Post-Diagnosis Support

Case Study 1 – Asymptomatic

A 31-year old male found out 2 months ago that he was HIV-positive. He and his
girlfriend had decided to get married and they had gone for a test at the anonymous
clinic in Bangkok. He tested positive and his girlfriend tested negative. After he got his
positive result, his girlfriend left him. He has previously had sex with many other girls
and thinks he could have infected some of them. He worries whether he can find a
wife and have children. His family is asking why he is no longer getting married and he
is not sure how to explain to them. He does not know anyone who is HIV-positive and
feels scared about what would happen to him.

Case Study 2 – Symptomatic

Eight months ago, a 22-year old male had a rash on his body that would not go away.
He was tested for HIV by a doctor and was diagnosed HIV-positive. He lives at home
with his mother, father, and two sisters. They are aware of his HIV status but have
kept it a secret from other family members and friends. Recently, he has been losing
weight and feeling very tired. Some traditional medicine recommended by the village
healer made him feel a bit better for a time, but then he started to have diarrhea
everyday. He went to the pharmacy and was given tablets that help the diarrhea
sometimes. When he last weighed himself at the pharmacy he had lost another five
kilos. These physical symptoms have led him to stay home more than he used to.
Case Study 3 – AIDS

A 37-years old male found out three years ago that he had HIV. He has had many
opportunistic infections since then. He has been very distressed by his recurrent
periods of illness and feels that he is a burden to his family. He is currently in hospital
with TB and a second episode of pneumonia (PCP). Doctors have recommended
antiretroviral (ARV) treatment but he has no money to buy expensive medicine. The
doctors are not sure he will recover from his infection and believe he may be too ill to
return home again. His family is at his bedside when the doctors tell him the bad news.
Case Study 1 – Asymptomatic

A 31-year old male found out 2 months ago that he was HIV-positive. He and his girlfriend had decided to get married and
they had gone for a test at the anonymous clinic in Bangkok. He tested positive and his girlfriend tested negative. After he
got his positive result, his girlfriend left him. He has previously had sex with many other girls and thinks he could have infected
some of them. He worries whether he can find a wife and have children. His family is asking why he is no longer getting
married and he is not sure how to explain to them. He does not know anyone who is HIV-positive and feels scared about
what would happen to him.

Key Issues Key Support Strategies

 They decided to get married, he tested positive,
girlfriend left him (loss of relationship)
 He tested positive (adjustment to diagnosis, lack of
information about HIV and disease progression)
 previously had sex with many other girls (history of
unprotected sex)
 thinks he could have infected some of them, worries
whether he can find a wife and have children, feels
scared about what would happen to him (Guilty
feelings, anxiety, fear)
 family is asking why he is no longer getting married and
he is not sure how to explain to them (disclosure issues)
 not know anyone who is HIV-positive (lack of patient
support group)
 Immediate Strategies: Normalization of adjustment
difficulties
 Immediate Strategies: education and information about
HIV and AIDS; discussion about possible reaction to
diagnosis
 Immediate Strategies: education and information about
HIV and AIDS
 Immediate Strategies: Normalization of adjustment
difficulties; education about safer sex
 Ongoing Strategies: planning and rehearsing for
disclosure
 Referral Options: peer support

Case Study 2 – Symptomatic

Eight months ago, a 22-year old male had a rash on his body that would not go away. He was tested for HIV by a doctor and
was diagnosed HIV-positive. He lives at home with his mother, father, and two sisters. They are aware of his HIV status but
have kept it a secret from other family members and friends. Recently, he has been losing weight and feeling very tired. Some
traditional medicine recommended by the village healer made him feel a bit better for a time, but then he started to have
diarrhea everyday. He went to the pharmacy and was given tablets that help the diarrhea sometimes. When he last weighed
himself at the pharmacy he had lost another five kilos. These physical symptoms have led him to stay home more than he
used to.

Key Issues Key Support Strategies

 Noticeable rash, weight loss, fatigue, diarrhea, loss of physical appearance,
possible discrimination due to physical symptoms, social withdrawal, lack of
access to other forms of care, fear of disclosure to extend families and
friends
 Immediate Strategies: education information about HIV and AIDS, strategies
for managing discrimination, strategies for continuing social activities
 Ongoing Strategies: planning for rehearsing for disclosure to other family
members and friends (if desired), counselling for loss of physical control and
change in physical appearance
 Referral Options: ongoing counselling, peer support, health clinic or hospital
for prophylaxis for opportunistic infections

Case Study 3 – AIDS

A 37-years old male found out three years ago that he had HIV. He has had many opportunistic infections since then. He has
been very distressed by his recurrent periods of illness and feels that he is a burden to his family. He is currently in hospital
with TB and a second episode of pneumonia (PCP). Doctors have recommended antiretroviral (ARV) treatment but he has no
money to buy expensive medicine. The doctors are not sure he will recover from his infection and believe he may be too ill
to return home again. His family is at his bedside when the doctors tell him the bad news.

Key Issues Key Support Strategies

 Recent history of recurrent illness, Unlikelihood of recovery, Possible fear of
death, Concern for family, Lack of money for care/treatment, Physical
deterioration, Loss of control (hospitalization)
 Immediate Strategies: grief counselling for illness and unlikelihood of
recovery, support for family, strategies for maintaining control and dignity
 Ongoing Strategies: preparation for further deterioration and death, will
making, discussion of ideas and fears related to dying
 Referral Options: ongoing counselling, peer support, palliative care, spiritual
support, pastoral care, home-based care