Individualized stepped care of chronic illness

What pervades social interaction is that the person with AIDS or HIV infection is expected to manage the awkward and difficult emotions that may arise. 8inally, living with a chronic disease requires a different view of the self and the meaning of the illness and one's life.When AIDS was an acute illness, the diagnosis was delivered as a death sentence.Wills were written, funeral plans made, and possessions distributed to friends and family.Many long-term survivors have described the reorganization their lives had to undergo as they realized that if, indeed, they were going to die, it might not be anytime soon.In some respects, the uncertainty of chronic illness is as difficult to live with as the knowledge that you will soon die. BELIEFS ABOUT NORMAL LIFEAll societies hold beliefs about what the normal life course should be.Anthropologist Gay Becker observes that in the United States, the life course is generally viewed as a linear progression of events from birth to death in a predictable sequence.Life is an orderly process.Chronic and lifethreatening illnesses challenge this view of continuity and order.Life is no longer predictable.During an acute crisis, a person's life is suspended.As the crisis subsides, the person must make sense of it to reestablish continuity and normality.Becker says, "Management of a serious chronic illness that has frequent ups and downs entails a continual reworking of identity."Many HIV-positive people suddenly realized they have a future, if limited, where there had been none.The energy required to reorganize one's identity to move forward into the future, and the disappointment, frustration, and depression that can occur when the process must be repeated after a crisis, should not be underestimated.One consequence of chronic illness is that the responsibility for all aspects of management-physical, mental, and social-increasingly falls on the shoulders of those who have the illness.In the absence of a crisis, it is easy to forget that people with an illness are still working hard to care for themselves and to resume what could now constitute a normal life......