My 19 year-old brother-in-law (I'll call him Bryan) recently told us of his positive status. Most of his family is supportive, although the relationship is somewhat rocky (lots of blaming him for getting HIV). Bryan's family is also rather undereducated about HIV and not terribly interested in learning the details of the disease or how to treat it.

I am an attorney who has paid a lot of attention to HIV since the events surrounding Ryan White. I am going with Bryan on his next trip to the doctor (a trip he avoided for 6 months before he told us). He wants me to go and I want to be useful.

My questions:

1. What questions should I ask the doctor or encourage Bryan to ask regarding treatment options, disease progression, etc.? He has not asked a lot of questions when he went before. 2. What should I look for as signs of high quality care? One of the reasons I am going is so that the doctor can see that Bryan has supportive, knowledgeable people on his side who want to ensure high quality care. I don't want to be annoying or threatening (as an attorney) to the doctor, but at the same time I want the doctor to know that someone's paying attention to what is going on. Are there some things I should look for? 3. Bryan and I (and his brother, my husband) have agreed that Bryan and I will keep all medical information strictly confidential between us. Only Bryan can share anything regarding his health. I will say nothing, even to my husband, because with confidentiality, I fear I won't be much help. Any advice or warnings about this?

Thank you for your kind consideration of my questions and for the valuable information on this site.

1. The first few visits are devoted to understanding where a patient is on the spectrum of HIV infection, getting them to understand what HIV infection means, etc. Thus, the CD4 and HIV viral load are the most important lab tests, which determine whether HIV treatment is necessary at this point or not, and in general how fast HIV infection has progressed. 2. HIV specialists can be internists, infectious disease specialists, or other physicians. One benchmark is whether they belong to and are credentialed by the American Academy of HIV Medicine (AAHIVM). That requires a practitioner to take care of a minimum numbers of HIV patients, obtain HIV specific CME annually, and take a test on HIV knowledge every 2 years. 3. You might want to become his medical power of attorney (if he agrees), that way the doctors can share information with you. Otherwise they can't, and you only get the story from Bryan, which may or may not be completely correct.