Caring About Your Meds...Wherever You Are

I recently began working with a homeless patient who reported that they would like to start taking their HIV medication. After being homeless for over 10 years, this was what I sometimes would call a social breakthrough only because many patients find taking medications while on the streets next to impossible. Whether this is due to their insecurity of being able to stay adherent to the regimen while not stably housed or if it's just a way to avoid their disease, I do not know. When I asked them what had caused this change, they responded that their living conditions were not going to improve and therefore they felt that it was time to take the next step in making sure that their health, as opposed to finding a stable home, became their top priority. After unpacking many of the profound statements made by the patient we ended our conversation on starting meds on the importance of caring for oneself in their own environment. When taking into account the fact that they are homeless, living under an overpass, and only accessing about two small meals per day via the homeless shelter and open kitchen a couple of blocks away, this patient had come to the conclusion that they were ready to take this next step in their health journey and that they could, in theory, reach viral load suppression in a very unwelcoming environment.

I have often counseled patients with various addictions on the importance of taking anti-retrovirals and that they with their addictions could take heir medicine with no issue. I provide them with stories of other patients, other substance users, who manage to reach viral load suppression and who manage to engage in the health clinic even though their behavior in one that is socially unacceptable and stigmatized by most of the health industry. The patient mentioned above is a substance user of many years, their addictions is what lead to the losing of their home, as well as the contracting of HIV. Overtime this patient has managed to navigate their way through their addiction, social services, and healthcare. The patient has managed, in the environment, to build the necessary network of support needed in order to accomplish their new goal, becoming healthy.

Their environment is not one that is welcoming. Their environment is one that causes pain and sadness and creates major hardship. The stress of having to be without a home is immense, and yet here they are. Two months after working with the patient they report 100% adherence and are demonstrating overall improvement in regards to their mental and physical health. They chose to care for themselves in a harsh environment, but the level of care was one that was thought of and profound because it was one that was self-adopted.