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Help! Do I pursue my goals?
Jul 14, 1999

Dr Remien, I am hoping that you can advise me on a serodiscordant and somewhat personal issue. I am HIV+ as the result of being raped four years ago. So far, my health is really good, counts are really good, and I do not have to be on medication yet. I have been actively engaged in earning my Bachelor's degree and obtaining the research experience necessary to attend graduate school in clinical psychology for the past five years. I have just been accepted into a graduate program, which I am thrilled about. The problem is that I have been married for 11 years to a man who is fortunately negative, but is obviously having a harder time dealing with this disease than what he often lets me know about. He has supported my decision to go on with school throughout the application process; however, now that I have been accepted, he tells me that he doubts that I will live long enough to finish a graduate program, much less to reap any of the benefits of my training through actually contributing to the field. Therefore, he is rather upset with me for choosing to continue down this road, as he believes it is foolish to "spend my last days in pursuit of professional development." I am somewhat non-traditional in that I am 30 years old and would just be beginning graduate work in the fall, but I do not see why I should abadon a goal that I have worked very hard for because of this disease! However, I do understand that for someone dealing with this disease there are many pragmatic issues (e.g., insurance, potential employment discrimination, problems if health begins to decline, adverse reaction to medications when and if needed, etc.) that must be considered in deciding to forgo full-time employment to pursue further education. Fortunately, my husband works for a company with very good insurance coverage, and I do receive regular and through medical care from a specialist. I, however, am continually wondering whether or not I am seeing this situation clearly and acting appropriately in deciding to continue toward my professional goals. In your experience in dealing with healthy HIV+ individuals, do you think it is possible for a person to meet the demands of graduate training (i.e., a five year long program and year long internship at best) and deal with this disease simultaneously? I would greatly appreciate your honest thoughts on this issue.

Response from Dr. Remien

While I nor anyone an predict what lies ahead for you, it is my very strong opinion that it IS possible for you to pursue your graduate training, to meet its demands, and to have many years of working in your chosen career. While some people, particularly years ago before the current antiviral therapies, have gotten ill and died from this disease relatively quickly, most people live many healthy years with HIV. In the past it was estimated that approximately 50% of people lived without significant symptoms for 10 years or more. Since the advent of combination therapies many more people will be living even longer without symptoms. If you are currently in good health, do not yet require medication, and are only now infected 4 years, there is every reason to expect that you have many years of health ahead. How would you feel if you find yourself 20 years from now, still living without significant illness, and having not pursued your dreams? I have already seen many people having regretted not pursuing their goals because they thought they wouldn't have the health or the time.

Many people living with a variety of serious and chronic illnesses are able to achieve the goals you describe. The pragmatic concerns you raise are real and worthy of consideration. However, you say that you have insurance coverage and good medical care; adverse medical reactions can occur but can also be dealt with; and problems with possible health decline would be confronted if and when they occur. Also, I do believe it is important for people to continue to pursue important goals in life for their general health and well-being. While nobody can offer you any guarantees, neither can such guarantees be offered to anyone else - living with, or without, HIV.

I recommend that you ask the opinion of your physician(s) and that you and your husband talk more about this. Again, it is important for people to pursue their interests, goals, and dreams and to have the best quality of life they can achieve - even in the context of "uncertainty," which exists in everyone's life.

Low t-cell count, HIV negative?
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