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Three questions...
Dec 4, 2003

Dear Dr. Wohl.

I have two dudes, an stupid dude and other...

1) All the Doctors speak about antiretroviral meds, cd4, viral load, before start a treatment, but the social treatment and the psychological treatment is more important, because the society refuse to accept the hiv+ people...

What kind of special psychological treatment is available for the hiv+??

2)Which is the best treatment for start a treatment or it depends of viral load, cd4 count??

3)This is a stupid question...

Six weeks ago I inserted two fingers with a little cut (because I eat nails), in a sex-worker's vagina. I didn't see my blood or her blood in my fingers... Yesterday I tested HIV-...

Should I be retested?? Am I in a high risk level?? Am I HIV-.

Thanks...

CACTK

Response from Dr. Wohl

Psychological support is certainly a key aspect of managing HIV infection. Learning you have been infected with a dangerous virus for which there is no cure is obviously a shock to most people. In his wonderful memoir, 'My Own Country', Abraham Verghese described his life as an HIV treating physician and immigrant and how as he was an alien so too were his patients. They too have crossed over a border to a place they can not leave. Everything is different and never the same after they became HIV+.

Unfortunately, as you hint at, mental health care is in most places challenging to obtain. More attention does need to be paid to providing psychological services to persons livng with HIV, particuarly as many of those being diagnosed today (at least where I live) have mental health and/or substance abuse problems.

What regimen to start does depend on CD4, viral load, concomitant illnesses, lifestyle, etc. Previous postings on this topic will help you get an idea of what we recommend in different scenarios.

As far as your finger fright, you have little to worry about if that is all you inserted. As I am sure your mom has told you, you should really stop biting your nails. Whether you should be having sex with prostitutes is a topic for another post in another forum. DW



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