With HIV positive patients you get two types of families. Either the family abandons the patient altogether, or they are highly involved and do everything they can to ensure the patient gets help.
(Unfortunately, even with the latter type, patients who have been away from their families often only return to their families when it is too late and sometimes even refuse treatment even when the family members -usually their mothers - do everything they can - even forcing them to go to hospital etc.)
One day I saw a very elderly woman who tested HIV positive. She was about 75 years old and demented. She also had a previous stroke (found on examination, not history), was blind from cataracts, and was in
adult nappies (diapers) with a severe nappy (diaper) rash.
I couldn't help wondering why, with all these co-morbidities, she had been brought in to test for HIV. I was even more surprised that she had tested positive.
The only thing that could really be attributed to the HIV was that she also had a severe peripheral neuropathy. The dementia may also have been attributed to the HIV but AIDS Dementia is really a diagnosis of exclusion and I thought it was probably due to something else in her case considering her condition. According to her family member though, she had been quite functional before and had rapidly deteriorated in the last month or so. I felt that she was in a dismal condition, but in view of this, decided to do a work up.
The family member who accompanied this woman was her 20-something year old grandson. He had been taking care of her for a while. This was an exceptional case so I didn't expect him to fall into either family category frankly. In fact, I felt quite sorry for him: I thought his sick grandmother was probably quite a burden for this young man but that he had been caring for her out of duty and now needed some reprive.
I got the social worker involved. My plan was to admit her to hospice, treat her other problems symptomatically and do a work up for the dementia. Thereafter I planned to place her in a long term palliative care facility. I decided that if the dementia was due to AIDS Dementia Complex, I would start her on ARV's, otherwise I didn't think it would be practical or beneficial.
I asked the social worker to explain the situation to the grandson and then arrange placement. The grandson however was not happy with this plan. He did not want his grandmother to be placed in a palliative care home, he wanted to take care of her himself!
I was amazed. Here was a young, single male telling me he wanted to care for his sick elderly moribund grandmother.
As it turns out, this woman had only one child - a daughter. Her daughter in turn had 3 children. The youngest of these was the young man now accompanying his grandmother. His mother (the patient's daughter) and 2 siblings (the patient's other 2 grandchildren) had all passed away (I didn't ask what of but in our setting it's likely it was also due to HIV). This sick elderly woman was therefore the only family he had left.
I was so touched I nearly cried.
I had such sympathy for this young man, but more than that I was deeply impressed by his devotion to his grandmother.
It seems there really are selfless people out there willing to do whatever they can for the people they love.