Thought for the Day...

[geminigirl]

(If anyone finds good citations or has access to good information, please pass it along. Free sites are great, but let me know if you're willing to make a few photocopies and send paper articles otherwise)

Okay. Assume Man X is HIV positive. Assume Man X. was infected by having sex with other men. Assume also that Man X. is not comfortable with the fact that he does have sex with men...therfore may or may not identify as gay, and is to a large extent, closeted.

Okay...now that we know a bit about Man X...

Consider, Man X is receiving treatment for his HIV, and is being medically managed. Consider that physician of Man X wants to put him onto some kind of antiviral therapy-not necessarily a complicated protease inhibitor regimen, but something antiviral.

What I'm wondering here is if Man X will be less compliant with his drugs than someone not closeted. I'm hypothesizing here that it's possible that Man X will be less compliant, and that it might have something to do with his closetedness...that the drug taking might remind him of the HIV which might then remind him of how he got infected. It all intersects the level of personal comfort with the sexual orientation piece.

Hrm....

Comments

[mactavish.livejournal.com]

I know someone who might know the answer. Mind if I link your question from my journal?

[geminigirl]

Of course it's okay to do that. Thanks!

[roosterbear.livejournal.com]

I don't have any links for you, or any hard data, just my own observations.

It's been difficult, but not impossible, for me to be compliant with my relatively simple regimen. And this is with me being not at all closeted about my orientation, and a somewhat mixed level of closetedness (if you are going to revert to the discussion on soc.bi about "either you are or you aren't" in terms of being closeted, back off) regarding my HIV status. I know that not being completely out of the closet about my status in the past has led to some circumstances where it was difficult for me to remain compliant all the time (although I have managed for the most part; I have missed three doses since October '99).

I can only imagine that not even being out about my orientation, when that was clearly related to my HIV status, would make things even more difficult. When you've got the elephant in the living room you are trying very hard to steer conversation away from, popping a few pills where someone might see you and ask about it is going to be problematic at best. I've noticed that people rarely notice me taking my pills, but then, that was usually when I was comfortable with answering questions that might have come up from them. If it's the Big Dark Secret that Man X is trying to keep hidden, there might be a lot more times when taking the meds would draw attention where he doesn't even necessarily want to look himself, much less want others looking.

I am not sure where you are going with this, although I can make a couple of guesses. I don't know how to make it easier for people like Man X to be compliant, without challenging him to open some closet doors and let some air in.

[geminigirl]

It was a bunch of thinking that grew out of a conversation with someone about whether or not the guy he was seeing should take meds or not, if medically the guy was at a place where it was something to consider. I was wondering if emotionally the guy was ready...and if he's not, I'm thinking it's not such a good idea. Non-compliance can do bad things.

It's actually going nowhere, other than into the "things I want to do more research on when I get a chance" pile. That said, I'd love to do some preliminary reading on it now...or read whatever work has been done thus far.

It's been interesting to ask other friends about this...some of them say that if this man is responsible enough to get tested and get medical care then he's more likely to be compliant. I'm not so sure. Just because I have asthma doesn't mean that I take my medicine-just the fact that I'm using my rescue inhaler far more frequently than is appropriate and yet haven't bothered to go to the doctor is a good example.

Now I'm even more intrigued though. Need answers.

[roosterbear.livejournal.com]

I was wondering if emotionally the guy was ready...and if he's not, I'm thinking it's not such a good idea. Non-compliance can do bad things.

This is a huge consideration, and I think you are absolutely right. Taking the meds sporadically can be worse than taking nothing at all.

...some of them say that if this man is responsible enough to get tested and get medical care then he's more likely to be compliant. I'm not so sure.

There is a big difference between getting tested (which requires getting one's nerve up one time), getting regular medical care (which might require a few visits a year, if he's not on medication yet; probably once every three or four months at most) and making a daily commitment to taking what will likely seem to be a dizzying array of pills, which will undoubtedly cause at least a few unpleasant side effects. Apples and oranges (and pears, I suppose). I am not saying that he is irresponsible or that getting regular medical care is no big thing, but it's not the same thing as being on the medication.

There is another thing to consider as well. Breaking in a new regimen, especially for someone who has never taken any HIV meds, takes usually 2-3 weeks. During that time, the person feels nauseous, dizzy, crampy, basically like hell. If he is very closeted about his "alternative lifestyle", then I would think that he will most likely be pretty tight lipped about his status as well. But then how is he going to explain this? I cannot fathom trying to work while going thru that, at least not without a very understanding employer. And being understanding requires, well, to understand what is going on. I was fortunate enough to already be out on a medical leave of absence when I started my regimen, and we had to switch it around because I wasn't tolerating one of the meds well. The Side Effect Hell went on for two weeks, not being able to eat, not wanting to move really, and throwing up a lot, and it took about six weeks to figure out that I wasn't tolerating the AZT (it made me dangerously anemic after we had spent so much time trying to treat my anemia, another whole can of worms), which then meant switching my regimen, and going thru a bit of an adjustment again, although not as severe. Is he prepared to try to pretend something like this isn't happening? Is he prepared for people to be asking questions about it? Is he in a position where he could disappear for two or three weeks, or else deal with people wondering why he keeps running to the bathroom and skipping lunch?

It's quite possible that it's time for this guy to come to terms with a lot of stuff, and this might be a major catalyst for him to open up more about himself. I think we all manage to surprise ourselves sometimes. But this is so big. And going thru it even with the support of the people around you is hard enough. Some people are more able to compartmentalize than others, I suppose, and maybe I am making a big deal out of a small thing, but I don't think I am. I would hope, at the very least, that he is getting some good counseling about all the issues involved, if he does decide it's time to start taking meds.