The psychological issues related to being alive long past expectations from a few years ago are immense. Could you relate some of the major issues you've encountered in your counseling experience that have emerged in the 1970s that weren't issues, say, 5 years ago?

I assume that there was a typo and you meant the new issues that have emerged in the 1990s that were not issues 5 years ago? There is now a whole host of issues that have to do with balancing hope in the face of the new combination therapies. In addition some people have to manage their despair if they are one of the approximately 30% of people for whom the combination therapies do not work or who can not tolerate the side effects of them. For newly infected people, or for those just finding out that they are HIV positive, there is the entire question of: Do I immediately begin triple combination therapy now and begin to use up my treatment options by hitting the disease hard and hitting it early? or do I wait until my viral loads suggest that I should begin the therapy? With their not being any uniform correct medical answer to this very vexing question, people have to be able to tolerate an excruciating uncertainty and really educate themselves so that they are comfortable with what ever course of treatment or inaction they decide to take.

Many of us who have benefitted from the combinations are very angry and sad that these have arrived too late to have benefitted loved ones who are already dead. In addition, there is just much more uncertainty now than earlier. We do not know how long the new treatments will remain effective. Several of my patients have described their renewed health as being like having a reprieve from a death sentence. Accompanying the joy of a renaissance of health comes the need to grapple with issues that people thought they would never have to face again. There are many people who went into enormous debt expecting to die soon and now they can not afford their debt loads. Thousands of people with HIV and AIDS are also wrestling with questions about whether or not to return to work since their health has improved so much. Issues about dating, relationships and being sexually active are also all coming up for people who had put these issues aside long ago.

-- Michael Shernoff