What Does This Worse-Than-Normal Flu Season Mean for PLHIV?

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Sad woman with tissue and medicines lying on bedI found myself unable to sleep the other night because I was so worried about this year’s severe flu, and if I, a person living with HIV (PLHIV), am more susceptible to acquiring it. The stress of outbreaks is already heightened given the recently increased rates of Hep A. My paranoia isn’t unfounded; after all, HIV is a virus that weakens the immune system. And most of us Positive folks have received a stern warning from a doctor or nurse regarding the vulnerabilities of our weakened immune systems. In response to my concern, I looked into why this year’s flu is so bad and if PLHIV are more susceptible to flu in any given year.

Thankfully, the Washington Post read my mind and reported today on this flu season and why it is the most widespread (see map below) on record. The Post’s article explains that more than 8,900 people have been hospitalized since Oct. 1, the beginning of the flu season, and has lead to a higher than normal number of deaths of children.

The Center for Disease Control and Prevention (CDC) further explains that part of the problem this year is that this strain, H3N2, is one of the “nastiest” to confront our modern population. It is good at working around our immune systems’ defenses and current vaccinations are less effective at blocking it. They also state that the season was predicted to peak the first week of January, but rates have continued to rise. So we, as a general population, are up against a powerful influenza virus without knowing when it will end.

But what about us Positive folks? Are we even more at risk of catching this year’s scary flu? I read a December 2015 interview with Christina Schofield, M.D., from The Body Pro, a go-to site for many HIV health professionals. Dr. Schofield says, “There’s probably a little bit of physician bias, and a bit more cautious treatment toward patients that are HIV positive, despite the fact that our patient population is a very healthy HIV-positive population.” She continues, “I would say that, just because somebody’s got HIV doesn’t mean they’re going to have more severe disease.”

But us PLHIV know that not all of our HIV experiences are the same. If you are one who has an immune system already damaged by HIV, then your doctor may suggest flu-fighting medications sooner than they would to someone who was able to fight against their HIV earlier on.

Doctor giving patient a shot

With that said, it remains important to take steps to protect yourself against this year’s flu, just as your HIV-negative friends and family ought to do. The CDC continues to recommend a flu shot even though it has been less effective this year. They recommend it is because states where H3N2 has been prominent have also seen high rates of more common strains against which the current flu shot is more effective. They caution that there is still a long time to go in this flu season and, like stated above, it is very difficult to predict when it will end.

Beside the flu shot, there are many ways to protect yourself and we hear them every year: wash your hands with soap for at least 20 seconds; cover your mouth and nose when sneezing and dispose of tissues right away; avoid touching your nose, eyes, and mouth; and avoid contact with sick people. I’ve also seen it suggested that you keep your toothbrush away from others’, clean surfaces with anti-bacterial products, and frequently launder your bedding.

A note on adherence: It can be difficult to maintain your HIV-medication regimen when you are sick with the flu or otherwise. Heck, it can be hard to remain adherent even when you feel great. Remember: it’s just as important to take your antiretroviral therapy when you are sick as when you are not.

Tobacco Reduction – What’s In A Quit Kit?

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By: Kayla Gamino (UNIFIED Tobacco Treatment Specialist)

An ample part of UNIFIED’s tobacco reduction program includes creating quit kits for clients.  During the initial assessment, we bring out the quit kit while discussing possible quit dates.  Each client accessing tobacco reduction services receives 1 quit kit for their time working with the tobacco treatment specialist.  Each quit kit includes: a journal, pens, candy/gum, educational tools, and fidget toys.

Journal- The journal is an especially important piece of the quit kit.  The journal is a good tool to help keep track of a person’s smoking habits prior to their quit date.  Many clients use it to write down when they have cravings, what they are doing when they have cravings, and how they are feeling when they have a craving.  This will help the tobacco treatment specialist and client to better come up with coping mechanisms and a quit plan together for when the client experiences cravings.  For example, if Mike records that he has a craving every time he is feeling bored then coming up with things for Mike to do while he is bored can help combat cravings.

Originally posted by gerimagsakay

Pens- The pens are good for when the client needs to journal.  We put 2-3 different colored pens in each quit kit to make it easier for the client to be able to journal. Pens can also act as a fidget toy.

Candy/Gum-  Each quit kit comes with a variety of candy.  We use Twizzlers, Life Savers, and mints normally.  The Twizzlers can help with the hand to mouth habit of smoking.  It is a similar shape to a cigarette.  The Life Savers, mints, and gum are good at combating the oral fixation that often comes with smokers.

Originally posted by fadedmapdots

Educational Tools-  In each quit kit, we put a pamphlet for the Michigan Tobacco Quit Line.  In the pamphlet, it gives little facts on how smoking affects the body as well as the number to the Quit Line for clients to utilize.  We also include a UNIFIED Tobacco Services palm card that has contact information and HIV and Tobacco use facts.  As an added bonus, we include the Michigan HIV/STD Hotline number.

Fidget Toys-  Each quit kit includes rubber bands that are used by switching wrists when a craving occurs.  It helps to keep the hands and mind busy.  Additionally, each client gets to choose another fidget toy.  We have two different options.  One is a bike chain fidget toy that is small enough to fit in a pants pocket.  The other is a Bendeez toy that can be molded into different shapes.  Both are used to help combat boredom and keep the hands and mind busy.

Originally posted by cracked

All of these items have gotten positive feedback from current tobacco clients.  If you are a current tobacco user and you think that a quit kit would be beneficial to your quit/reduction attempt, please contact UNIFIED- HIV Health and Beyond to meet with a Tobacco Treatment Specialist!

Introduction to UNIFIED’s Tobacco Reduction Program

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By: Kayla Gamino (UNIFIED Tobacco Treatment Specialist)

A session with the tobacco treatment specialists is different for everybody.  We meet you wherever you’re at and will continue to be there for you every step of the way.  It all starts with a referral from your case manager.  At each visit, they will ask about your tobacco use and assess your readiness to quit.  If you both decide that you are a good candidate for the tobacco program, the case manager will fill out a referral form with you and give it to the tobacco treatment specialists (TTS).

So how is your readiness to quit determined?  Through The FIVE A’s; ask, advise, assess, assist, and arrange.

  • Ask- Your case manager is required to ask every client about their tobacco use at each visit and record it in our records.
  • Advise-  If the client answered that they were a tobacco user, then the case manager will advise them to quit their tobacco use and discuss the benefits of doing so.
  • Assess-  Next, the case manager will assess the clients willingness and readiness to make a quit attempt.  If the client is interested in talking to the TTS about tobacco reduction, the case manager will then make the referral to the tobacco treatment specialist.  In some cases the case manager will refer the client, with the client’s consent, to the TTS before they are considered “ready” in order to get the client thinking about quitting and to help establish the relationship between the client and the tobacco treatment specialist.
  • Assist- At this point, the case manager and the tobacco treatment specialist have touched base and the client is now being assisted by completing sessions with the TTS.  During the sessions, the client and TTS will discuss reduction strategies and possible nicotine replacement therapy options.  These sessions can go many ways depending on the clients needs.  Some clients need to talk about outside sources that are affecting their tobacco use, while others simply want information on tobacco and health.
  • Arrange-  The TTS will arrange follow-ups with the client.  Depending on the clients stage of change and the client’s schedule, the TTS will likely meet weekly or biweekly with the client.  These follow-ups can be by phone or in person.  In some instances, the TTS will also meet the client at their home or a local business.  This is the point in the treatment where the TTS tries to meet the client wherever is easiest for them in order to help make the client more successful in their quit attempt.
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Originally posted by firelordasami

How we assess a client’s stage of change:
The Transtheoretical Model

The transtheoretical model is a behavior change model that was specifically created with tobacco cessation in mind.  The 5 stages of change are precontemplation, contemplation, preparation, action, and maintenance.  It is important to know that the stages of change are not linear (that they don’t go in a single straight order).  Someone can go from being in action to contemplation in an instance.

  • Precontemplation- the client is not ready to quit or is not even considered quitting.
  • Contemplation- the client is considering quitting in the next 6 months.
  • Preparation- the client is ready to quit within the next 30 days.
  • Action- the client is currently on their quit attempt.
  • Maintenance- the client has successfully quit for 6 months.
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Because the transtheoretical model is not linear, a client can attempt to quit many times before being successful.  It is important to know that the tobacco treatment specialists are aware that not everyone will be successful right off the bat.  The specialists are there to help the client every step of the way in a completely non-judgmental environment.  Whether you’ve been working with them for months and relapse, or you met with them once and decided the program isn’t for you, they will always be there for you when you are ready to talk again.

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Want to learn more about UNIFIED’s tobacco reduction program? Visit us online at http://miunified.org/Get-Help/Services/Tobacco-Reduction-Services for more information.

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