A new paradigm for HIV care: Ethical and clinical considerations

Although dramatic advances in clinical treatment have greatly improved the lives of many people with HIV/AIDS, many other patients do not have informa tion about or access to these treatments because of health care providers' presumptive judgments about patients' ability to adhere to medical regimens . The authors contend that with sufficient support and education most patie nts, even those with difficult social and medical problems, can be helped t o initiate and maintain HIV treatment in accordance with current clinical s tandards. This commentary delineates a new paradigm for HIV care in which patients an d providers collaborate on individualized plans to establish patients' read iness for treatment, ensure maintenance of treatment. and make use of the s ocial services necessary to accomplish these goals. Providers have an ethic al responsibility to do everything possible to see that patients who might benefit from new HIV treatments have a fair opportunity to do so, and healt h systems have a responsibility to facilitate this process. Substantial pro gress toward meeting these responsibilities can be made within the current health care environment.