Clinical management and treatments Antiretroviral therapy Antiretroviral Therapy (ART) reduces HIV-associated morbidity and mortality, with life expectancy now approaching that of people without HIV (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022). Many factors are taken into consideration when determining ART for the patient. The ART guidelines for adults and adolescents differ from the pediatric guidelines and the perinatal guidelines. Goals of ART • Durable suppression of plasma HIV RNA • Restoration of immune function • Reduction of HIV-associated morbidity and prolonging the duration and quality of survival • Prevention of HIV transmission It is unlawful to prohibit a person living with HIV/AIDS from participating in services offered to others, and it is illegal to deny them a benefit because of their HIV status . Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, and the
Adherence to therapy Adherence remains a challenge. Although most current medications used to treat newly-infected patients are available in a convenient one-pill regimen (containing at least three drugs) with minimal side effects, they present a challenge in that they make patients feel better quickly, making them think that they no longer need the medication. The following factor can influence a patient’s adherence to the regimen: • Age, both young and old • Psychosocial Issues • Characteristics of the regimen • Characteristics of the clinical setting • Active mental health issues
KNOW YOUR RIGHTS: PROTECTIONS
Health Insurance Portability and Accountability Act of 1996 (HIPAA) protect those living with HIV/AIDS and their friends and family from this type of discrimination.
Timeline of Protections Rehabilitation Act of 1973, Section 504
No qualified individual with a disability shall, by reason of their disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance or under any program or activity conducted by any executive agency or by the U.S. Postal Service. No qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of services, programs, or activities of a public entity or be subjected to discrimination by any such entity. This act mandates privacy and confidentiality restrictions to protect those living with HIV/ AIDs. This act maintains the confidentiality of health information and provides people the right not only to review but also to make corrections to personal medical records.
Americans with Disabilities Act of 1990, Title II
Health Insurance Portability and Accountability Act of 1996
The Rehabilitation Act of 1973 ensures that every person is given equal opportunity to participate in and receive benefits from any program or activity that receives federal funding, and every person in the U.S. is afforded equal opportunity in employment under the Americans with Disabilities Act (ADA), despite disabilities (including positive HIV status). The ADA maintains that people with HIV, whether or not it is symptomatic, are physically impaired to the point that it substantially limits their life activities, and they are therefore covered under the act. Thus, the ADA protects against discrimination against HIV-positive persons and specifically those who are denied an occupational license or admission to a school on the basis of their HIV status. Title II of the ADA prohibits both state licensing agencies and occupational training schools (including barber and cosmetology schools) from discriminating against individuals with HIV/AIDS. A licensing entity, trade school, or training program cannot exclude a person with HIV/AIDS because of their status. However, a person infected with HIV may be excluded from the activities or services of a private or public entity if there is a health concern that they pose a significant risk
to the health or safety of others or are a direct threat that cannot be eliminated or reduced to an acceptable level by reasonable modification. Evidence of the direct threat must be based on an individualized assessment of the person with the disability and on current medical evidence. However, transmission of HIV will rarely raise a legitimate direct threat issue because the virus cannot be transmitted by casual contact. Therefore, circumstances are unlikely for the transmission of HIV in a school or workplace setting. If a licensing entity or trade school requires an applicant to provide a doctor’s certification that they are free of infectious, communicable, or contagious disease, this must exclude diseases, such as HIV, that are not transmitted through casual contact or the usual practices of the occupation for which a license is required. Furthermore, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates privacy and confidentiality restrictions to further protect those living with the disease. This act maintains the confidentiality of health information and provides a person with the right not only to review but also to make corrections to personal medical records.
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