The Empowered patient by Lance Feeney,Positve Life NSW, Australia

Factors influencing patients decision making: One of the major factors that influenced patients decision on starting treatment was having a trusted, educated and engaged HIV doctor who explained treatment and care options and provided quality advice. In a survey conducted by positive life NSW 57% would go with above option as one of the most important factor influencing them starting on treatment. Other factors include articles from publications, via internet and community HIV agencies(33%) and advice from other PLHIV (10%)

What makes it difficult HIV? 20% say they have no factors making it difficult to reach an informed decision about HIV treatment and care, however 80% do. Majority worry about its potential side effects, drug interactions with non-HIV meds and their impact on long term use. Other factors include lack of information on new treatments, information being too technical and difficult to understand. there were a few who did agree that the Stigma and discrimination associated with HIV itself is an independent factor that will influence their treatment and care.

 It was interesting to know that patients rather preferred Drs with professionalism( open, motivated, engaged, non-judgemental and listens and discusses issues) and a relationship built on mutual respect, trust and confidentiality over Drs with competency (educated and up to date with HIV care and the management of otherb health conditions).

"Holding Space for those who hold doubts" by Christy Newman, was very interesting. It described a view from a patient's perspective of what it means being on long term treatment possibly for rest of their lives and the implications.

There are several reason as to why patients may not choose to be on treatment. Some being just not ready for a life time commitment, some dealing with the new diagnosis, financial situations, co-morbidities that they already have which may affect or delay them from starting ARVs or simply being on long term medications.

It was clearly outlined with examples that patients need to have an option of being able to make choices in regards to when and whether they want to be on treatment. Are they on treatment as they need to be on it for their own benefit or is it to protect others from acquiring? Sometimes the side effects or the disruption caused by taking these medications would raise the question in their mind " protecting others from acquiring HIV? not a good enough reason to start meds"..... A point to be noted.

As clinicians it is our responsibility to explain the individual benefit of ARVs and the Public health benefit to the patients. However it is the individuals choice as to which direction they want to take. Hence holding space for those who hold doubts is an important step in HIV care.

Day 2 had so many interesting topics. The use of Information Technology to improve sexual health care, by Dr Christopher Fairley was interesting. It is true that all people have access to internet and most of them use internet as their first source of information. Websites can be use to educate people, make online appointments and ask queries. It makes things so much quicker and easier.

Everybody is busy these days and do not like waiting for hrs. CASI is a very good system which is being used in some clinics to answer sexual history by the patient itself. this has proved to be quicker, avoids awkward questioning by the clinicians and more honest answers are given this way. It is also beneficial for the clinicians if they know some sexual behaviors and risks prior to seeing the patient.

SMS results and SMS reminders are being favoured by patients and clinics. SMS results within 90 minutes or even in 24 hrs makes it so easier and quicker. SMS are also used for vaccination reminders and TOC reminders and have proven to be very successful. It saves time and is quick for both parties. The number of patients have increased in the last 10 yrs from 15000  to 50000, due to using IT appropriately . Websites like "let them know" and "Dramadownunder" have been very successful in contact tracing.

Take home message of " Set up a good database and it will save you for life" was food for thought.