Jeff Meyers, M.D.

Kathy Lawless

Dr. Meyers' patients include Kathy Lawless

Kathy Lawless has been living with HIV disease for a number of years. What the HIV has done is reduced her immune system to a point that she now does have a diagnosis of AIDS. What's called a T-cell is what the immune system requires to fight infections. Her T-cell count is low, and as a result she is at risk for a number of different infections with respect to her HIV disease. In addition, she's got a number of other medical problems that do make it challenging for her, in addition to the HIV, to get through the day, absolutely.

In order for people living with HIV disease to get through the day requires a number of different factors. It does depend upon the stage of the disease for that individual. Somebody who is newly positive that is physically feeling well often requires a few number of medications with few side effects and can get through the day fairly easily. Other people, though, who have advanced disease often are on a number of different pills, upwards of forty or fifty, that have an enormous side effect potential, and it can make it quite difficult to get through the day and dealing with all these things.

The prevalence of HIV disease in Southern California is under a big period of transition. Initially it was very much a disease of men who have sex with men and intravenous drug users. Now the disease is really not discriminating, and the majority of newly-infected people are women, generally from minority backgrounds, either African American or Latina women. In addition, there is a new wave of young men who have sex with men that are acquiring HIV disease. There is a belief out there that this disease is easily controllable and easily treated, and so I think that a number of people are not using the education that they have about HIV and are hoping that they are not going to be infected, and they actually are.

The best quantifiable piece of data that's come out recently is in San Francisco, where the new infection rate, the rates of infection that are newly positive, is equal to what it was in the early 1980's, and that's particularly amongst the younger men who have sex with men population. That rate has also been seen amongst minority women as well, so it is a rather alarming statistic that has come out recently, and definitely bears attention.

I think what the community has to do is educate; that's the bottom line. First of all, this is not a disease that discriminates, and so really the education has to include everyone. That includes married people single people, women men of all race and ethnic backgrounds and of all sexual orientations. Education, I think, is the key, and it really should begin earlier. The new infection rates are the highest amongst the age group from eighteen to twenty-five, which suggests that education has to begin before then, long before then.

I think what's needed first of all is adequate healthcare. When somebody finds out that they are HIV positive, there is a mentality that they presume that this is a death sentence, which is no longer a case with adequate health care. So, adequate healthcare for people that are HIV positive can effectively keep this as a treatable disease, as a treatable chronic disease. In that way, getting people into care will allow them to sort of reverse that role of care receiver back into a functioning part of society. It's a very difficult thing, though, for people that mentally begin to prepare themselves for chronic care receiving to transfer that and transition more into an active member of society. It's a new challenge with an HIV disease that we're facing.

There are people that are shunned by families, by their race, by different communities, by their friends. I see it often, and I think again what's important is education. A lot of the difficulties that people endure is because of fear; and if we were to educate the community that HIV is actually quite difficult to transmit and take away a lot of the misconceptions that exist as a result of the disease, it may take away a lot of the fear.

Support groups have been helpful in the past. In the past they tended to marginalize, however. Support groups often are just for young gay men or for Latino women. I think that the really effective ones in my experience, have been all-inclusive and have been, with respect to HIV disease, have been for people that either are themselves HIV positive or know of somebody or have family members in some way affected by HIV. It's those support groups that I think are the most beneficial, because the focus is not necessarily on the marginalisation, the focus is actually on the support which is what they are intended to be.

Some support groups are not very successful in terms of maintaining the numbers of people that join or that continue to attend, and then the other end of the spectrum is there are some highly -highly successful support groups, one example would be the Church of the Valley support group here in the San Fernando Valley, which, from my understanding has been in existence for upwards of seven or eight years. That is an incredible feet and something that I have not heard of before. I think the key for that support group is that it is all-inclusive, that it doesn't discriminate and that it's based on just pure support, giving people love, giving people support and trying to care-give in that way.

Caregiving in the context of HIV disease is highly complex. What it requires is not only an excellent understanding of the disease process, but it requires a sensitivity and a consideration to human beings and an awareness of the psycho-social issues in the day-to-day challenges that people face. It's understanding that how unnecessary it is to have go through the day with nausea because they are on twenty different pills. It's understanding the data and applying it in such a way that it's unique to each patient.

And I think that the other big piece of care giving that's important is empowering the patient to make their own decisions, and that's something that I do personally. I don't see it as my responsibility to make decisions for people. I see my responsibility as educating people, regardless of what their background is, in a way that they understand their situation well enough to make their own decisions for themselves, and in that way people are more likely to adhere to whatever treatment outline the two of us have decided upon.

HIV and AIDS has caused a great deal of devastation worldwide, and it certainly has transitioned more into more of a chronic disease. I think the goal for me in providing caregiving for people living with HIV disease is to give them some hope, and in doing so give them some understanding about the disease, about their life. It does alter their life, but it doesn't have to end their life, and I think my goal everyday in caring for people with HIV disease is to continue that hope, continue that fire inside them, and allow them to contribute to society in the way that they would like to.

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