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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 45 PREVENTION Prevention begins with avoiding high-risk behaviors. High-risk behaviors include unprotected sexual activity with someone who might be HIV positive (including oral sex) and the use of contaminated needles or other skin-piercing equipment. Pre-exposure prophylaxis (PrEP) is a drug protocol for someone who is not HIV positive, but is at high risk for infection—maybe because they have sexual partners who are HIV positive or because they are an injected drug user. PrEP is effective at reducing the risk of HIV transmission, but it should still be used with barrier methods for safe sex. TREATMENT The mainstay of HIV and AIDS treatment is called ART (antiretroviral therapy), or HA ART (highly active antiretroviral therapy). This is a combination of medications that interfere with the process of viral replication by inhibiting the necessary enzymes. Unlike AIDS treatments from even just a few years ago, ART can now be administered in a single daily pill, with little risk of developing resistance to the drug. PATHOLOGY PERSPECTIVES so these are the people who really need us to be healthy when we see them. It is possible for a person with AIDS to have a complicating infection that could be spread by way of casual contact—herpes simplex is an example. This is really the only way a massage therapist is at risk for picking up a new infection in an interaction with a client who is HIV positive. And a final risk is that the medication for HIV and AIDS can create some side effects for the client that might change how we work. Peripheral neuropathy, bone thinning, or kidney stress are situations that demand some adaptation in massage, so we need to be sure to have a complete picture of all our clients' medication-related challenges. On the other hand, it is difficult to overstate what a gift we can bring to the experience of a person who is living with HIV, or who is in end-stage AIDS. When this disease was first widely identified and publicly discussed in the 1980s, it carried a huge social stigma that meant many patients lived in isolation and rejection. That stigma has not entirely lifted, and massage therapy, with our welcomed touch and the unconditional positive regard that we bring to every interaction, can be an especially powerful intervention, as long as we adjust our work to the resilience of our clients. This will range from people who are active and healthy to people who are frail and dying—we need to be ready to meet them all. For resources for this column, please see page 58. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com. It is difficult to overstate what a gift we can bring to the experience of a person who is living with HIV, or who is in end-stage AIDS. AIDS medications can be extremely effective, but they also have some potential side effects including fatigue, nausea, diarrhea, and rashes. Some of the more serious side effects of the ART protocol include: • Bone thinning. • Fat lipodystrophy (fat cells decrease in some areas and increase in others). • High cholesterol. • Insulin resistance. • Low blood cell count. • Pancreatitis. • Peripheral neuropathy. The good news is that most of these problems are manageable, and several options in ART are now available so people can find the strategy that is best suited for a long-term treatment. Most experts agree that starting ART as soon after a diagnosis as possible is important for longevity and disease management, and it has the added benefit of reducing the risk of transmission of the infection to others or from mother to child. IMPLICATIONS FOR MASSAGE When a massage therapist and a client who is HIV positive meet, one person is at higher risk for picking up a new infection than the other—and it's not the massage therapist. Our clients who are HIV positive may be immune-compromised,