ABSTRACT
For almost everyone, happiness and well-being are related to the attainment and preservation of good health or the restoration of health following acute episodes of illness. A variety of factors influence the potential of each person to achieve these goals, including social, political, economic and occupational circumstances and inherited attributes. Freedom from infectious diseases is an additional critical influence underpinning both individual and community health. Throughout the world, and especially in resource-poor regions, acute and chronic infections account for a substantial and preventable amount of misery, ill-health, disability and premature deaths. Having an effective immune system for preventing or containing and minimising the consequences of inevitable incidents of infection during life is an essential prerequisite for good health. However, for many, individual genetic characteristics, life events, external circumstances and infections and diseases can temporarily or permanently impair the ability of their immune system to provide this protection. Immunosuppression is relatively common in many populations throughout the world, significantly increasing the global burden of infectious diseases. In order to facilitate an understanding of the causes of immunosuppression, this chapter begins with a brief review of the salient features of the immune system, followed by a brief account of the range of immunodeficiency disorders. The remainder of the chapter will focus on the care and support of persons who are immuno-compromised as a result of chronic infection with the human immunodeficiency virus (HIV), the most prevalent and challenging cause of progressive immunosuppression in people throughout today’s world. Following an exploration of the pathophysiology of HIV disease, essential elements of the care and support of clients will be discussed, including clinical monitoring, anti-retroviral therapy and infection control. A principal goal of clients with chronic disease is to manage their condition effectively. Using the experience gained over many years in London with the HIV Positive Self-Management Programme (PSMP), this chapter will conclude with a detailed consideration of the role of community-centred programmes led by ‘expert patients’ in supporting clients to develop knowledge, skills and attitudes to help them better manage their chronic condition and improve the quality of their lives.
