Medication strategy
Veerle: “People that come to the HIV consultation, can call on us for a variety of things they come across. For instance, medication is important, because you have to take HIV medication for the rest of your life. This sounds obvious, often just one tablet a day, but can be very difficult. Together we look for a medication strategy, think for instance a pillbox, and a suitable time of the day when it feels safe to take the medication. Some people hide the fact that they have HIV from their surroundings, also for their family or partner, and we absolutely want to avoid that they would hide or not take their medication. Which unfortunately happens.”
It sounds obvious, ofteen only take one tablet a day, but it can be very difficult. Together we look for a suitable and safe time of the day to take the medication.
Veerle Vandebos, HIV nursing consultant
Julie: “We see that practical and psychosocial problems often go together. Sometimes someone is afraid to make a dentist's appointment out of shame, and then we help them with that. For people with HIV but without a big social network, we also act a bot as replacement or additional network. If necessary, we refer to a psychologists, sexologist, dietician or other healthcare provider.”
Anonymous telephones
Those not physically attending consultations can contact Julie and Veerle by email or phone.
“That's our own patients with an urgent question, but it could just as well be external people”, says Veerle. “Someone left with questions after a high-risk contact: how big is the risk and what should I do? Those are anonymous phone calls and we respect that as well. In addition, we get questions from GPs and we work together with the Zorgcentrum na Seksueel Geweld (Care centre after sexual violence) when it becomes clear the victim had a high-risk contact.”
Julie adds: “There are also questions about HIV from within the hospital that come to us, and we also monitor needlestick and splash injuries. Apart from those possible incidents, you are perfectly protected against HIV as a caregiver if you follow standard hygiene guidelines. Even if you care for someone who is HIV-positive. So if our own patients are admitted for any other medical reason, we don't necessarily come into the picture. We do sometimes check whether the therapy is continued properly during admission, because we know that it can be a barrier to talk about this with other healthcare providers.”
HIV in Belgium
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93% of all people living with HIV were diagnosed.
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95% of people with an HIV diagnosis is receiving correct therapy.
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98% of all people with HIV that are receiving the correct treatment, have an undetectable viral load which means they can no longer pass on the virus.
Hiv image from 20 years ago
Huge advances have been made in HIV treatment in recent years. Although these advances do not yet seem to have penetrated society.
Julie: “People often still have the HIV image from 20 years ago in their heads, that it is bad and you die from it. However, this is no longer true. Therapy is simplified and well tolerated, there are few side effects and the immunity of people with HIV usually recovers to a large extent. Almost all HIV patients continue to keep an undetectable amount of virus in the blood. The biggest problem today is actually the ignorance in our society that perpetuates the stigma.”
The biggest problem today is actually the ignorance in our society that perpetuates the stigma.
Julie Printemps, HIV nursing consultant
Ignorance about on the one hand the successful treatment, and on the other who those people with HIV are. That it is only about men having sex with men is a big misconception, according to Julie and Veerle. “The population is much more varied, but that misconception does make heterosexuals less likely to get screened early or come to preventive consultations.”
This preventive consultation is for people that are aware of high-risk contacts. Since 2017 you can take preventive HIV medication in that case, the so-called PrEP medication (pre-exposure prophylaxis). “We see that this is really gaining awareness, almost booming,’ it echoes. ‘Meanwhile, there are weekly requests to start preventive medication, which is a good thing.”
Lifelong follow-up
HIV is something you irrevocably carry with you all your life. Which makes it special to monitor these people. Veerle: “That long-term follow-up appealed enormously to me. People with HIV come to the hospital twice a year and this stays like that. Of course, we have not been doing this for very long, but our professors have known some patients since the early 1990s. You really step into their lives and have to stay alert for certain changes or life stages, because these can affect therapy adherence.”
“People with HIV come at least twice a year to the hospita and this remains. You really do step into their lives.”
"You also feel that as a nurse you can be a mainstay for people living with HIV, that you can defend their interests,’ says Julie. ‘When I read that in our country there is still discrimination in healthcare against people living with HIV, I think it's disgraceful. It is not talked about, so it remains a taboo and people living with HIV continue to experience guilt and shame. They are afraid of being rejected, even by their own friends and family. While provided therapy, you can perfectly live a long and healthy life with HIV. The psychosocial aspect is often more troublesome than the infection itself, and we really need to get rid of that.
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