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Refusing treatment
Sep 6, 2002

If one were to refuse to take anti-retroviral drugs etc what would some of the possible coping mechanisms be in order to adapt to circumstances?

Response from Mr. Shernoff

First the person would really have to examine his or her resons for choosing not to begin antiretroviral medication. It is always best if the decision was made in consultation with a medical professional with whom the person is working. Incresingly people are choosing to wait to begin antiretroviral medication until either their viral load is at a certain high level and/or their CD4 count is very low, or they have become symptomatic with an AIDS related medical condition to beign medication. Thus if someone has a clear idea of what criteria have to be met before they will begin medication, they have to be ready to live with the emotional uncertainty of having HIV progress, and once they do begin medication it may or may not be effective to arrest their disease progression.

The decision to wait may confuse one's friends and loved ones who feel that taking some definitive medical action sooner rather than later is in the person who is living with HIV or AIDS' best interest. Thus he or she may find that they are not getting the kind of support they want from their loved ones. Thus, this can be a difficult path to go.

But if someone is not choosing to take these medications because they do not believe in the effectiveness of Western medicine and are choosing another treatment route, they have to really believe in the chosen course of treatment or nontreatment that they are committed to. This is also likely to result in not getting the kind of support from loved ones who do not agree with this course of action.

But some people choose not to take medications because they are so depressed that they are feeling hopeless, and overwhelmed. This is the worst reson not begin medication.

I suggest that anyone who is considering not taking the medications who is not absolutely clear about his or her reasons for not doing so, consult with a skilled mental health professional who is very knowledgeable about HIV to explore all of the motivations for going in this direction. I am not assuming that the reaons are necessarilly pathological. But this kind of a consulation can help assess whether or not there is anything self-destructive going on in a person's thinking or psyche that is contributing to not wanting to take the medication. Another option is to find a support group of people living with HIV where he or she can really discuss all of his feelings and thoughts about this very important decision.

Michael Shernoff, MSW



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