Starting your life as a person living with HIV

Summary

• You must take anti-retroviral treatment (ART) as soon as possible to stop it from becoming AIDS

• The goal is to achieve undetectable viral load. This may take 3-6 months of treatment to get there.

• There are medical subsidies available for HIV medication.

• You must take your medication every day to ensure its effectiveness

💊 Medication is necessary

For your medical treatment, you will be asked to take anti-retroviral treatment (ART).

ART is a form of HIV medication. There is no effective cure for HIV. However, ART helps you to control and manage this chronic condition. 

ART is prescribed to all people diagnosed with HIV, no matter how long they have had the condition or how healthy they feel. 

ART is the only way to reduce the amount of HIV (viral load) in your body and boost your immune system (CD4 count). With ART, you can live a long and healthy life! 

Without ART, the virus will progressively weaken your immune system and you can develop acquired immunodeficiency syndrome (AIDS). This puts you at higher risk of opportunistic infections, which can be life-threatening.  

👌 Getting ART is faster now

Starting from 1 September 2020, people newly diagnosed with HIV will only wait up to 4 days to start anti-retroviral treatment. If your initial result is reactive, you can request to be referred to the HIV clinic in National University Hospital (NUH).

Once you make the request, you will be offered an appointment within 96 hours, receive a comprehensive assessment, and also counselling. You will also have the option to start ART on the same day as your appointment. 

When you meet with your doctor, inform them about any medical conditions you may have or any other medicines you are taking. It can affect your eventual treatment plan.

👉 What to do during your meeting with the doctor

Tell them about any other medications you are taking

When you meet with your doctor, inform them about any medical conditions you may have or any other medicines you are taking. It can affect your eventual treatment plan.

Herbal Medicine

Herbal medicine cannot replace ART to treat HIV. However, a study found that 84% of people living with chronic conditions use herbal remedies to treat day-to-day ailments and side effects of their medication. 

Your general practitioner may not be very well-informed about the possible drug interactions between your HIV medication and herbal remedies (e.g. jamu, herbal extract, ginseng, etc.). It is best to ask your doctor (an HIV specialist). 

Viagra

When you meet with your HIV specialist during your check-ups, it is important to ask and update them if you are taking herbal medicine. If you are considering taking viagra, it is possible to use viagra and continue taking your HIV medication.

But this depends on the drug class of your HIV medication, you must first consult your doctor and ask about the possibility of any drug interactions between your HIV medication and viagra. 

👉 Cost of medicine

✅ Subsidies are available

In September 2020, the Ministry of Health (MOH) added 16 anti-retroviral medications to its Standard Drug List (SDL) of subsidised medications and Medication Assistance Fund (MAF). 

This means that Singapore Citizens (SCs) and Permanent Residents (PRs) living with HIV will receive 50% to 75% of subsidies to help afford their medication, the exact subsidy amount is subject to means-testing. 

Those who cannot afford their HIV medication can also apply for the Medication Assistance Fund (MAF). You can speak with your medical social worker to apply for financial assistance. 

This is the list of subsidised anti-retroviral medications:

Standard Drug List (SDL)

• Abacavir 600mg/Iamivudine 300mg tablet [ABC/3TC]

• Abacavir 600mg/dolutegravir 50mg

• Atazanavir capsules (200mg, 300mg) [ATV]

• Darunavir tablets (600mg, 800mg) [DRV]

• Dolutegravir tablet (50mg) [DTG]

• Efavirenz tablets (200mg, 600mg) [EFZ]

• Etravirine tablet (200mg) [ETR]

• Lamivudine tablet (150mg) [3TC]

• Lopinavir (200mg)/Ritonavir (50mg) tablet and 

• Lopinavir (80mg/mL) & Ritonavir (20mg/mL) oral solution (160mL) 

• Nevirapine tablets (200mg immediate release tablet, 400mg extended release tablet) [NVP]

• Rilpivirine tablet (25mg) [RPV]

• Ritonavir tablet (100mg) [RTV]

• Tenofovir disoproxil fumarate tablet (300mg) [TDF]

• Zidovudine capsule (100mg) [ZDV or AZT]

Medication Assistance Fund (MAF)

• Emtricitabine 200mg/ tenofovir disoproxil fumarate 300mg tablet (FTC/TDF)

• Raltegravir film-coated tablet (400mg, 600mg) [RAL]

If you still need medical assistance, consider taking a look at our compiled list of financial assistance schemes relevant to people living with HIV 50 years and above.

✈️ You can buy ART from overseas

It is possible to buy generic versions of ART in places like Bangkok, Thailand. The generic versions usually cost around SGD$55 a month. Generic ART can only help about 70% to 75% of people living with HIV, and are as effective as branded versions of ART. 

However, the supply of generic ART may not have a reliable supply chain, especially during the COVID-19 pandemic. It may also be difficult to consult a local doctor in the event that you experience side effects. 

💊 Take your medication every day

It is best to take your medication at the same time every day. If your HIV medication comes with instructions, please follow your doctor’s advice. For example, some medications have to be taken with food for it to work. 

Even after you reach an undetectable viral load, you must continue to take your medication every day to remain undetectable.

Missing a dose

If you miss a dose and do not know what to do, call your doctor immediately and ask for advice. 

In many cases, take the missed dose as soon as possible and take the next dose at your usual scheduled time. Do not double dose at your usual time!

Do not skip days

You must not skip days as it can lead to drug resistance. Your strain of HIV could mutate and cause your existing treatment plan to fail. This could create difficulties in finding a future treatment plan as you may become resistant to similar types of HIV medication. 

💊 Tips to taking your medicine more easily

Taking medicine on schedule

To help you remember to take your medication on time, you can use either a pill organiser, keep a daily log, or set an alarm. 

Ingesting the medicine

Swallowing pills can be difficult for some due to physical and psychological reasons. There are a few techniques that you can practice to help make this easier, like the pop-bottle or lean-forward method. 

If these techniques are not for you, you can put your pill in soft foods such as yoghurt, pudding, ice cream, and so on. The texture can make it easier to swallow the pills whole. Make sure to ask your doctor if your medication can be taken with food as this is not always the case. 

If the pills are too large, you must ask your doctor if you can cut your pill or grind it into a powder. If your doctor approves, you can cut your pill with a pill splitter and swallow the smaller pieces one at a time.

🤔 Long term effects of HIV medication

The HIV/AIDS epidemic emerged globally in the 1980s. We are only now starting to know about the long-term effects of HIV medication on the body and brain.

So far, researchers have found that people living with HIV for decades may experience:

• Cardiovascular disease

• Liver disease, including hepatitis B and hepatitis C

• Lung disease

• Certain cancers

• HIV-Associated Neurocognitive Disorders (HAND), although this is becoming rare

• Higher risk of fragility fractures

• Increased vulnerability to stressors

As research into the long-term effects of HIV medication is ongoing, more information and guidelines may emerge in the following years.

Still, do not let this stop you from taking HIV medication. People living with HIV are generally advised to monitor the onset of the above-mentioned conditions and work with their HIV specialists on managing these conditions.