Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-16T15:26:06.436Z Has data issue: false hasContentIssue false

5 - What have clinicians learnt from working with HIV/AIDS? A medical perspective from London

Published online by Cambridge University Press:  14 January 2010

By
Chris G. A. Wood  and
George T. H. Ellison
Edited by
George Ellison ,
Melissa Parker  and
Catherine Campbell
Chris G. A. Wood
Affiliation:
HIV Unit, North Middlesex University Hospital, London N18 1QX, UK
George T. H. Ellison
Affiliation:
Professor of Public Health and Director of the Institute of Primary Care and Public Health, South Bank University, London
George Ellison
Affiliation:
South Bank University, London
Melissa Parker
Affiliation:
Brunel University
Catherine Campbell
Affiliation:
London School of Economics and Political Science
Get access

Summary

Introduction

This chapter sets out to provide a narrative account of learning from HIV and AIDS drawn from the perspective of a clinician (CW) who has been working with HIV/AIDS patients in London since 1990. It draws on CW's clinical experience gained during his initial specialist HIV training at the Chelsea and Westminster Hospital in Central London from 1990 to 1993, and on his experiences of working at the HIV Unit at the North Middlesex University Hospital (NMUH), a district general hospital in Edmonton), and in the Sexual Health Centre at St Ann's Hospital in Tottenham, both in North London. The community served by these two hospitals might best be described as ‘inner–outer London’ – a multicultural, multiethnic community with a large and diverse population comprising long-term residents and recent immigrants, including refugees and asylum seekers, living in an area with high levels of social deprivation, unemployment and welfare support. This local community happens to reflect the pattern of HIV infection globally and therefore provides an ideal setting from which to consider the impact of the disease on clinical perspectives and clinical practice, as well as some of the social and cultural dimensions of HIV/AIDS in the UK.

By reflecting on clinical practice this chapter aims to demonstrate how, despite the changing clinical context of HIV/AIDS in London, the barriers to treatment and therapy are common to many of the groups most at risk.

Type
Chapter
Information
Learning from HIV and AIDS , pp. 111 - 147
Publisher: Cambridge University Press
Print publication year: 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ades, A. E., Walker, J., Botting, B., Parker, S., Cubitt, D. and Jones, R. (1999). Effect of the worldwide epidemic on HIV prevalence in the United Kingdom: record linkage in anonymous neonatal seroprevalence surveys. AIDS 13: 2437–2443CrossRefGoogle ScholarPubMed
Altman, D. (1986). AIDS and the New Puritanism. London: Pluto
Ammassari, A., Murri, R., Pezzotti, P.et al. (2001). Self-reported symptoms and medication side-effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. Journal of Acquired Immune Deficiency Syndromes 28: 445–449CrossRefGoogle ScholarPubMed
Armes, P. J. and Higginson, I. J. (1999). What constitutes high-quality HIV/AIDS palliative care? Journal of Palliative Care 15: 5–12Google ScholarPubMed
Babiker, A., Darby, S., Angelis, D.et al. (2000). Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis. Lancet 355: 1131–1137Google Scholar
Barnett, T. and Whiteside, A. (2002). AIDS in the Twenty-First Century. Disease and Globalization. Hampshire: Palgrave MacmillanCrossRef
Beck, E. J., Mandalia, S.Williams, I.et al. (1999). Decreased morbidity and use of hospital services in English HIV-infected individuals with increased uptake of antiretroviral therapy 1996–1997. AIDS 13: 2157–2164CrossRefGoogle ScholarPubMed
Bennett, L. and Kelaher, M. (1993). Variables contributing to experiences of grief in HIV/AIDS health-care professionals. Journal of Community Psychology 21: 210–2173.0.CO;2-L>CrossRefGoogle Scholar
Bogart, L. M., Kelly, J. A., Catz, S. L. and Sosman, J. M. (2000). Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. Journal of Acquired Immune Deficiency Syndromes 23: 396–404CrossRefGoogle ScholarPubMed
Bongaarts, J. (1996). Global trends in AIDS mortality. Population and Development Review 22: 21–45CrossRefGoogle Scholar
Bonhoeffer, S., Holmes, E. C. and Nowak, M. A. (1995). Causes of HIV diversity. Nature 376: 125CrossRefGoogle ScholarPubMed
Brashers, D. E., Neidig, J. L., Cardillo, L. W., Dobbs, L. K., Russell, J. A. and Haas, S. M. (1999). ‘In an important way, I did die’: uncertainty and revival in persons living with HIV or AIDS. AIDS Care 11: 201–219CrossRefGoogle ScholarPubMed
Bruneau, J., Lamothe, F.Franco, E.et al. (1997). High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. American Journal of Epidemiology 146: 994–1002CrossRefGoogle ScholarPubMed
Bungener, C., Marchand-Gonod, N. and Jouvent, R. (2000). African and European HIV-positive women: psychological and psychosocial differences. AIDS Care 12: 541–548CrossRefGoogle ScholarPubMed
Burns, F. M., Fakoya, A. O., Copas, A. J. and French, P. D. (2001). Africans in London continue to present with advanced HIV disease in the era of highly active antiretroviral therapy. AIDS 15: 2453–2455CrossRefGoogle ScholarPubMed
Catalan, J., Burgess, A., Pergami, A., Hulme, N., Gazzard, B. and Phillips, R. (1996). The psychological impact on staff of caring for people with serious diseases: the case of HIV infection and oncology. Journal of Psychosomatic Research 40: 425–435CrossRefGoogle ScholarPubMed
Catalan, J., Meadows, J. and Douzenis, A. (2000). The changing pattern of mental health problems in HIV infection: the view from London, UK. AIDS Care 12: 333–341CrossRefGoogle ScholarPubMed
Cheek, R. (2001). Playing God with HIV: rationing HIV treatment in southern Africa. African Security Review 10: 19–28CrossRefGoogle Scholar
Cox, L. E. (2002). Social support, medication compliance and HIV/AIDS. Social Work in Health Care 35: 425–460CrossRefGoogle ScholarPubMed
Del Amo, J., Petruckevitch, A.Phillips, A.et al. (1998). Disease progression and survival in HIV-1-infected Africans in London. AIDS 12: 1203–1209CrossRefGoogle Scholar
Delius, P. and Glaser, C. (2002). Sexual socialisation in South Africa: a historical perspective. African Studies 61: 27–54CrossRefGoogle Scholar
Olalla, P. G., Knobel, H., Carmona, A., Guelar, A., Lopez-Colomes, J. L. and Cayla, J. A. (2002). Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes 30: 105–110CrossRefGoogle Scholar
Devine, P. G., Plant, E. A. and Harrison, K. (1999). The problem of ‘us’ versus ‘them’ and AIDS stigma. American Behavioral Scientist 42: 1212–1228CrossRefGoogle Scholar
Duran, S., Saves, M.Spire, B.et al. (2001). Failure to maintain long-term adherence to highly active antiretroviral therapy: the role of lipodystrophy. AIDS 15: 2441–2444CrossRefGoogle ScholarPubMed
Elford, J., Bolding, G., Maguire, M. and Sherr, L. (2000). Do gay men discuss HIV risk reduction with their GP? AIDS Care 12: 287–290CrossRefGoogle ScholarPubMed
Erwin, J., Morgan, M., Britten, N., Gray, K. and Peters, B. (2002). Pathways to HIV testing and care by black Africans and white patients in London. Sexually Transmitted Infections 78: 37–39CrossRefGoogle Scholar
Erwin, J. and Peters, B. (1999). Treatment issues for HIV+ Africans in London. Social Science and Medicine 49: 1519–1528CrossRefGoogle Scholar
Fauci, A. S. (1988). The human immunodeficiency virus: infectivity and mechanisms of pathogenesis. Science 239: 617–22CrossRefGoogle ScholarPubMed
Feeney, G. (2001). The impact of HIV/AIDS on adult mortality in Zimbabwe. Population and Development Review 27: 771–780CrossRefGoogle Scholar
Fenton, K. A., Chinouya, M., Davidson, O. and Copas, A. (2002). HIV testing and high risk sexual behaviour among London's migrant African communities: a participatory research study. Sexually Transmitted Infections 78: 241–245CrossRefGoogle ScholarPubMed
Fuller, G. N., Jacobs, J. M. and Guiloff, R. J. (1991). Subclinical peripheral-nerve involvement in AIDS – an electrophysiological and pathological study. Journal of Neurology, Neurosurgery and Psychiatry 54: 318–324CrossRefGoogle ScholarPubMed
Gaillard, P., Melis, R.Mwanyumba, F.et al. (2002). Vulnerability of women in African settings: lessons from mother-to-child HIV transmission prevention programmes. AIDS 16: 937–939CrossRefGoogle Scholar
Gaitskell, D. (1982). ‘Wailing for Purity’: prayer unions, African mothers and adolescent daughters, 1912–1949. In Industrialization and Social Change in South Africa: African Class Formation, Culture and Consciousness, 1870–1939, ed. S. Marks and R. Rathbone, pp. 338–357. Harlow: Longmans
Garnett, G. P., Bartley, L., Grassly, N. C. and Anderson, R. M. (2002). Antiretroviral therapy to treat and prevent HIV/AIDS in resource-poor settings. Nature Medicine 8: 651–654CrossRefGoogle ScholarPubMed
Gillies, P. (1998). Effectiveness of alliances and partnerships for health promotion. Health Promotion International 13: 1–21CrossRefGoogle Scholar
Gras, M. J., Weide, J. F., Langendam, M. W., Coutinho, R. A. and Hoek, A. (1999). HIV prevalence, sexual risk behaviour and sexual mixing patterns among migrants in Amsterdam, The Netherlands. AIDS 13: 1953–1962CrossRefGoogle ScholarPubMed
Green, E. C. (1992). Sexually transmitted disease, ethnomedicine and AIDS in Africa. Social Science and Medicine 35: 121–130CrossRefGoogle ScholarPubMed
Green, E. C. (1999). Indigenous Theories of Contagious Disease. London; Sage Press
Greene, W. C. (1993). AIDS and the immune system. Scientific American 269: 98–105CrossRefGoogle ScholarPubMed
Gregson, S., Anderson, R. M., Ndlovu, J., Zhuwau, T. and Chandiwana, S. K. (1997). Recent upturn in mortality in rural Zimbabwe: evidence for an early demographic impact of HIV-1 infection? AIDS 11: 1269–1280CrossRefGoogle ScholarPubMed
Guasset, Q. (2001). AIDs and cultural practices in Africa: the case of the Tonga (Zambia). Social Science and Medicine 52: 509–518CrossRefGoogle Scholar
Hahn, A., Eirmbter, W. H. and Jacob, R. (1994). AIDS – ordinary knowledge and insecurity. Actes de la Recherche en Sciences Sociales 104: 81–89CrossRefGoogle Scholar
Hayter, M. (1999). Burnout and AIDS care-related factors in HIV community Clinical Nurse Specialists in the North of England. Journal of Advanced Nursing 29: 984–993CrossRefGoogle ScholarPubMed
Heald, S. (2002). It's never as easy as ABC: understandings of AIDS in Botswana. African Journal of AIDS Research 1: 1–11CrossRefGoogle Scholar
Hurba, G. J., Panter, A. T.Melchior, L. A.et al. (2000). Do characteristics of HIV/AIDS education and training affect perceived training quality? Lessons from the evaluation of seven projects. AIDS Education and Prevention 12: 455–476Google Scholar
Ives, N. J., Gazzard, B. G. and Easterbrook, P. J. (2001). The changing pattern of AIDS-defining illnesses with the introduction of highly active antiretroviral therapy (HAART) in a London clinic. Journal of Infection 42: 134–139CrossRefGoogle Scholar
Jain, R. G., Furfine, E. S., Pedneault, L., White, A. J. and Lenhard, J. M. (2001). Metabolic complications associated with antiretroviral therapy. Antiviral Research 51: 151–177CrossRefGoogle ScholarPubMed
Kalichman, S. C., Sikkema, K. J., DiFonzo, K., Luke, W. and Austin, J. (2002). Emotional adjustment in survivors of sexual assault living with HIV-AIDS. Journal of Traumatic Stress 15: 289–296CrossRefGoogle ScholarPubMed
Kelly, B., Raphael, B., Judd, F., Kernutt, G., Burnett, P. and Burrows, G. (1998). Suicidal ideation, suicide attempts, and HIV infection. Psychosomatics 39: 405–415CrossRefGoogle ScholarPubMed
Kelly, B., Raphael, B.Statham, D.et al. (1996). A comparison of the psychosocial aspects of AIDS and cancer-related bereavement. International Journal of Psychiatry in Medicine 26: 35–49CrossRefGoogle ScholarPubMed
Klaits, F. (2002). Housing the Spirit, Hearing the Voice: Care and Kinship in an Apostolic Church during Botswana's Time of AIDS. Baltimore: Unpublished PhD dissertation, Johns Hopkins University
Kleinmann, A. (1980). Patients and Healers in the context of Culture. Berkeley: University of California Press
Kopelman, L. M. and Niekerk, A. A. (2002). AIDS and Africa. Journal of Medicine and Philosophy 27: 139–142CrossRefGoogle ScholarPubMed
Kupek, E., Dooley, M., Whitaker, L., Petrou, S. and Renton, A. (1999). Demographic and socio-economic determinants of community and hospital services for people with HIV/AIDS in London. Social Science and Medicine 48: 1433–1440CrossRefGoogle Scholar
Lichtenstein, B., Laska, M. K. and Clair, J. M. (2002). Chronic sorrow in the HIV-positive patient: issues of race, gender, and social support. AIDS Care 16: 27–38CrossRefGoogle ScholarPubMed
Malanda, S., Meadows, J. and Catalan, J. (2001). Are we meeting the psychological needs of Black African HIV-positive individuals in London? Controlled study of referrals to a psychological medicine unit. AIDS Care 13: 413–419CrossRefGoogle ScholarPubMed
Mallinson, R. K. (1999). Grief work of HIV-positive persons and their survivors. Nursing Clinics of North America 34: 163–169Google ScholarPubMed
McMunn, A. M., Mwanje, R., Paine, K. and Pozniak, A. L. (1998). Health service utilization in London's African migrant communities: Implications for HIV prevention. AIDS Care 10: 453–462CrossRefGoogle ScholarPubMed
Moatti, J. P., Spire, B. and Duran, S. (2000). A review of socio-behavioural studies on adherence to antiretroviral treatments: beyond biomedical models? Revue D'Epidemiologie et de Sante Publique 48: 182–197Google ScholarPubMed
Mocroft, A., Barry, S. and Sabin, C. A. (1999a). The changing pattern of admissions to a London hospital of patients with HIV: 1988–1997. AIDS 13: 1255–1261CrossRefGoogle Scholar
Mocroft, A., Sabin, C. A. and Youle, M. (1999b). Changes in AIDS-defining illnesses in a London clinic, 1987–1998. Journal of Acquired Immune Deficiency Syndromes 21: 401–407CrossRefGoogle Scholar
Mogensen, H. (1997). The narrative of AIDS among the Tonga of Zambia. Social Science and Medicine 44: 431–439CrossRefGoogle ScholarPubMed
Moneyham, L., Hennessy, M., Sowell, R., Demi, A., Seals, B. and Mizuno, Y. (1998). The effectiveness of coping strategies used by HIV-seropositive women. Research in Nursing and Health 21: 351–3623.0.CO;2-E>CrossRefGoogle ScholarPubMed
Nicoll, A., Laukamm-Josten, U.Mwizarubi, B.et al. (1993). Lay health beliefs concerning HIV and AIDS – a barrier for control programmes. AIDS Care 5: 231–241CrossRefGoogle ScholarPubMed
Nzioka, C. (2000). The social meanings of death from HIV/AIDS: an African interpretative view. Journal of Culture, Health and Society 2: 1–14CrossRefGoogle Scholar
Pakenham, K. I., Dadds, M. R. and Terry, D. J. (1995). Psychological adjustment along the HIV disease continuum. Psychology and Health 10: 523–536CrossRefGoogle Scholar
Page, S. (1999). Accommodating persons with AIDS: acceptance and rejection in rental situations. Journal of Applied Social Psychology 29: 261–270CrossRefGoogle Scholar
Paxton, S. (2002). The paradox of public HIV disclosure. AIDS Care 14: 559–567CrossRefGoogle ScholarPubMed
Pierson, C. M., Randall Curtis, J. and Patrick, D. L. (2002). A good death: a qualitative study of patients with advanced AIDS. AIDS Care 14: 587–598CrossRefGoogle ScholarPubMed
Powellcope, G. M. and Brown, M. A. (1992). Going public as an AIDS family caregiver. Social Science and Medicine 34: 571–580CrossRefGoogle Scholar
Pryor, J. B., Reeder, G. D. and Landau, S. (1999). A social-psychological analysis of HIV-related stigma – a two-factor theory. American Behavioral Scientist 42: 1193–1211CrossRefGoogle Scholar
Quinn, T. C., Wawer, M. J.Sewankambo, N.et al. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England Journal of Medicine 342: 921–929CrossRefGoogle ScholarPubMed
Rose, A. M. C., Sinka, K., Watson, J. M., Mortimer, J. Y. and Charlett, A. (2002). An estimate of the contribution of HIV infection to the recent rise in tuberculosis in England and Wales. Thorax 57: 442–445CrossRefGoogle ScholarPubMed
Schoepf, B. G. (1992). Sex, gender and society in Zaire. In Sexual Behaviour and Networking. Anthropological and Socio-Cultural Studies on the Transmission of HIV, ed. T Dyson, pp. 353–375. Liège: IUSSP Ordina
Schonnesson, L. N. (2002). Psychological and existential issues and quality of life in people living with HIV infection. AIDS Care 14: 399–404CrossRefGoogle Scholar
Setbon, M. (2000). The paradoxical normalization of AIDS. Revue Francaise de Sociologie 41: 61–69CrossRefGoogle Scholar
Sherman, D. W. (2000). AIDS-dedicated nurses: what can be learned from their perceptions and experiences? Applied Nursing Research 13: 115–124CrossRefGoogle ScholarPubMed
Sherman, D. W. and Ouellette, S. C. (1999). Moving beyond fear – lessons learned through a longitudinal review of the literature regarding health care providers and the care of people with HIV/AIDS. Nursing Clinics of North America 34: 1–12Google ScholarPubMed
Sherr, L., Bergenstrom, A. and Hudson, C. N. (2000). Consent and antenatal HIV testing: the limits of choice and issues of consent in HIV and AIDS. AIDS Care 12: 307–312CrossRefGoogle ScholarPubMed
Stone, V. E. (2001). Strategies for optimizing adherence to highly active antiretroviral therapy: lessons from research and clinical practice. Clinical Infectious Diseases 33: 865–872CrossRefGoogle ScholarPubMed
Sumartojo, E. (2000). Structural factors in HIV prevention: concepts, examples, and implications for research. AIDS 14: S3–10CrossRefGoogle ScholarPubMed
Tawil, O., Verster, A. and O'Reilly, K. (1995). Enabling approaches for HIV/AIDS promotion: can we modify the environment and minimise the risk? AIDS 9:1299–1306CrossRefGoogle Scholar
Temin, H. M. (1989). Is HIV unique or merely different? Journal of Acquired Immune Deficiency Syndromes 2: 1–9Google ScholarPubMed
Troop, M., Easterbook, P., Thornton, S., Flynn, R., Gazzard, B. and Catalan, J. (1997). Reasons given by patients for ‘non-progression’ in HIV infection. AIDS Care 9: 133–142CrossRefGoogle ScholarPubMed
Valimaki, M., Suominen, T. and Peate, I. (1998). Attitudes of professionals, students and the general public to HIV/AIDS and people with HIV/AIDS: a review of the research. Journal of Advanced Nursing 27: 752–759CrossRefGoogle Scholar
Vanservellen, G. and Aguirre, M. G. (1995). Symptoms, symptom management, and psychological morbidity among persons with HIV disease. AIDS Patient Care 9: 134–139CrossRefGoogle Scholar
Walsh, J. C., Horne, R., Dalton, M., Burgess, A. P. and Gazzard, B. G. (2001). Reasons for non-adherence to antiretroviral therapy: patients' perspectives provide evidence of multiple causes. AIDS Care 13: 709–720CrossRefGoogle ScholarPubMed
Wesselingh, S. L. and Thompson, K. A. (2001). Immunopathogenesis of HIV-associated dementia. Current Opinion in Neurology 14: 375–379CrossRefGoogle ScholarPubMed
Williams, J. E. (1997). Discourses on death: obituaries and the management of spoiled identity. Omega Journal of Death and Dying 34: 301–319CrossRefGoogle Scholar
Wood, C. G. A., Kumalo, P., Ainsworth, J., Govind, A. and Meates, M. (2002). Disclosure, discordance and decisions – the psychosocial impact of antenatal HIV testing. Poster presentation: Abstract 319. Sixth International Congress on Drug Therapy in HIV Infection, 17–21 November 2002, Glasgow, UK
Wood, C. G. A., Whittet, S. and Bradbeer, C. S. (1997). HIV infection and AIDS. British Medical Journal 315: 1433–1436CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×