7 Queens Park East, Port of Spain, Trinidad & Tobago 
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    Tue & Thu: 8am - 6pm
    Fri: 8am - 4pm
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Patient Health Information

HIV is a chronic illness and do date, there is no proven cure for HIV. Although there is no cure, HIV can be effectively managed with Anti-retroviral medication, which, when taken correctly, will allow for a long, healthy, productive life. The life expectancy can be similar to an individual who is not HIV infected but only if medication is taken every dose, every day.

Taking care of your physical and emotional health goes a long way in ensuring you remain well. The key to your wellness is being completely adherent to your medication!

15 Steps to Better Health While living with HIV

HIV Positive women are at greater risk for developing cervical cancer than women who are not HIV positive.

Cervical cancer is caused by a virus known as HPV-Human Papilloma Virus. HPV is transmitted during sex and by skin-to skin contact. Many persons have HPV and have no symptoms, but the minute virus can go on to develop into cancer. HPV causes vaginal warts and if you suspect you have these, please report to your doctor or nurse. Women up to the age of 45 years are encouraged to get the HPV vaccine. The vaccine prevents you from the strains of HPV that cause cervical cancer. The HPV vaccine is now available at MRFTT clinic-ask at clinic for the current vaccine days/times.

A pap smear is a screening tool that could detect cervical cancer in the earliest stages, and therefore intervention could be done so as not to develop into cancer. If cancer cells are found, women can access treatment to prevent the cancer from spreading. Women are advised to have a pap smear once a year, even if the result is normal. Pap smears can be done at your local health center, The Family Planning Clinic, The Cancer Society or your private doctor. Please remember to bring a copy of your result to your next MRFTT appointment.

Q: What causes cervical cancer?
A: Cervical cancer is caused by Human Papilloma Virus (HPV) which is spread by sexual contact and skin to skin contact

Q: Is there a way to detect this type of cancer?
A: A Pap smear is a procedure that takes a small sample to send to the lab to see if there are cancer cells

Q: My pap smear was abnormal does that mean I have cancer?
A: Not necessarily. Abnormal results can be caused by infection or inflammation. Your doctor will advise you about whether the test has to be repeated

Q: How often should I get a Pap smear?
A: Women who are HIV positive should have a Pap smear every year

Q: How can I prevent getting cervical cancer?
A: Take your Anti-retroviral meds every day, stay healthy by eating well and not smoking, have your annual pap smear and get vaccinated for HPV

Q: Where can I get a Pap smear?
A: You can get a Pap smear at your Local Health Centre, The Family Planning Clinic, Cancer Society or your private Gynaecologist.

HPV vaccine: HPV-Human Papilloma Virus is a virus that can be contracted through sexual contact or skin to skin contact and HPV is the virus responsible for causing certain cancers including cervical cancer, penile cancer, anal cancer and some mouth and throat cancers. These cancers have been shown to occur in higher numbers among persons who are HIV infected.

Man and women up to the age of 45 years are encouraged to have the HPV vaccine which is now available at MRFTT clinic. The HPV vaccine protects women against cancer of the cervix and protects men against cancer of the penis. The 3-dose HPV vaccine is available to males and females at the MRFTT clinic and clients can discuss further with the vaccine nurse. The MRFTT now has vaccinations available onsite. Please check at the clinic for the current schedule.

Pneumovax: this vaccine protects against the development of serious infections (e.g. pneumonia, meningitis) due to a certain bacteria called Streptococcus pnuemoniae. HIV positive clients are encouraged to be vaccinated for Pneumovax as their immuno-compromised condition may cause greater chance of developing these infections. Pneumovax vaccines are a single dose and available at MRFTT to clients.

Hepatitis B: The Hepatitis B virus is acquired through blood and body fluids and can in the long term be responsible for liver disease including cancer of the liver. A three-part vaccination, the Hepatitis B vaccine is available at the MRFTT and you can check with the vaccine nurse to see if you are eligible for Hepatitis B vaccination.

Flu:
Every season the flu virus changes and as a result there is a different flu vaccine each season. Clients are encouraged to get the Flu vaccine as this can go a long way to maintaining health, preventing time lost from work and maintaining a good health status. Available as a single dose, the MRFTT will give the seasonal Flu shots. Speak to the vaccine nurse for more information.


Both men and women should check their breasts monthly as both men and women can develop breast cancer. Follow the chart to see how examinations should be performed and be sure to report any concerning finding, lumps or bumps.

While looking in the mirror, visually inspect your breast with your arms at your sides, next raise your arms high overhead. Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match- few women’s breast do, so look for any dimpling, puckering, or changes, particularly on one side. While lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular options covering the entire breast area and armpit. Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast. Feel up and down your breasts, first with a soft touch, the increase the pressure. Feel for changes from top to bottom and side-to-side. Cover your entire breast and don’t miss any tissue.

HIV infection puts you at greater risk for oral and dental problems including fungal infections, and gum disease. A common fungal infection that occurs in HIV when your immune system is weak is oral thrush. This may also occur in conditions like diabetes, cancer and from wearing dentures. Be sure to see a doctor if you think you have oral thrush, and if you are given medication, be sure to take the medication as prescribed.

Tips to maintain good oral hygiene
Brush your teeth twice a day
Change your toothbrush every 3-6 months or went the bristles are bent
Change your toothbrush after a major illness or the flu
Floss daily
Drink water instead of sugary drinks
Avoid sugary snacks
Have a dental checkup every 6 months
Brush your teeth for at least 2 minutes each time with 10 circular movements of the brush per tooth
Quit smoking
Avoid excessive alcohol intake

Ask yourself:
You need to see a dentist if you answer YES to any of these questions.

1. Has it been more than 1 year since you have been to the dentist?
2. Do you have tooth pain, mouth sores, bleeding gums or loose teeth?
3. Do you often have a dry mouth or experience a change in your sense of taste?

Sexually Transmitted Infections (S.T.I’s) can be varied and have different symptoms. If you have any unusual growths, discharge or other worrying symptom, please inform a doctor or nurse at MRFTT clinic.

Some common S.T.I’s
Gonorrhea:
Signs and Symptoms
Abdominal pain and pain with intercourse
Vaginal discharge and bleeding
Infected kidneys
Urinary tract infection
Burning sensation with urination
Inflammation o the penile
Swollen testicles
Discharge from the penis

Syphilis:
Syphilis has different stages. In the first stage you may notice a small sore on any part of the body, although commonly on the penis, vagina, anus or mouth. This sore may be painless and will disappear after a few weeks without medication. Although the sore has disappeared syphilis remains in the body and can be transmitted to your sexual partners. Syphilis may stay in your body for years but it will be slowly increasing. If you have sores/spots to your body, palms of your hands or soles of your feet, be sure to be seen by a doctor. Syphilis at this stage can still be treated. If left untreated, syphilis can cause debilitating illness including paralysis, heart problems, mental illness.

HPV-Warts
Human Papilloma Virus (HPV) is the most common sexually transmitted infection There are many different types of HPV, some types can cause health problems including genital warts and cancers. HPV is contracted by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms. Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.

Herpes:
Oral herpes is usually caused by a virus HSV-1 and can result in cold sores or fever blisters on or around the mouth. However, most people do not have any symptoms. Most people with oral herpes were infected during childhood or young adulthood from non-sexual contact with saliva. Oral herpes caused by HSV-1 can be spread from the mouth to the genitals through oral sex. Oral herpes will go away without treatment in about 2 weeks, but your doctor can prescribe medication that will make it more manageable. Genital Herpes is spread by vaginal, anal or oral sex as herpes can be spread from your partner when you come in contact with a herpetic sore, genital fluids and skin to skin contact if your partner has genital herpes.

Not all herpetic sores can be covered by a condom, and herpes can be spread from one person to another even without the sore being visible.
Herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take a week or more to heal.
These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.
People who experience an initial outbreak of herpes can have repeated outbreaks as the infection stays in the body for the rest of your life. There is no cure for herpes.
However, there are medicines that can prevent or shorten outbreaks.
Do not touch the sores or fluids to avoid spreading herpes to another part of your body such as your eyes. If you do touch the sores or fluids, immediately wash your hands thoroughly with soap and water.

The Right way to use a Male Condom

  • Do you a condom every time you have sex.
  • Do put on a condom before having sex.
  • Do read the package and check the expiration date.
  • Do make sure there are no tears or defects.
  • Do store condoms in a cool dry place.
  • Do use latex or polyurethane condoms.
  • Do use water-based or silicone-based lubricant to prevent brakeage.

The Right Way To Use A Female Condom
Female Condom Do's and Don'ts

  • DO use a female condom from start to finish, every time you have vaginal sex.
  • DO read the condom package insert and check the expiration date.
  • DO make sure there are no tears or defects.
  • DO use lubricant to help prevent the condom from slipping and tearing.
  • DO store female condoms in a cool, dry place.

*Female condoms can also be used for anal sex.

  • DON’T use a male condom with a female condom, as this can cause tearing.
  • DON’T reuse a female condom.
  • DON’T flush female condoms as they may clog the toilet.


Some Anti-retroviral medication can cause you to put on a lot of weight.

Having a good exercise regime is part of maintaining good health.

Exercise 2-3 times a week, for about 20minutes and should be at a level you can tolerate, enough to increase your heart rate and build a sweat.

Exercises can include walking, jogging, skipping rope, cycling, swimming or joining a gym for a program that suits your level of exercise.

Benefits of Regular Exercise:
Helps maintain your weight
Assists in maintaining a normal blood pressure
Digest your food better
More mentally alert
Sleep better
Helps regulate your blood sugar levels and prevent diabetes
Improves your mood
Improves muscle strength and endurance
Strengthens the body so better able to fight off colds
Boosts your confidence
Creates a better appearance
Makes you feel more in control of your health
Feel mentally stronger

Common emotions after being diagnosed with HIV are sadness and grief. This sadness and grief that may be present for a while but gradually go away as time passes and you adjust to accepting, understanding and effectively coping with your diagnosis.
Depression occurs when you no longer have the capacity to effectively manage the emotions for yourself and they begin to negatively impact your life.
 
 Symptoms of depression:

  • Overall depressed mood
  • Loss of interest or pleasure in activities you enjoyed before your HIV positive diagnosis
  • Suicidal thoughts or feelings
  • Feelings of guilt and remorse
  • Not feeling to eat or over-eating
  • Sleep disturbance
  • Attention and concentration problems
  • Felling tired, sluggish or easily fatigued
  • Feelings of  hopelessness
  • Social isolation
  • Persistent agitation
  • Not wanting to socialize with friends or family
  • Crying especially when alone and for no reason
  • Easily agitated and moody
  • Using substances like pills, alcohol, drugs to cope with painful feelings
  • Decreased sex drive

Over the last two weeks, how often have you been bothered
by any of the following problems?
1. Little interest or pleasure in doing things Yes No
2. Feeling down, depressed, or hopeless Yes No
3. Trouble falling or staying asleep, or sleeping too much  Yes No
4. Feeling tired or having little energy Yes No
5. Poor appetite or overeating Yes No
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down Yes No
7. Trouble concentrating on things such as reading the newspaper or watching television Yes No
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual Yes No
9. Thoughts that you would be better off dead… or thoughts of hurting yourself or someone else Yes No


If you answered yes to any of the questions 1-8 above, you should speak to a health care provider at MRFTT.
If you answered yes to question 9, you should contact a health care provider at MRFTT immediately.

There are many treatment options available to help you cope with your depression, which in turn can improve your HIV prognosis as well. Anti-depressants and lifestyle can be effective in helping you cope with depression.

 

Healthy eating Tips:
Eat 3 balanced meals and have healthy snacks every day
Avoid fatty/oily foods
Limit alcohol intake
Avoid refined and sugary foods
Include fish and seafood in your diet
Have a fruit every day
Include vegetables in your foods every day
Drink lots of water
Eat a wide variety of foods
Choose items that are in season
Choose whole grain foods like whole wheat breads and brown rice

Smoking Cessation

This may be more challenging than you think, however, keep trying and seek help at Smoking Cessation Clinics near you.
Tips to help you quit:

  • Be honest with yourself and recognize your strengths and challenges
  • Select one specific date when you will quit
  • Tell friends, family, and co-workers about your quit date
  • Get a friend who will also quit and buddy up through the process
  • Select a personal message you will recite to yourself eg. “I am a champion, I can do this”
  • Make a plan for challenging situations like at a party where your friends are smoking
  • Start an exercise program
  • Examine your regular routine eg. If you smoke after dinner, then make a plan for another activity after dinner. Eg. Do the dishes
  • Cigarettes may taste better after eating certain foods. Be self-aware and make different food choices
  • Be aware of whether you use cigarettes after particular drinks. Choose different drinks so lessen the chance of having a craving
  • Throw away all cigarettes and ashtrays
  • Make a list of reasons you want to quit and post it in a visible place
  • Decide whether you are going to go "cold turkey" or use a nicotine replacement therapy such as the nicotine patch or gum
  • Stock up on oral substitutes, such as hard candy, sugarless gum, carrot sticks, toothpicks
  • Identify a friend or family member that has successfully quit and will be your support person through the process
  • Ask friends and family who smoke to not smoke around you
  • Stay away from your friends who smoke
  • In a social situation, hold a non-alcoholic drink in the hand you tend to hold the cigarete and use a straw to sip your drink
  • Identify the times you smoke eg. at what time of the day and associated with which activities? Make a list to change these patterns/activities

 On the day you will quit smoking:

  • Do not smoke at all
  • Stay busy with work, hobby or a project
  • Start using your nicotine patch or gum
  • Drink lots of water or juice
  • Do not use alcohol
  • Stay away from friends or family who are smoking
  • Attend a stop-smoking group or follow a self-help plan
  • Be prepared to manage the cravings; these last 3-5 minutes and will pass
  • Use a distracting agent like gum to assist you until the craving passes
  • Practice deep breathing exercised and visual distraction
  • Go for a walk or participate in an activity that will distract you from wanting to smoke

Alcohol Use & Abuse Alcoholism is the most severe form of alcohol abuse and involves the inability to manage drinking habits.
Individuals struggling with alcoholism often feel as though they cannot function normally without alcohol. This can lead to a wide range of issues and impact personal, professional, and social situations and negatively affects family, relationships and your job. Alcoholism can cause serious medical problems
Talk to a health care professional if you want to get help for alcoholism.

Symptoms of alcohol abuse
  • You have tried stopping for a week or more, but can’t make it past a few days
  • You can’t stop drinking once you start
  • You recognize you need to stop or cut back
  • You are unable to perform at work or home when you are drinking
  • You feel guilty after drinking
  • Others are telling you that you have a problem
  • You feel annoyed by criticism of your drinking
  • You have a drink in the morning to get yourself going even after drinking too much the night before
  • You have accidentally or intentionally physically hurt someone else or yourself after drinking too much
  • You hide your drinking
  • You hide your alcohol
  • You have blackouts and memory lapses after drinking too much
  • You are depressed
  • You are getting traffic or driving tickets while under the influence of alcohol
  • Your drinking is interfering with your relationships
  • Your hands are shaking

Partner Notification and Testing
It is crucially important that you inform your partner or partners about your HIV status and encourage them to be tested as soon as possible. HIV testing is available nationwide and your partner can be tested at MRFTT.

If your partner tests HIV Positive, please encourage him or her to join an HIV Treatment Clinic as soon as possible.
We understand that informing your partner or partners about your HIV status may be difficult or challenging for you. Please speak to a doctor, Medical Social Worker, nurse or peer advocate at MRFTT clinic about your concern. Your privacy and confidentiality will be respected.

Prevention of Mother to Child Transmission of HIV
One of the ways that HIV is transmitted is from a pregnant woman to her unborn baby. It is possible however for an HIV positive woman to have a baby who is HIV negative. In order for this to happen, the woman must follow all the instructions and guidelines given. Medication during pregnancy: The HIV positive woman will be given HIV medication during her pregnancy and it is vitally important that medication is taken as prescribed every day. The aim is not to miss any doses and to never stop taking medication. The medication will not cure the virus but it will decrease it to small amounts and be an important factor in protecting your baby’s health.
Viral Load testing: Your Viral load will be monitored closely during your pregnancy and the results will be given to you and the doctor at your ante-natal clinic. The doctors will use this information to determine the safest way to deliver your baby.

No Breastfeeding: HIV mothers in Trinidad and Tobago are encouraged not to breastfeed as HIV is expressed in breast milk. Baby formula is given monthly to mothers until the baby is 1 year old. It is important to NEVER give the baby breast milk- not even once, as this is very dangerous for your baby’s health. Baby gets medication: When your baby is born, he/she will be given an HIV medication called AZT. Be sure to follow the instructions given to you and be sure to give the baby every dose, on time, every day. This medication is very important in ensuring your baby’s health.

Meet with the PMTCT Nurses at the antenatal clinic. At all public hospitals, there are nurses who will meet with you to counsel, advise, monitor and assist you so that you will be well and to work towards your baby being HIV negative.
Your baby will be referred to the Paediatric departments where the baby will be tested at approximately 2 months, 4 months, 6 months and 18 months of age. Speak to the doctors at the Paediatric Clinic to find out your baby’s HIV status.

U=U


U=U refers to Undetectable =Untransmittable
Understanding what this means….
Q: What does U=U stand for?
A: U=U means Undetectable equals Untransmittable. It means if your viral load is undetectable you will not pass the HIV virus to your partner during unprotected sex

Q: What is my viral load?
A: Your viral load is a measurement of the amount of HIV in a tiny sample of your blood

Q: What does undetectable viral load mean?
A: An undetectable viral load means there is a very small amount of virus in your blood sample; therefore, overall, you have a very small amount of HIV in your body

Q: How can I keep my virus undetectable?
A: The ONLY way to keep your virus undetectable is to take your HIV medication every single day without missing any doses

Q: How will I know if my HIV is not under control?
A: Your viral load result will show increasing levels of the virus.

Q: How often will my viral load be checked?
A: Your viral load will be checked every 6 months

Q: If U=U, does that mean I can breastfeed?
A: NO! U=U was developed based on studies of persons who were sexually active. It does not support breastfeeding. You must follow the guidelines given by the health care staff to safeguard your baby from developing HIV.

Q: If my partners viral load is undetectable now, but I know he is not taking medication 100% correctly, am I at risk of getting HIV from him?
A: It is possible your partner’s virus will start to increase if he is not taking medication correctly. If his virus goes from being undetectable to detectable, then you will be at risk for contracting HIV if you have unprotected sex

Q: Does U=U work for MSM couples?
A: Yes, U=U has been shown to useful in MSM couples

Q: If my partner who is HIV positive has not had a viral load test in over a year, and I know he misses medication, could I get HIV from him if we have unprotected sex?
A: Yes, there is a possibility that your partner’s HIV is not under control, in which case you could get HIV during unprotected sex

Q: How does HIV medication work?
A: HIV medication cannot cure the virus, but it will get it under control and then keep it under control. When the virus is in small amounts in the body, your body will be healthy and you will not be able to pass the virus to your partner

Q: Which are the U=U studies?
A: The U=U studies were the HPTN 052, PARTNER and Opposites Attract studies. These studies followed heterosexual and MSM couples in where one partner was HIV positive and one partner was HIV negative. The HIV positive partner was correctly using HIV meds and was virally suppressed. During the studies, none of the HIV negative partners contracted HIV from their HIV positive partners. This therefore led to evidence that U=U.

Q: How long after I start taking my HIV meds will my viral load become undetectable?
A Your viral load will be checked 6 months after you start taking your HIV meds to determine of your viral load is undetectable.

Q: If my partner starts using HIV meds tonight, how long before it is safe for us to be U=U?
A: Your partner’s viral load will be checked in 6months to determine of it is undetectable. Until that time, your partner should use condoms.

Adherence
The key to being successful when using HIV meds is Adherence. Adherence means taking every single dose of medication, every single time.
The advantages to adherence are:
Sustained viral suppression
When you take HIV meds correctly you are able to get the HIV under control then keep it that way. Medication is lifelong.
Reduced Risk of Drug Resistance
It is important that you take your HIV every day without missing doses. Taken the correct way, you will manage the virus. If you miss doses, you may develop resistance to the HIV meds and the meds will stop working.

Better Overall Health
When you are completely adherent you will be able to keep the HIV in small amounts in your body. When the virus is in small amounts, you won’t be ill with AIDS. Your body can function as normal, or near normal, once the virus is in small amounts. You have to follow the medical advice, take your medication and address any issues that arise, however, overall, you can expect better overall health.

Improved Quality of Life
You can live a long and productive life even though you are HIV positive. You can get married, complete your studies, get that promotion, build your house, or buy your car…all the things you hoped to do. To maintain a good quality of life with HIV, you must first get the virus under control, and then secondly take medication without missing doses, so you can keep the virus under control. You can live a well life once the virus is under control. The only way to keep the virus under control is to take your medication every day without missing any doses.
Decreased Risk of Transmission
When you take HIV meds correctly, you are able to get the virus under control. When your virus is under control, you will not be able to infect your partner if you have unprotected sex. Known as U=U, Undetectable means Untransmittable, this is an important reason you should always adhere to your medication.
TIPS TO HELP MAINTAIN ADHERENCE:

  • Use a daily pill box
  • Set an alarm on your phone
  • Always carry “extras” for when you are away from home
  • Have a trusted relative or friend supporting you
  • Ask your health care provider questions so you understand your illness
  • Inform the staff about side effects from the medication
  • Do not stop using your meds-discuss with a doctor or nurse
  • Be honest when informing about missed doses-the staff are here to help you improve
  • Keep your appointments
  • Call the clinic to re-schedule if you cannot make your appointment