viral load is above 1,000 Complete blood count Total cholesterol count Blood sugar Pregnancy test Hepatitis B and C screening Full GYN exam, including Pap smear Anal Pap smear, if at risk for anal cancer (HPV) Sexually transmitted infection screening and history Consider various vaccines as needed Oral exam by a dentist Attaining HIV, Health & Wellness: After you ve tested positive 17

20 Consider your general health Many people find that in dealing with HIV they also confront many other aspects of their lives. The most notable one is their overall health, as good general health can contribute greatly to positive outcomes when treating HIV. This includes addressing the mind, body, spiritual and social connections. People make choices daily about their health through both action and inaction. Taking time to identify and explore ways to improve your health will contribute to a strong foundation. Some of these issues include quitting smoking, getting enough rest and sleep, reducing stress, improving your level of exercise and nutrition, reducing or eliminating the use of drugs or alcohol, and keeping a close circle of friends. For example, eating certain foods, especially those high in sugar and saturated fats, can contribute to conditions like diabetes, heart and liver disease. Stress creates chemicals in the body that then aggravate the immune system. Continuing to engage in safer sex may not only prevent you from getting other sexual infections, it can also help you prevent passing HIV to others. Smoking and depression are common in people with HIV. Studies show that stopping smoking can greatly decrease health risks within the first year or two of quitting. Recognizing and properly treating depression can help individuals make better health decisions. Drinking alcohol and using drugs can harm the liver and other organs, so protecting these organs from unnecessary inflammation and damage is critical to living well. HELPFUL RESOURCES Ways to Maintain Your General Health Nutrition & Diet Tips 18 Attaining HIV, Health & Wellness: After you ve tested positive

21 Ways to improve your health There are many things that you can do to improve your health. The list below is offered as a way to help you think about what may work for you. Understand that HIV treatment works. Newer drugs are generally less toxic, and they re easier to take and tolerate. Reduce or eliminate drinking alcohol to protect the liver. Reduce or eliminate using street drugs. Get into a harm reduction or recovery program. Take your meds as prescribed. Buy a pill box. Set a pill reminder notice on your cell phone. Consider disclosing your status to others you trust. Keep up with your doctor appointments. Take daily walks instead of watching TV. Stop smoking. Improve your diet. Consult a nutritionist and friends. Get your other conditions under control through proper treatment, such as diabetes, hepatitis, high blood pressure, etc. Find a social network that suits you. Share ideas with others. Exercise at levels that best suit you. Get enough good sleep every night. Reduce stress when you can. Ask questions when you don t understand something. Get the proper vaccinations, including annual flu shots. Be alert to symptoms if/when they happen. Find HIV-experienced doctors, such as dentists, OB-GYNs, etc. Screen and treat OIs and other conditions appropriately. Ask for help. There are many resources available. Attaining HIV, Health & Wellness: After you ve tested positive 19

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23 SELF-ADVOCACY: Learning to support yourself

24 Getting into health care Some people have few problems getting their health care costs covered by private insurance, which is generally funded by your current or former employer. However, many other people living with HIV rely on public health care programs or insurance that is funded by federal and state governments to cover their health care costs. These include Medicaid, Medicare, the Ryan White program and the AIDS Drug Assistance Program (ADAP). Some of these are guaranteed for all who qualify and others have limited funding and may or may not be available in your area. However, it is likely you can find health care that you can afford or that s free of charge. The difficult part can be locating them and piecing together affordable care by combining several services. A more thorough discussion can be found in Project Inform s publication, Attaining Health & Wellness: Considering treatment and your health care. A qualified benefits counselor can help in figuring your way through this maze. Case managers and social workers can sometimes help as well. Check with your local AIDS service organization. Project Inform can also help, toll-free at HELPFUL RESOURCES Getting into Health Care High Risk Pool Program Access Project Centers for Medicaid & Medicare Services 22 Attaining HIV, Health & Wellness: After you ve tested positive

25 Disclosure: Telling others about your HIV status Telling others about your status can feel scary, but it can also help you cope. People who share their news enjoy better health, probably due to relieving the stress from keeping their status a secret, among other reasons. Not hiding your status from your medical providers can also help ensure that you get the most appropriate care. You don t have to tell everyone, or even anyone. But finding those who can support you will go a long way to staying healthy. Choose carefully who you want to tell and who you think will respond well to the news. And take your time when planning on whom to tell. For some people, telling others can mean facing the risk of abandonment or even violence. If you fear telling those close to you, find a support group, a therapist, or even a domestic violence assistance group to work through those relationship issues before you make final decisions. Think about what you would do if your disclosure doesn t go well. Some people, even some doctors, may not react well. It s best to be prepared for various reactions from those you tell and seek support if you need it. HELPFUL RESOURCES Telling Others about Your HIV To Tell or Not to Tell Attaining HIV, Health & Wellness: After you ve tested positive 23

26 Lining up support Although services are out there, like medical help, support groups, a treatment buddy, or referrals to housing and other resources, it s up to you to engage with them and decide how well they suit your life. You may have to keep working at it because the first group or first doctor may not be the right fit, or you may want more resources. Many people seek peer and other types of support in the first few months and even couple of years after a diagnosis. It s a helpful way to get used to the new surroundings, so to speak. For many people, this is a temporary but important way to seek help until you feel secure about what you need or don t need. You may even find someone who becomes your friend or confidante because they ve gone through the same things you re going through now. CASE MANAGER / SOCIAL WORKER / Benefits Counselor Many community agencies have case managers or social workers who know their local social service system and can help steer you in the right direction. Regularly touching base with them can solve some of the practical issues you may have, like finding transportation or housing, finding a doctor, paying for your health care, etc. Many organizations offer these services for free. Dial 211 for local service referrals, or call Project Inform for more information at Attaining HIV, Health & Wellness: After you ve tested positive

27 SUPPORT GROUPS / FRIENDS Support groups are one way to regularly find a safe space to talk about your life with others. You may need to check out different groups to find one that suits you best. Or, some people have even started their own groups. Check local AIDS service or community based organizations near you for referrals. You can also dial 211 to get free local referrals, or call the HIV Support & Info Line at INTERNET CHAT ROOMS, BLOGS, and ASK THE EXPERTS Several HIV-related websites offer support anonymously. Thousands of people have used this type of support for ongoing help or even a quick answer to a nagging question. A short list is provided below. HELPFUL RESOURCES RESOURCE FINDERS National Prevention Information Network ASO Finder ASO Directory State AIDS Hotlines COMMUNITY SUPPORT RESOURCES Ask the Experts AIDS Meds/Poz Community Forums Strength In Numbers (for HIV+ gay/bisexual men) Yahoo support groups for HIV+ people HIV+ Bulletin Boards Attaining HIV, Health & Wellness: After you ve tested positive 25

28 Laws regarding disclosure and discrimination Telling your co-workers or employers about your status is a different type of disclosure and should be considered carefully before making decisions. It s helpful to investigate your options with legal experts before disclosing your status at work. Under the Americans with Disabilities Act (ADA), employers do not have the right to ask about a disability or your health before hiring you. People living with HIV/AIDS are protected under the ADA, which means your employer can t discriminate against you and must reasonably accommodate your physical needs at work. In order to get reasonable accommodations, you will need a letter from your doctor, but it can state a chronic condition as opposed to stating that you live with HIV or AIDS. Some people who are concerned about testing for HIV fear that if they re HIV-positive they may experience discrimination. However, important federal and state laws prohibit both the disclosure of medical information and discrimination against HIV-positive people. The laws are not perfect and are interpreted differently in each state, so it s important to understand the limits of the laws in your area or jurisdiction. In some states, there are laws that make it a crime to knowingly transmit HIV to someone else. While these laws are clearly meant for those who knowingly try to infect another person, they have been used to threaten or prosecute others. In fact, some laws state that a transmission doesn t have to happen for possible prosecution. Though these cases are few, they re still a possibility. HELPFUL RESOURCES Americans with Disabilities Act Q&A AIDS Legal Referral Panel 26 Attaining HIV, Health & Wellness: After you ve tested positive

29 Important questions Do you know of any support groups that might work for me? How can I get my health care and/or prescriptions paid for? How is your relationship with your doctor? Do you go to an HIV-experienced doctor? Is s/he taking new patients? What resources do you use to learn about HIV? Have you thought about taking HIV meds yet? What types of support have worked for you? Is there anything I should be concerned about now that I ve gotten a full physical and my test results back? Do you know of a helpful case manager or benefits counselor? Are you worried about people finding out? Have you told anyone about your HIV? How did that go? Attaining HIV, Health & Wellness: After you ve tested positive 27

30 Checklist for getting started I have found support people, such as a social worker or benefits counselor, who can help me find local services or care. I ve found a doctor who s experienced in treating HIV. I know a doctor to go to for my first appointment. I ve made my first appointment. I ve also found other doctors, like a dentist or gynecologist, who understand how to treat HIV. I ve written a list of questions for my first doctor s visit. I ve considered telling others about my status and have made a plan on how to do it. I ve considered my emotional support needs and will seek help. I know how I ll pay for my health care, meds and tests. I talked to my doctor about the types of vaccines that I should take. I talked to my doctor about the types of screenings that I should get done, such as for hepatitis B and C or cervical and anal Pap smears. My first set of results are: CD4s, viral load. My second set of results are: CD4s, VL. I know what these test results mean. I talk to people I trust about HIV and how to treat it. I know what I need to do to get ready for making decisions about treatment. If I have questions and my doctor s not available, I will call or. 28 Attaining HIV, Health & Wellness: After you ve tested positive

31 Online resources that may help To Find resources for HIV care Project Inform , and Directories for ASOs (CA only) (click on HIV/AIDS at left) Directories for HIV Providers (click on MEMBERS at top) (click on RESOURCES >> FOR PATIENT at top) (click DIRECTORIES at top) State AIDS Hotlines state.shtml To Find public insurance programs Centers for Medicaid & Medicare Services HealthCare.gov The Access Project Resources for women The Well Project Three Poz Gals WORLD Women Alive Connecting with HIV-positive People HIV+ Bulletin Boards ubbthreads.php Strength In Numbers (gay/bi men) Yahoo Support Groups com/group/hivaidsnetwork/ Resources for people of color Asian/Pacific Islander Wellness Project Black AIDS Institute Latino Commission on AIDS National Native American AIDS Prevention Center Attaining HIV, Health & Wellness: After you ve tested positive 29

32 Test dates charting my CD4 cell counts charting my CD4 Cells my regimen

33 200, , ,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Test dates charting my viral load results charting my viral load my regimen

34 year month January February March April May June July August September October November December keeping track of my periods mark the Type of Flow in the boxes below L = exceptionally light N = normal h = exceptionally heavy S = spotting O= none

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36 1375 Mission Street San Francisco, CA HIV Health InfoLine: , M F, 10a 4p To order copies of this booklet, Project Inform at questions@projectinform.org.