HIV INFECTION AND ITS EFFECTS ON INTERPERSONAL RELATIONS: FEELINGS ABOUT SEX-SOLVING THE PROBLEMS

April 16th, 2011

Some people react to these feelings, as Alan did for a while, by becoming celibate, not having sex at all. Celibacy is one solution. If you are uncomfortable having sex, or if you feel no desire to, don’t bother with it. Many find sexual release in masturbation.     After a while, many people adjust to safer sex. “The way I’ve adjusted to safer sex,” says Alan, “is by psyching myself into thinking I prefer it. It wasn’t easy, but I did it, and now I can’t not practice safer sex, even if my partner wants to do it differently. I can’t ejaculate inside someone any more.”     Lisa and her husband also worked out a mutually satisfying solution: “The virus was pretty hard on our sexual relationship. Oral sex had been an important part of our lives. I tried oral sex with him while he was wearing a condom, but it tasted too bad. We ended up having sex with him wearing a condom, and with mutual masturbation. It was satisfying enough.”     Some people set limits on sex. Dean and his partner had sex less often. That made Dean feel guilty, but his partner said, “I can handle that better than he can. I look at him and he looks so tired.” Some couples have sex quickly, and say that is better than nothing. Some couples in which only one person is infected give control to the uninfected person to determine how often they make love and what happens during love-making.     One good solution is to accept the necessary changes in sexual practices, and where those changes are less than satisfying find other ways to accomplish the same intimacy, reassurance, comfort, and bonding. “Sex always created a bonding between me and my husband,” Lisa said. “Safer sex could do that too. But I also tried to re-create that bond by doing more things together and having more communication.” Dean said the same thing: “We gave up having sex and make love now.” All kinds of physical intimacies that are not sexual can also create bonding: holding hands, touching, giving baths, giving massages, combing hair, napping together, taking showers together, playing card games, lying in bed together, sitting together to read the morning paper or to watch TV or to listen to music, sitting together and reading aloud to each other. Lisa found that her husband responded as she had hoped: “My husband had always had a fear of intimacy. I saw that dissolve. He told me things he never had before. It took time and love to overcome the fear and guilt.”
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NATURAL HISTORY OF TYPE 1 DIABETES: EFFECT OF INTENSIVE MANAGEMENT – RETINOPATHY

April 15th, 2011

The DCCT has yielded important longitudinal information about the natural history of microvascular and macrovascular complications in people with type 1 diabetes. Long-term information is provided by the ongoing study of DCCT patients in the Epidemiology of Diabetes Interventions and Complications Trial (EDIC). The study also afforded the best information available about the effect of intensive glycemic management on the natural history of type 1 diabetes and its complications. Because the DCCT led to a major change in guidelines for diabetic care, with a focus on obtaining HbA1c values as close to normal as safely possible, a discussion of the natural history of type 1 diabetes must incorporate major DCCT findings.
At the inception of the DCCT in 1983, the natural history of diabetic retinopathy had been carefully defined from cross-sectional analyses of large numbers of type 1 diabetic patients with varying duration of diabetes. It was clear that retinopathy was a function of duration of the disease and that virtually 100% of people with type 1 diabetes of over 15 years’ duration would have some degree of retinopathy. It was also recognized that the disorder can progress in stages: from microaneurysms alone to the addition of hemorrhages, exudates, and microinfarcts6 to a proliferative process in which friable new vessels may bleed into the retina, macula, and/or vitreous. Laser therapy successfully avoids serious vision loss, if administered properly at the preproliferative or proliferative stage of retinopathy or when vision is threatened by maculopa-thy. It was recognized that the process proceeded at variable rates and extents in people with type 1 diabetes and that it can be accelerated by hypertension, cigarette smoking, genetic factors, and metabolic control. Some of the evidence related to the effect of glycemic regulation on retinopathy progression was conflicting. Although short-term studies suggested that intensive glycemic management can accelerate preproliferative or proliferative retinopathy, many correlative analyses and animal studies indicated that intensive glycemic management was associated with slower progression.
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