Primary care of the HIV patient: standard practice and new developments in the era of managed care

HIV/AIDS challenges the normative model of healthcare delivery in Canada

With advances in therapeutics, effective therapy for human immunodeficiency virus (HIV) has shifted the focus of HIV care from an acute illness to a chronic disease requiring the services of several disciplines in a primary care setting. This article describes a collaborative model in the delivery of HIV care for HIV-infected individuals who remain fragile, both physically and psychosocially.

"Making all the difference in the world": how physicians can help HIV-seropositive patients become more involved in their healthcare

Physicians who treat HIV-seropositive patients can and should help them become more involved in their healthcare. This qualitative study investigated HIV-seropositive persons' perspectives regarding when and how physicians could have a pronounced effect on their involvement. Sixty-four HIV-seropositive patients, diverse in gender, ethnicity, and risk factors, were purposefully selected from three San Francisco Bay Area healthcare delivery settings. A combined interview-guide approach with a standardized open-ended interview was used to elicit participants' healthcare and physician relationship experiences. Data analysis revealed the themes that (1) involvement led to improved health outcomes and quality of life, (2) three life circumstances served as "opportune moments" for persons becoming more involved with their healthcare (a diagnosis of HIV/AIDS, the onset of symptoms, and beginning drug treatment intervention), and (3) participants became more involved when their physicians used a relationship-centered approach to healthcare. The results of the study suggest that physicians should be aware of opportune moments to intervene with their HIV-seropositive patients and of the helpful effect a personal, caring, relationship-centered approach can have on these individuals' involvement in their care. The recognition of opportune moments also may have implications for treating other chronic illnesses.