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Refusal to take drugs - what can I do?
Mar 25, 2007

Ho doctors, I just came across your website in my research, and since I am really freaking out, I thought I would see if you could advise. Anything you tell me would be greatly appreciated... My closest friend tested positive four months ago. He has always been highly skeptical of western medicine, and has been reading many alternative AIDS theories, which have led him to believe that AIDS meds are toxic and can be the culprit behind very sick HIV+ people (who are on the therapies). I was inclined to believe that maybe this was true, and that there do seem to be so many unanswered questions that perhaps the alternative theories (HIV does not necessarily mean AIDS and death) could be just as plausible. As a relatively uninformed citizen in this area, I thought that his choice to not go on meds was ok for the time being, because he seemed totally healthy. Frankly, I think the alternative theory was so appealing to me because I didn't want to believe that his diagnosis was going to lead to illness and death. I thought, "I will rethink this if he gets sick, but for now he is a healthy young man and he is fine." And now he is sick. He got the flu, and then a severe rash on his face and neck, as well as a fever of 103. He went into the emergency room, and they admitted him. He has excema herpeticum, strep and a staph infection. Initially he told them he didn't want to know his CD4 count, but I think he gave in and they told him that it was low, but said it was normal for someone with all these infections to have a low CD4 count. He is supposed to be in the hospital for another week or so, and I think that he is really beginning to let it sink in...what it means to be +... But what can I do? I am so scared for him, and I want to be able to give him the best possible advice. How can I convince someone who believes "The Other Side of AIDS" (Maggiore) to rethink everything, to believe that the drugs are necessary, that simply doing alternative therapies is just not going to cut it this time?

Thank you...

Response from Dr. Pierone

I wish I could give you some easy instructions to follow to help your friend, but every situation is different.

Learning about a diagnosis of HIV infection is a traumatic experience and everyone reacts differently. Denial is one of the most basic and potent emotional defense mechanisms and is seen fairly commonly. Repression is another defense mechanism and there are patients who have absolutely no memory of being told of an HIV diagnosis in the past. Rationalization is another means to protect ones ego in the face of a threatening condition.

But of the defense mechanisms, denial is so incredibly frustrating for concerned friends and family members to deal with because it raises such serious doubts about the judgment of the person exhibiting the behavior. One example of medical denial would be a woman who does not seek help for a breast mass until it becomes so large that it is erupts through the skin and becomes ulcerated and infected. The first thought when faced with such a situation is that this individual either has very poor judgment or is mentally ill. There are people who will carry their denial to the grave with them; having died of a disease which they insisted did not exist. The good news is that most people do not let things get this far out of hand. Once the signs and symptoms of AIDS become obvious, most people will listen to the advice and pleas of close friends and will try medication, even if they do so grudgingly. If they do respond favorably, and see that they are regaining their health, they usually have a 'eureka' moment and change (or at least modify) their previously held beliefs.

I wish you the best in helping your friend through this difficult time.



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