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Relabeling means redefining a troubling situation so that it seems more benign. Relabeling is related to thinking positively: any situation, no matter how bad, contains the possibility for something good. The idea is to focus on the possibilities for good and define the situation in those terms. “If I approach it with the right attitude,” says Steven, “I can see the blessings.”     Call something a challenge rather than a struggle, a preference rather than a need, an opportunity rather than a problem, caring rather than dependency. People who have to quit work say they are not losing their usefulness but gaining freedom and opportunity: the chance to volunteer, to read certain books, to learn to paint, to teach, learn a language, put together models, and especially, spend more time with the people they love. Helen knows that even though HIV infection is not curable, it is treatable, and seeing the disease as treatable, she says, “does a lot for me.” Dean, who has lived a long time with the virus and has weathered several serious illnesses, defines himself not as a sick person but as a survivor, a winner: “I’ve survived a lot of illnesses, and some even the doctors thought I wouldn’t,” he says. “So even if I die, I’ll still feel I’ve won.”*241\191\2*

HIV: OPTIONS FOR MEDICAL CARE-PHYSICIANS: PRIMARY CARE PHYSICIANSMost people receive medical care for HIV infection from one or more kinds of physicians: primary care physicians, AIDS physicians, and specialists.     Primary Care Physicians-Primary care physicians are usually family practice physicians or internists who have broad medical knowledge, and who may or may not have a special interest in HIV infection. Many people have gone to their primary care physicians for medical care for years and have developed close relationships with them. For a person with HIV infection, however, whether this relationship continues depends on whether the primary care physician feels able or willing to care for HIV infection and how much confidence the person with HIV infection has in the adequacy of that care.     Some primary care physicians practice in groups of between three and ten. Physicians in such groups usually have different areas of expertise: some treat stomach problems, for example, and some treat lung problems. The person with HIV infection will usually see the same physician for general health care, but will see other physicians for specific problems. The advantage of group practice is that these physicians are all under the same roof, and communication between physicians with specializations is good. Group practice is especially useful when one member of the group becomes skilled in AIDS care and becomes the primary physician or a consultant for people with HIV infection.     Most primary care physicians, whether they practice alone or in groups, received their training before HIV infection was known. Furthermore, new diagnostic tests and drugs and other therapies emerge constantly, so that many physicians have found it difficult to maintain their knowledge of both this field and the rest of medicine as well. As a result, some primary care physicians simply do not accept patients with HIV infection and will refer their previous patients who have become infected with HIV to another physician. Other primary care physicians provide medical care during early stages of the infection when medical complications are few and the guidelines for treatment are relatively simple.     During later stages of infection, the primary care physician will often either refer the person with HIV infection to a specialist or consult with a physician more experienced in HIV infection. If the primary care physician is in group practice, the referral may be to another physician in the group; if the physician practices alone, the referral may be to a completely different physician, to a clinic specializing in the care of HIV infection, or to a teaching hospital. In any case, the person with HIV infection will often see physicians informally called AIDS physicians.*153\191\2*

HIV: CAUSES OF CONSTITUTIONAL SYMPTOMS-DRUGS AND HIV INFECTIONConstitutional symptoms can also be caused by drugs. People with HIV infection take many drugs either to treat or to prevent infections, and to treat anxiety, depression, fever, aches, and problems with sleep and appetite. Many of these drugs have side effects, ranging in seriousness from drowsiness (from antihistamines) to kidney damage and anemia (from amphotericin B). The only side effects of many drugs are constitutional symptoms, particularly fever and rash.     For reasons that are unclear, side effects are more common in people with HIV infection. For instance, trimethoprim—sulfamethoxazole (Bactrim or Septra) causes side effects in 10 percent of the people without HIV infection and 50 percent of those with HIV infection.     Finding out which drugs are causing side effects and stopping the side effects requires the advice of a physician. The physician will either advise what is called a drug holiday—discontinuation of all drugs—or will stop drugs one at a time.     HIV infection-Some people have constitutional symptoms that cannot be attributed to an opportunistic infection or an opportunistic tumor, or to the side effects of drugs. In such cases, HIV itself might be responsible.      Constitutional symptoms with no causes other than HIV usually occur late in the course of the infection. The treatment is drugs directed at HIV—like AZT—or drugs that simply relieve the constitutional symptoms—aspirin, acetaminophen, ibuprofen, or similar drugs. These drugs are often given on a trial basis, in varying combinations and increasing doses.*143\191\2*