Tina Rosenberg assesses the impact of a private sector enterprise – microinsurance – that seems to be genuinely extending the lives and self-care of people living with HIV:
Ross Beerman, AllLife’s managing director, says that clients average a 15 percent improvement in their CD4 count — an immune system marker — six months after buying insurance, whether or not they are taking antiretrovirals (the majority of clients have not yet reached that stage). That improvement may partly be the psychology of seeing their disease in a different way: “If you think you have a terminal disease, you don’t care how you eat and exercise,” said Beerman. AllLife helps patients to be more adherent. Doctors are busy and do many things. AllLife does only one thing, and sometimes catches a problem before a doctor can. “If necessary we’ll give the doctor a call,” said Beerman.
Felix Salmon adds his two cents. I can certainly attest to the fact that psychology plays a part in defeating sickness. I credit my own survival to believing from the get-go that I could be part of the first generation that survives this. And I was. Talking to smart researchers (Jerry Groopman was my intellectual rock), doing research into new treatments, closely monitoring your own health, better diet and exercize: all these make it likelier you will do better. It's not dispositive. Everyone is different. But confidence in the future makes a huge difference.
On the TMI front, my latest HIV news is pretty good. Still no viral load detectable by the usual tests; CD4 counts within the lower portion of the normal range. The one thing that resiliently affects my life is the HIV-related collapse of testosterone and the side-effects of the drugs. My body has all but stopped producing testosterone on its own; and when I had to inject myself every two weeks, I often delayed it (who wants to stick a needle in their rump if they don't have to?). By this spring, I realized I had effectively reduced my dosage of testosterone by more than half simply by non-adherence to the regimen (which I am punctilious about when it comes to swallowing handfuls of pills). No wonder I found myself struggling against exhaustion and depression.
This week, I got a new implant that will deliver testosterone evenly in my body over four months. It still hurts a bit when I sit down, but that will pass. Even after three days, I feel a lot better. This small, incremental change will doubtless be another life-saver. But my own failure to stay on top of my health with respect to testosterone is a reminder that illness can lead to depression which can easily lead to hopelessness which can become self-fulfilling.
It's not that I haven't succumbed to depression or despair at times. I did this spring. It's just that I have realized I have a very strong survival instinct; and I have learned that survival with a chronic disease is a process, not an event. It requires life-long vigilance and will. And that's often harder than it seems. Anything – even small things – that can help you stay vigilant and in charge of your health is a good thing. From micro-insurance to testosterone implants to single-pill drug combos to preventative use of Truvada, it all adds up.
Which is a very roundabout way of saying: for me, as for anyone with a chronic disease, it's always a challenge, but, through it all, I'm so grateful to be alive. If you forget that fact, and we all do, it's good to remind yourself from time to time. I regard HIV in this way as a kind of blessing.
By figuring out how I might die, I learned how to live.
(Photo: Scanning electron micrograph of HIV-1 (in green) budding from cultured lymphocyte. Multiple round bumps on cell surface represent sites of assembly and budding of virions.)