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Starting HIV Medications: Preparing for a Lifesaving Challenge

September 26, 2013

David Fawcett, Ph.D., L.C.S.W.

David Fawcett, Ph.D., L.C.S.W.

Gwen's Dilemma

Gwen was 30 when she found out she was HIV positive, yet this news didn't come as a surprise. She had injected heroin for several years, but managed to get clean when she was 28. Her struggle with drugs was a terrible phase in her young life, and it left her with HIV. But those years also had given her a beautiful baby girl whom she totally adored and who, thankfully, did not have the virus.

Gwen now faced a dilemma. Her doctor just told her, based on her recent lab results, that she needed to start HIV medications. While not unexpected, she felt pangs of anxiety at this news. Since getting clean, she had always been determined to create a good life for herself as well as her baby. She worked part-time from her home and attended community college in the evenings. Gwen's only nearby relative, her sister, worked during the day but was able to watch her daughter while she was at class. Gwen's mind began racing. Who would care for her child if the medications made her sick? The lab, the doctor and her case manager were available only during business hours. Who would watch her baby while she took public transportation to various appointments so she could get her meds and the follow-up labs? How could she afford time away from work? How could she even afford the drugs? She knew there must be some programs to help her obtain them, but she had also heard there were waiting lists for medication assistance.

diving in

Diving In

Starting HIV meds is among the most serious commitments one will ever make. Like Gwen, anyone facing this decision needs to consider numerous factors that will affect their ability to consistently take a daily regimen for the rest of their life. Disruptions cause resistance, which can render a drug ineffective. And fewer medication options increase the risk of dire consequences.

More than almost any other, one's relationship with his or her HIV medications is an intensely personal, long-term obligation. While it's certainly lifesaving, it requires consistency, determination and acceptance of side effects, both anticipated and unanticipated.

From 1990 to 2010

I have been on this road since 1988, and I am most certainly alive only because of these medications.

I am fortunate that my body generally tolerates them and I am able to maintain my daily routines, although it has not always been a smooth ride. In the early days, I survived Retrovir (AZT, zidovudine), the only HIV drug available at the time, which was dosed every four hours around the clock and which caused anemia that hospitalized me and killed several friends, including my HIV doctor. In the 1990s, when the situation was far more desperate, I, along with thousands of others, lent my body for drug trials. Despite pancreatitis and permanent neuropathy, I have no regrets because new, lifesaving medications became available. And I remember the miracle when protease inhibitors arrived and, despite serious side effects, dramatically reshaped the AIDS epidemic in the late 1990s.

Preparing Yourself for HIV Treatment

Coexisting with our HIV meds has certainly become easier. There are more medication options than ever before, there is an increased understanding of side effects, and drug combinations are much more convenient to take.

But it is critical not to lose awareness of the tenuous balance between the risk and benefit of HIV medications. Despite today's reassuring, carefree, almost casual portrayal of life on HIV meds, taking them remains a serious, lifelong commitment with medical, emotional, social and financial consequences.

In the following slideshow, I walk through six factors we need to consider before starting treatment.


Next: 6 Factors to Consider Before Starting HIV Treatment >>

This article was provided by
See Also
HIV Medications: When to Start and What to Take -- A Guide From
More on When to Begin HIV Treatment

Reader Comments:

Comment by: Deepak kumar (bharpura sonpur bihar) Sat., Apr. 19, 2014 at 12:12 am EDT
start medicine
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Comment by: lynell o. (Philadelphia PA) Sun., Dec. 8, 2013 at 1:23 pm EST
Yes I have HIV
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Comment by: Etaoin S. (WA) Fri., Sep. 23, 2011 at 7:15 pm EDT
Without discounting or disrespecting anything Mr. Fawcett wrote, I'd like to offer an alternate perspective. For background: I'm middle-aged, male, work in an office, get most of my exercise only from walking, eat a decent diet, sleep about seven hours a night, and travel occasionally. Like most folks, I have certain daily routines: every day I take a shower, every day I shave, every day I eat food. A daily dose of three pills is, for me, simply one more facet of that routine. I've been on meds for four years now and have been free of side effects the entire time. I've never needed supplements (most of which are of questionable value anyway), don't abuse other substances, and am in a healthy mental state. My sense is that the examples Mr. Fawcett cites, while true, are edge cases; collecting them in one article might give a reader the impression that the majority of people on meds face tiresome daily struggles as a result of that. For me, and for many others I know, starting (and remaining on) the meds is certainly not "a big deal" requiring "personal empowerment" to live in "tenuous balance." Modern meds are vastly superior to what was available 20 years ago. Although I appreciate what Mr. Fawcett has to say -- and yes, some people need to hear this message -- I'd like for people to know that keeping HIV in check can be a simple thing. More troubling, for me, is knowing that millions of people had to die before drug technology advanced to where it is now.
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Replies to this comment:
Comment by: P Flynn (Tucson AZ) Fri., Jul. 12, 2013 at 4:42 pm EDT
Right on brother. I'm getting combination therapy and it kicks butt. Taking 3 pills every day is easy considering what they do for me. I've had zero side effects and couldn't be happier. Now that Swiss doctors have stated that individuals that are positive, taking antiretrovirals, testing undetectable and have tested that way for 6 months or more can have unprotected sex with committed partners is even more awesome. It's so cool that as my father said people are starting to open their eyes and learn about what the reality of HIV actually is. It's also awesome to consider where the treatment will actually go. A post infectious vaccine? Hell yes! So pick your head up and be happy. Brave doctors and researchers are fighting for you! Go, antiretrovirals! Ciao, all.


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