human immunodeficiency virus get help at
human immunodeficiency virus
You are working in a community health clinic and you have just taken C.Q., a 38-year-old woman, into
the consultation room. C.Q. has been divorced for 5 years, has two daughters (ages 14 and 16), and works
full time as a legal secretary. She is here for her yearly routine physical examination C.Q. states she is in a
serious relationship, is contemplating marriage, and just wants to make certain she is “okay.” No abnormalities
were noted during C.Q.’s physical examination. Blood was drawn for routine blood chemistries
and hematology studies; since she has never been tested, C.Q. agrees to a human immunodeficiency
virus (HIV) test. The physician requests you perform a rapid HIV test, which is an antibody test. Within 20
minutes, the results are available and are positive.
1. Does a positive rapid HIV test mean that C.Q. definitely has HIV? If it is negative, does it mean she definitely does not have HIV?
2. . What counseling do you need to provide to C.Q.?
CASE STUDY PROGRESS
C.Q. returns to the clinic two days later. The physician informs you that C.Q.’s Western blot test results
confirm that she is HIV positive; he requests that you be present when he talks to her. Before leaving C.Q.’s
room, the physician requests that you give C.Q. verbal and written information about local HIV support
groups and help C.Q. call a friend to accompany her home this evening. She looks at you through her tears
and states, “I can’t believe it. J. is the only man I’ve had sex with since my divorce. He told me I had nothing
to worry about. I can’t believe he would do this to me.” human immunodeficiency virus
3. C.Q.’s statement is based on three assumptions: (1) J. is HIV positive; (2) he intentionally
withheld the information from her; and (3) he intentionally transmitted the HIV to her
through unprotected sex. Based on your knowledge of HIV infection, how would you
4. . In addition to offering alternative explanations and exploring options, what is your most
important role at this time? human immunodeficiency virus
5. C.Q. asks you whether she has AIDS. What do you tell her?
6. . Why is it a good idea for C.Q. to have someone she trusts transport her home this evening?
7. . C.Q. gives you the name and phone number of a relative she wants you to call. You remain
with her until she leaves with her relative. Has C.Q.’s right to privacy been violated? Explain
why or why not.
CASE STUDY PROGRESS
C.Q. returns to the clinic 4 days later to discuss her diagnosis.
8. What are your goals for C.Q. at this time? human immunodeficiency virus
9. What additional laboratory tests would you anticipate for C.Q. and why?
10. . C.Q. asks whether there is any treatment available. How would you respond?
11. . C.Q. asks why she has to take so many drugs instead of a “big dose” of one drug. What would
you tell her?
12. . The physician starts C.Q. on a regimen of Truvada (tenofovir and emtricitabine) and human immunodeficiency virus
efavirenz (Sustiva). What general information will you give C.Q. about ART therapy?
13. C.Q. asks if she has to tell J. of her HIV status. Does she have a legal responsibility to inform
14. C.Q. asks if she has to tell J. of her HIV status. Does she have a legal responsibility to inform
15. What reporting obligations does the clinic have?
16. . Before C.Q. leaves the clinic, you recognize the need for further teaching when she says:
a. “Joining a support group can help me deal with my HIV diagnosis.” human immunodeficiency virus
b. “I will not use any other medications without checking with my health care provider.”
c. “If my viral load becomes undetectable, I will not have to worry about transmitting HIV to
d. “If my skin turns yellow, I have unusual muscle pain or feel dizzy or weak, I will call the
CASE STUDY PROGRESS
Two weeks later, C.Q. visits the office and asks to speak to you in private. She thanks you for talking to her
the day she received the news of her diagnosis. She tells you that J. confessed to her that he has hemophilia human immunodeficiency virus
and tested positive for HIV after having been infected through contaminated recombinant factor
VIII products. He was afraid to tell her about his diagnosis because she might leave him. C.Q. tells you that
she is angry with J. They are going through counseling and the wedding is “off” at the moment.