While the risk of developingAIDS increases based on the lengthof time a person has been infectedwith HIV, a major study of HIVsurvival among gay and bisexualmen has found that after 13 years,one-third of those with HIV hadstill not developed AIDS. The SanFrancisco City Clinic Cohort Studyhas looked at 562 gay and bisexualmen and found that less than 1% ofsubjects with HIV developed AIDSwithin two years of infection, 12%within five years, 51% within 10years, and 68% within 13.8 years.1

Furthermore, people who haveprogressed to AIDS are now livinglonger than ever. A study of peoplediagnosed with AIDS between1978 and 1983 showed that 5% to10% survived for three years

despite low T-helper cell levels;data since the late 1980s show that15% to 20% of people with AIDSsurvive at least three years afterbeing diagnosed.2 Recent develop-ments are even more encouraging.

Results of the Multicenter AIDSCohort Study of 5,000 gay men,including a group in Los Angeles,show that men diagnosed withAIDS in 1991 have twice the sur-vival time of those diagnosed in1984 because of improvements inmedication and health care.3 In a1990 study of 4,323 people withAIDS, the median survival timeafter development of AIDS was12.5 months, with 8.7% of peoplesurviving three years and 3.4%surviving five years.4 Studies ofsurvival have been conducted pri-

marily among gay, white men. Lessis known about survival trends ordifferences that may exist amongothers, such as women, AfricanAmericans, Latinos, and Asians.

HIVCOUNSELOR

PERSPECTIVESVolume 3 Number 5 October 1993Written and Produced by the UCSF AIDS Health Projectfor the California Department of Health Services, Office of AIDS

SURVIVAL AND HIVMost people do not develop AIDS until 10 years or more after being infected; a number of people who have been living

with HIV infection for 13 years or more have not developed AIDS. As well, many people with AIDS have lived several years.These people are often referred to as “long-term survivors.” The concept of long-term survival has been defined in various

ways, and is often self-defined by a person living with HIV or AIDS. This article accepts a commonly held view that a long-term survivor of HIV is someone who has been infected for seven or more years. A long-term survivor of AIDS is someonewho has lived with an AIDS diagnosis for at least three years; the Centers for Disease Control and Prevention (CDC) usesthis period to define a long-term survivor of AIDS.

This issue of PERSPECTIVES explores the prevalence of long-term survival and characteristics of survivors. TheImplications for Counseling section presents ways to counsel clients about surviving with HIV infection.

Research Update

Inside This Issue

1 Research Update

3 Characteristics of Long-TermSurvivors

4 Implications for Counseling

5 Disclosing a Positive Test Result

7 Case Study

8 Test Yourself

8 Using PERSPECTIVES

Spectrum of DiseaseT-helper cell counts, which

normally range between 800 and1,200 in uninfected people, mea-sure one of many cells of theimmune system that help the bodyfight HIV; although little under-stood, T-helper cell counts are usedas a marker to track progression ofHIV disease. HIV infection is asso-ciated with a rapid decline in T-helper cells during the first 18months after infection. During thisperiod, a person’s T-helper cellcount may fall by as much as one-third. For instance, a person whohad a T-helper cell count of 1,000before becoming infected mayhave a count of 700 by the end of18 months. After this initialdecline, T-helper cell counts gener-ally fall at a slower rate, with totalcounts becoming relatively stableat below-normal levels and stayingthat way, often for many years.

When T-helper cell counts fallbelow 500, many people begintreatment with antiviral drugs,such as AZT, ddI, and ddC. Whenthe T-helper cell count is below200, a person is diagnosed withAIDS and is likely to develop anopportunistic infection. Preventivetreatment against opportunisticinfections, such as Pneumocystiscarinii pneumonia, generally

begins only when a person’s T-helper cell count falls below 200.5

People can survive at eachstage of infection for long periods.Of the survivors followed in theSan Francisco City Clinic CohortStudy, after 13 years, 27% had T-helper cell counts above 500, 48%had counts between 200 and 500,and 25% had counts below 200.1

A variety of studies give a gen-eral picture of the physical healthof people with HIV. Most peopleinitially infected with HIV have nosymptoms. About 50% to 70% havea brief illness, with symptoms sim-ilar to those of mononucleosis.6

The longest period of HIV infec-tion, particularly the early stage ofthis period, is accompanied by noserious health problems. As infec-tion progresses, many peoplebecome increasingly symptomatic,experiencing diarrhea, fatigue,swollen lymph glands, fever, nightsweats, and other debilitating con-ditions. Such signs of illness caninterfere with daily activities andgreatly affect quality of life.7

Some research indicates thateven when HIV-infected people arein a period that is generally symp-tom-free, some symptoms appearmore commonly than in those whoare not infected with HIV. Gay menwith HIV have reported at least 5.6

more days of symptoms each yearthan uninfected gay men.8 Thesame study showed that those withHIV were more likely to bedepressed, even without knowl-edge of their HIV serostatus.

Role of TreatmentsTreatment with AZT has been

considered at various times to be asignificant factor in extended sur-vival and health. Recent studies,however, have seriously ques-tioned the effectiveness of AZT.

Studies in the 1980s found AZTto effectively prolong people’s liveswhen they develop AIDS.9 On thebasis of early evidence, the medicalcommunity and treatment advo-cates proposed that AZT be givento people without symptoms, andAZT received federal approval forwidespread use in 1987.10 Themedical community was, therefore,set back by results of the ConcordeStudy at the Ninth InternationalConference on AIDS in early June1993. This study, conducted inEurope, suggested that peoplewithout symptoms who were tak-ing AZT had similar rates of pro-gression to AIDS as those not onAZT. This has been interpreted bysome as a failure of AZT at earlystages of infection; others see it as apredictable result of the ability ofHIV to resist treatment.

The Concorde study has facedsignificant criticism, and because ofsome methodological weaknesses,its findings have been discountedby some researchers. However,partly in response to the study’sfindings, an expert panel broughttogether by the National Institute ofAllergy and Infectious Diseases(NIAID) in late June establishednew guidelines for antiviral treat-ment. The new guidelines are lessaggressive in recommending AZTat earlier disease stages, allowingmore choice to patients and physi-cians. New recommendations placemore emphasis on disease symp-toms, rather than on T-helper cellcounts alone.

2 PERSPECTIVES: SURVIVAL AND HIV

T-Helper Cells and SurvivalT-helper cell counts of 593 gay men infected with HIV 10-15 years.1

64% developed AIDS died prior to diagnosis, or had nothad a recent T-helper cell test

25% did not have AIDS

200-500 t-helper cells

more than 500 t-helper cells

below 200 t-helper cells

*Based on thedefinition ofAIDS prior toJanuary 1,1993. On thisdate, the defi-nition wasrevised toinclude peoplewith T-helpercell countsbelow 200.

8%

11%

11%

6%

Health care providers report a variety of charac-teristics among long-term HIV survivors.1 The fol-lowing are some of the most common characteristics:• Optimism• Feeling that they are personally responsible for,

and can influence, their health• Feeling satisfied with the quality of life• Belief that life is meaningful• Belief that life has become more meaningful as a

result of infection• Experience of having dealt with or healed emo-

tional wounds• Able to employ healthful coping mechanisms• Able to avoid feeling negative effects of difficult

people or situations • Involvement in meaningful life and activities

• Involvement in fitness or exercise programs• Pragmatic and realistic outlook• Able to take each day as it comes• Have sought HIV-related medical care• Skill in communicating their needs• Have sought physicians they can trust. They

expect to be treated as equals and collaboratorsand will change doctors if not satisfied

• Good medical consumers; they stay informedabout medical developments and assertivelydemand the best treatment possible

• Generally not obsessed by T-helper cell counts• In some cases, have survived other life-threaten-

ing or psychologically disturbing circumstances• Involvement in helping others — socially, politi-

cally or in other meaningful ways

Quality of life is one factor inconsidering whether antivirals areultimately beneficial and in deter-mining at which stage of infectionthey might be taken. Side effects ofantiretrovirals clearly diminishquality of life. AZT causes severaladverse reactions including ane-mia, headaches, nausea, and vom-iting. Both ddI and ddC causepainful neuropathy, sometimeseven after the drugs are no longerbeing used. But, all three, taken incombination or independently,have demonstrated an ability toboost the immune system.11

Survival StrategiesAmong survivors in various

studies, no single method of med-ical therapy predominates, andsurvivors have taken what mayappear to be conflicting approach-es. For instance, while some peoplewho have survived many yearshave used antiviral therapies, oth-ers have not taken any treatments.1Personal testimonials of many sur-vivors support the view thatlifestyle changes, and not treat-ment-related choices, may wellprolong symptom-free infection.

The ability to cope with infection

appears to play a large, but stillunclear, role in the mental and per-haps physical health of those withHIV. A common characteristicamong those who have survivedwith HIV or AIDS is that their atti-tude toward life has changed fol-lowing diagnosis. Most speak ofhaving made their lives “fulfilling”;they have reduced stress and self-destructive influences, openedthemselves to living and focusedtheir lives on building a future. [Formore on this, see “Related Issue:Characteristics of Long-TermSurvivors,” below.]

There is little scientific data toexplain why personal attitudesmay influence survival, but thereare some interesting observationsthat support such claims. Whilestudies have not found a direct linkbetween physical symptoms of dis-ease and conditions such as anxietyand depression, some researchersbelieve that a person’s ability tocope may be affected by anxietyand depression.12 It has even beenshown that an “active coping style”promotes the activity of naturalkiller cells, a specialized cell that islittle understood but is a possibly

vital part of the immune system.13

A ground-breaking study of femalebreast cancer patients participatingin support groups showed theaverage survival time was twice aslong for participants as for thosenot participating in groups.14

Because groups emphasized copingwith terminal illness, similarresults may be seen in people withHIV. As people continue to livewith HIV for extended periods, agreat deal more may be learnedabout characteristics of survivors.

Genetic and Viral DifferencesResearchers have proposed that

genetic differences, which are notyet understood, may explain whysome people with HIV survive orremain relatively free of symptomsfor longer periods than others. Inaddition, researchers have reportedthat differences in disease progres-sion may be partly based on thevirulence of the specific HIV strainin which a person is infected. Asurvey of six people who wereinfected during a blood transfusionfrom the same donor found thatfive of the six, as well as the blooddonor, remained symptom-free,and with normal T-helper cell

3PERSPECTIVES: SURVIVAL AND HIV

Related Issue: Characteristics of Long-Term Survivors

Many clients do not understandthe meaning of a positive testresult as it relates to survival andillness. For instance, some clientsbelieve a positive result means aperson is in immediate danger ofbecoming ill, while others do notrecognize that HIV infection is life-threatening. Attitudes about theseverity of HIV and survivinginfection greatly affect how a per-son responds to being infected.Someone who views HIV infectionas life-threatening but manageablemay seek health care and want tostay alive, while someone whoviews HIV as a “death sentence”may approach life fatalistically,doing nothing to prolong survival.

Pre-Test CounselingIn pre-test counseling, assess

attitudes and awareness about theseverity of HIV by asking what apositive test result means to theclient. This may include a discus-sion about the client’s attitudestoward survival, if he or she wereto test positive, as well as how theclient views those who are infect-ed. Taking time to discuss this inthe pre-test, rather than post-test,

session gives the counselor achance to clarify misinformationthe client may have. In addition, itgives the client an opportunity,perhaps for the first time, to con-sider what it would mean toreceive a positive result. Even if theclient later tests negative, such adialogue can help the client deter-mine the seriousness of HIV infec-tion and be motivated to avoidinfection in the future.

Pre-test counseling is also idealbecause it is a setting in whichinformation can be exchangedwithout the overwhelming feelingsthat can arise in post-test counsel-ing. In post-test positive sessions,clients who test positive may be intoo much shock to receive informa-tion, while clients who test nega-tive may have little interest.

Make sure clients understandthe spectrum of HIV infection.Clients may have outdated beliefsabout survival that they formed inthe early- and mid-1980s when sur-vival times were far shorter.Explain that a few people becomeseriously ill soon after infection butthat most people remain in good

health for many years, and somehave lived more than 12 yearswithout becoming ill.

When possible, explain the fol-lowing stages of infection, theirlength and how they are managed:

1) the symptom-free period;2) the period in which some

symptoms of disease, includingminor illnesses, occur; and

3) the period in which a personhas developed serious symptomsand conditions, some of which con-stitute an AIDS diagnosis.

Present statistics about eachperiod when this will be useful; beaware, however, that statistics mayunnecessarily complicate discus-sion and general statements areoften more helpful.

Ideally in the pre-test session,explain the relevance of taking careof oneself, for example, by estab-lishing ongoing medical manage-ment as soon as possible; maintain-ing proper nutrition; gettingappropriate exercise and rest; andmanaging stress in non-destructiveways. Make sure clients under-stand that a positive HIV test resultdoes not indicate when a personwas infected with HIV.

For clients who do not respondto a dialogue about the meaning ofa positive result, suggest that theyconsider postponing testing untilthey have had more time to thinkabout this, either on their own orthrough follow-up counseling.

Post-Test CounselingDiscussions of survival can be

especially challenging in post-testcounseling sessions when a coun-selor discloses positive results. Thisis a time in which the counselor istrying to focus not on the future,but instead on the client’s needsand feelings in the moment and thetime immediately after the counsel-ing session. Despite this, discus-sion of survival issues can takeplace, and in some cases, such dis-

4 PERSPECTIVES: SURVIVAL AND HIV

Implications for Counseling

75%

15%

2 years 5 years 10 years 13.8 years

45%

30%

60%

Median period oftime after beinginfected in whichpeople develop AIDS

*Based on the definition of AIDS in effect prior to January 1, 1993.

Development of AIDS

5PERSPECTIVES: SURVIVAL AND HIV

“I’ve lowered my expectations of drug treatment.Five years ago, I had high hopes about AZT, and Iassumed that people testing positive would behealthy until a cure came along. That’s not the reali-ty today, and I don’t like to face the reality. But, if Idon’t, I’m deceiving the client and deluding myself.”

“Considering that the news about treatments isdiscouraging, it helps me to know that people aresurviving by taking care of themselves, often timeswithout drug treatment. This helps me replace dis-appointing news about treatments with useful infor-mationthat if people take care of themselves, theycanlive with HIV.”

“To be present with clients, I have to work hardernow to separate from the epidemic. Outside theworkplace, I stay away from HIV. And I stay awayfrom areas of the city where a lot of people I knew

have died. And, I’ve slowed my pace. Years ago, Isaw clients’ needs as urgent and put them ahead ofmy own. Now, I put my needs first.”

“I didn’t think people would test positive or sero-convert after 1990. I’ve had to change my ideas ofhow long-lasting the epidemic would be.”

“In the ‘80s, HIV seemed so much simpler, andwe could assume there’d be a cure. Now, we know alot more about how hard it is to treat HIV, withoutreally knowing anything about how to treat it. We’refaced with concepts like prophylaxis, recombinantgene therapy, and cellular immunity. I acknowledgeto clients that these things aren’t tangible or simple.”

“I can’t say anything absolute about survivalrates. But, by qualifying what I say, I can make posi-tive statements about survival.”

Related Counseling Issue: Disclosing a Positive Test ResultWhile people are living longer than ever with HIV infection, advances in treatment options have been discouraging.

As a result, some longtime counselors report that disclosing a positive test result in 1993 is, in certain ways, more diffi-cult than it was in 1985. While little was known about survival and treatments at that time, it was commonly believedthat many people who tested positive would never develop AIDS, and that treatment and a cure might soon be available.

The following are observations of veteran counselors about their work now compared to several years ago .

cussion may be especially relevantto the feelings or thoughts theclient is having during the session.For instance, the client who haslost sight of the belief that peoplecan live with HIV for many yearsmay gain some relief from beingreminded of this.

This reminder about survivalcan also help clients counter thesense of urgency often felt, and itcan alter the decision-makingprocess from one that occurs in ahurried context to one in whichdecisions can be made at a moremeasured pace. Assure clients thatthere is time to reflect, discuss andconsider options, even though theclient may feel a decision or resolu-tion must be made immediately.Recognize, too, that a client whodenies his or her infection willhave time to adjust, and may laterdevelop plans for managing news

of his or her infection.When receiving a positive test

result, clients often present coun-selors with a variety of questions.A commonly expressed concern iswhether a positive result means aclient is going to die. The coun-selor’s direct answer to this type ofquestion may be less useful than adiscussion of the client’s feelingsabout and reasons for asking thequestion. Exploring these may helpthe client learn more about his orher thoughts related to living anddying, and about receiving a posi-tive result. Affirm the client’s fearsor other feelings about illness ordeath, and provide factual infor-mation the client can integrate withhis or her perceptions.

While it is important to commu-nicate messages of hope, it is nec-essary that counselors not respondto clients with inaccurate informa-

tion that could lead to unrealistichopes or expectations. Beyond dis-cussions of long-term survival,questions about the prospect ofdeath can be answered in a varietyof ways. Counselors might statethat although it is true that all peo-ple are going to die at some time,people with HIV are at increasedrisk of earlier death. Acknowledgethat while a few people with HIVbecome ill and die soon after theirinfection, most people remainhealthy for many years after beinginfected, and some people are stillalive and healthy more than 12years after being infected.

Whenever aspects of the futureare discussed, it is important tocontinue to be alert to clients’ feel-ings in the moment, and to addressimmediate needs for support.Clients may ask about the future toavoid the present. Counselors can

keep the focus on immediate feel-ings while confronting the futureby discussing the value of facinglife today, rather than the possibili-ty of death at an unknown time inthe future. Be attentive to andrespect clients’ revelations aboutspiritual beliefs or values. Thesecan provide an indication of howclients view the future and issuesof illness and death.

Counselors may meet with littleapparent success in discussionsabout survival even when clientsask questions about it — and mustaccept that clients may be unwill-ing or unable to have such a dis-cussion. Survival and living anddying can be better dealt with infollow-up and ongoing supportgroups or psychotherapy. Makeclients aware of these options.

Survival StrategiesUnderstanding the value of sur-

vival strategies may be confusingfor both clients and counselorsbecause some long-term survivorshave used techniques that othershave not. For instance, some haveused antiviral therapy, while oth-ers have not taken any medication.

Be prepared to discuss the rangeof survival strategies people withHIV use. Encourage clients toinvestigate strategies that interest

them. State that there is little spe-cific evidence about which stepsare more likely to lead to longersurvival, but that it is clear thatpeople survive for longer periodswith HIV now than they did earlyin the epidemic, based in part onimprovements in medical care andtreatments. State that others reportimproved quality of life as a resultof actively working toward sur-vival. Personal testimonials ofmany long-term survivors supportthe view that taking care of oneselfcan prolong symptom-free periods.

Support groups are perhaps themost useful strategy to discussduring post-test counselingbecause such groups relate both tosurviving with HIV infection aswell as meeting immediate needsfor support. State that HIV supportgroups have been shown toimprove attitude and outlook — inpart by offering a shared experi-ence with others in a similar situa-tion — and that these benefits mayextend life expectancy. Groupinvolvement may also allow peo-ple to more effectively mobilizeresources. Make referrals to suchgroups, and to the state’s EarlyIntervention Program (EIP), inareas where sites are located. Thisprogram offers support groups asa central part of its services.

To the extent the client is active-ly interested, present other sur-vival strategies, such as nutritionalplans and ongoing medical care. Ifclients are not interested in thisdiscussion, do not force it. Instead,focus on the client’s concerns andthe benefits of immediate support,and provide referrals for follow-upservices. EIP sites offer nutritionalplanning, health education, casemanagement, and medical care,without charge.

When presenting survivalstrategies, explain that they relateto and complement other strate-gies. For instance, make sureclients understand that supportgroups are in no way a replace-ment for ongoing medical care.

Similarly, it is important to under-stand that a sound nutritional planwill have reduced value if a personuses alcohol or other drugs.

It is important for clients to feelcomfortable with the strategies forsurvival they choose to apply.Some people with HIV havebecome preoccupied with investi-gating and implementing survivalstrategies at the expense of otherpleasurable daily activities, such aswork or social pursuits. For exam-ple, exercising or reading medicalresearch reports may become aperson’s most important pursuit atthe expense of all other activity.This response, which is often ashort-term one, may be normaland necessary for some people,including those who feel that pri-orities in their lives must change.Rather than discouraging this,encourage clients to assess thevalue of various strategies. Theextent to which survival strategiescan be integrated into and bal-anced with other parts of one’s lifeis especially important to a per-

6 PERSPECTIVES: SURVIVAL AND HIV

A Counselor’s Perspective

“As part of any discus-

sion of survival, I empha-

size that it is important for

clients to stay knowledge-

able and interested in how

they can take care of

themselves, and that they

be ‘partners’ with

providers in theit care.”

A Counselor’s Perspective

“Talking about long-term survival is sometimes

difficult because itinvolves discussing the

future at a time when it’simportant to focus on the

present. Any time I talkabout survival, I make sure

the client is comfortableenough with what’s going

on in the immediatemoment, and then I con-clude by coming back towhat’s most immediate.”

7PERSPECTIVES: SURVIVAL AND HIV

Counseling InterventionGain a better understanding of Mary’s impres-

sions of HIV infection and AIDS, and determine thesource of these. Mary’s experiences may be basedon people she has known who did not test for HIVand did not seek medical care when symptoms ofdisease arose. They may have learned they had HIVonly when they became seriously ill, perhaps manyyears after they were infected.

Explain that there are different profiles of survival,depending on physiological differences betweenpeople, as well as on how people respond to HIVinfection. Also explain the spectrum of infection.State that some people do become sick relativelysoon after being infected, but more commonly, peo-ple remain healthy for long periods, and evidencedoes not support the idea that illness and death areimminent for someone infected only three years. Donot deny, however, that HIV infection is life-threaten-ing; acknowledge that illness and death can occur.

Because she has chosen to test now, help Marysee that, especially if she was infected not more thanthree years ago, she is giving herself a chance totake charge of her life and infection in a way sheotherwise would not have. State that by managingher health, it is very possible she can remain as sheis now for an extended period.

Stress that there have been improvements in man-aging HIV infection, both in terms of understandingthe virus and in responding with primary and pre-ventive treatment. These changes have extendedsurvival, improved quality of life, and helped peoplebetter deal with illnesses that can arise.

Respect Mary’s fears and other feelings related tothe illness and death of her friends. Recognize thatit may be difficult for her to remember that a personcan live with HIV in the face of such reminders.Such images may lead her to deny her infection.Point out that she can use her fears to motivate her-self to actively face and manage her infection. Inmany cases, a person can reduce fears by facingthem in a supportive environment.

It is important that Mary have contact withproviders who can help her see that HIV infection ismanageable, and who understand HIV issues affect-ing women. A support group for healthy peoplewith HIV can be especially valuable in providing herwith images of HIV-infected people who leadhealthy, vigorous lives. Provide referrals to theseresources, help her see how they can immediatelybenefit her, and help her access them. Include refer-ral to the state’s Early Intervention Program (EIP), inareas where its services are available. Make surereferrals offer services appropriate to women.

Case StudyMary, who is 26, has tested HIV positive and is convinced she is going to soon become ill and die. She has been in a

primary relationship with an injection drug user for three years, and she says she was probably infected within theisperiod. When she thinks of HIV or AIDS she thinks only of friends and others who have become suddenly ill, then died.

References1. Buchbinder S, Mann D, Louie L, et al.Healthy long-term positives: cofactors fordelayed HIV disease progression. Oral pre-sentation at the Ninth InternationalConference on AIDS. June 1993, Berlin. 2. Rabkin JG, Remien R, Katoff L, WilliamsJBW, Resilience in adversity among long-term survivors of AIDS, Hospital andCommunity Psychiatry. 1993; 44(2): 162-167.3. Glick M, AIDS survival time nearly dou-bles since 1984. News from NIAID. June 8,1993.4. Lemp GF, Payne SF, et al. Survivaltrends for patients with AIDS. Journal of theAmerican Medical Association. 1990; 263(3):402-6.5. Batra P. AIDS: immunologic abnormali-ties following human immunodeficiencyvirus infection. Journal of Thoracic Imagaing.1991; 6(4): 1-5.

6. Tindall B, Cooper DA. Primary HIVinfection: host responses and interventionstrategies. AIDS. 1991; 5: 1-14

7. Goodkin K. Deterring the progression ofHIV infection. Comprehensive Therapy. 1990;149(4): 514-20.

8. Hoover DR, Saah AJ, Bacellar H, et al.Signs and symptoms of “asymptomatic”HIV-1 infection in homosexual men. Journalof Acquired Immune Deficiency Syndromes.1993; 6: 66-71.

9. Fischl, MA, Richman DD, Grieco MH, etal. The efficacy of AZT in the treatment ofpatients with AIDS and AIDS-related com-plex: a double-blind, placebo controlled trial.New England Journal of Medicine. 1987; 317:185-191.

10. Volberding P. The management of earlyhuman immunodeficiency virus infection.Journal of Thoracic Imaging. 1991; 6(4): 6-11.

11. Zurlo JJ, Lane HC. The role of antiretro-viral therapy in living long and living well.Maryland Medical Journal. 1990; 39(2): 161-5.12. Pedices M, Dunbar N, Grunseit A, et al.Anxiety, depression, and HIV-related symp-tomatology across the spectrum of HIV dis-ease. Australian and New Zealand Journal ofPsychiatry. 1992; 26(4): 560-6.13. Goodkin K, Blaney NT, Feaster D, et al.Active coping style is associated with naturalkiller cell cytotoxicity in asymtomatic HIV-1seropositive homosexual men. Journal ofPsychsomatic Research. 1992; 36(7): 635-650.14. Speigel, D, Bloom JR, Kraemer HC, et al.Support groups extend the life expectancy ofcancer patients. The Lancet. 1989; 2(8668):888-91.15. Learmont J, Tindall B, Evans L, et al.Long-term symptomless HIV-1 infection inrecipients of blood producets from a singledonor. The Lancet. 1989; 340(8824): 863-867..

Using PERSPECTIVES

PERSPECTIVES is aneasy-to-read educationalresource for HIV testcounselors and otherhealth professionals.

Each issue explores a sin-gle topic. A ResearchUpdate reviews recentresearch related to thetopic. Implications forCounseling applies theresearch to the counsel-ing session. Also includ-ed are a Case Study, andtwo sets of questions forreview and discussion.

Review Questions

1. True or False: In one large study,less than 1% of those infected withHIV were still alive 13 years afterthe beginning of the study.2. True or false: Survival times forpeople with AIDS are becomingshorter.

3. True or false: AZT use is urgedfor everyone with HIV.

4. Involvement in support groupsa) may allow a person to mobilizeresources, b) may prolong the lifeof the person with HIV, c) has beenfound to have no value in extend-ing the life of someone with a ter-minal illness, d) a and b are correct.

5. A large study found median sur-vival time after the development ofAIDS to be a) 3 months, b) 8 years,c) 12.5 months, d) 7 years

6. True or false: A survey of gaymen with HIV found that roughlyhalf live at least 10 years withoutdeveloping an AIDS-defining con-dition.

7. True or false: It has been conclu-sively proven that progression of

HIV is entirely halted by an “activecoping style.”

8. True or false: People with HIVemploy a wide variety of copingskills with great differences amongindividuals.

Discussion Questions1. Clients with HIV infection mayor may not survive for long peri-ods of time after they learn thatthey are infected. How can coun-selors present information aboutthe prospects for long-term sur-vival in a responsible manner?

2. Attitude is believed to be strong-ly linked to survival trends. Howcan this message best be conveyedin the limited time the HIV testcounselor has with the client?

3. How can HIV test counselorsremain current with informationon antiviral drugs and other issuesrelated to survival?

4. How can counselors bestdescribe various survival strategiesto clients?

5. How can counselors fairly pre-sent information about non-tradi-

tional survival strategies? How caninformation about any unproven,but potentially useful, strategies bepresented?

Answers to Test Yourself1. False. One-third of people in the SFCCCstudy have survived thirteen years.

2. False. Survival times are becoming longer.

3. False. Recommendations to use AZT are notmade for everyone. They are based upon suchfactors as the presence of symptoms of disease,a person’s T-helper cell count, and an individ-ual assessment made by both physician andclient.

4. D. Both a and b are correct.

5. C.

6. True.

7. False. An active coping style increases thenumber of certain useful “killer” cells in theimmune system; however, it is still unclear ifthese cells directly affect the progression ofHIV disease.

8. True.

Reader ResponsePERSPECTIVES encourages counselors torespond to discussion questions presented ineach issue. Replies may help in planningfuture issues. Share your thoughts related tothe questions by writing: Editor, HIVCounselor PERSPECTIVES, UCSF AIDSHealth Project, Box 0884, San Francisco, CA94143.

8 PERSPECTIVES: SURVIVAL AND HIV

Test Yourself on Survival and HIV

Writer and Editor: John TigheWriter and Researcher: Tamara SimonClinical Consultants: JD Benson, MFCC; Marcia

Quackenbush, MFCC; Jaklyn Brookman, MFCC Production: Leslie SamuelsAdministrative Support: Roger ScroggsPERSPECTIVES is an educational publication of the CaliforniaDepartment of Health Services, Office of AIDS, written and pro-duced by the AIDS Health Project of the University of CaliforniaSan Francisco. Reprint permission is granted, provided acknowl-edgment is given to the Department of Health Services. PERSPECTIVES is based largely on input from antibody test coun-selors and other health professionals. Among those who had asignificant influence on this issue: Lanz Lowen, Alejandra Acuna,Greg Smith, Kelly Butler, Jordana Raiskin, Susan Thompson andJack Hertzberg.

Director: James W. Dilley, MDPublications Manager: Robert MarksDesigner: Saul Rosenfield

Department of Health Services,Office of AIDS, P. O. Box 942732,Sacramento, CA 94234, (916)445-0553. UCSF AIDS Health Project, Box 0884, San Francisco, CA 94143-0884,(415) 476-6430.

Printed on recycled paper.

HIV Counselor PERSPECTIVES Volume 3 Number 5 October 1993

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