HIV/AIDS is widely recognized as a chronic illness within HIV care, but is often excluded from chronic disease lists outside the field. Similar to other chronic diseases, HIV requires lifetime changes in physical health, psychological functioning, social relations, and adoption of disease-specific regimens. The shift from acute to chronic illness requires a self-management model in which patients assume an active and informed role in healthcare decision making to change behaviors and social relations to optimize health and proactively address predictable challenges of chronic diseases generally and HIV specifically. An article by Swendeman and colleagues reviewed literature on chronic disease self-management to: (a) identify factors common across chronic diseases; (b) highlight HIV-specific challenges, and (c) review recent developments in self-management interventions for people living with HIV (PLH) and other chronic diseases. An integrated framework of common elements or tasks in chronic disease self-management was presented that outlined 14 elements in three broad categories: (1) physical health; (2) psychological functioning; and (3) social relationships. Common elements for physical health include: (a) a framework for understanding illness and wellness; (b) health promoting behaviors; (c) treatment adherence; (d) self-monitoring of physical status; (e) accessing appropriate treatment and services; and (f) preventing transmission. Elements related to psychological functioning include: self-efficacy and empowerment; cognitive skills; reducing negative emotional states; and managing identity shifts. Social relationship elements include: collaborative relationships with healthcare providers; social support; disclosure and stigma management; and positive social and family relationships.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that there is a global need to scale up chronic disease self-management services, including for HIV, but there are significant challenges related to healthcare system and provider capacities, and stigma is a significant barrier to HIV-identified service utilization. Recognizing that self-management of HIV has more in common with all chronic diseases than differences suggests that the design and delivery of HIV support services can be incorporated into combined or integrated prevention and wellness services.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The introduction of self-management techniques to control HIV/AIDS has been slower than it has with other chronic conditions. However, it is great to see a study that reflected what could serve as components of a successful self-management program a decade or so ago.

D Swendeman et al. Common elements in self-management of HIV and other chronic illnesses: an integrative framework. AIDS Care, 2009;21:1321-1334.