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HIV: PSYCHOLOGICAL AND SOCIAL ISSUES
Parts of this article are about dealing with the extraordinary stresses that HIV infection puts on people’s minds. The stresses are not limited to people with HIV infection; their caretakers often feel the same stresses. In general, people with HIV infection and their caretakers do not easily
divide themselves into sick people and people who have escaped sickness: they are all affected by the disease. They say, over and over, that they are in this together. For that reason, this book is addressed both to people with HIV infection and to their caregiversthat is, this book is
addressed to all the people affected by HIV infection.
People affected by HIV infection face greater emotional strain than most people ever do. Furthermore, many face it at an unconscionably young age. Those affected by the disease are shocked or angry or depressed or afraid or guilty or confused or have any number of these
emotions at once. They worry about revealing the diagnosis, about being dependent, about expressing sexuality, about relations with the people they love. They worry about dying. The rest of society not directly affected by the disease reacts with fear and prejudice, making those affected by the disease also feel like outcasts, isolated and lonely.
In general, people affected by HIV infection tend to run into three periods of particular emotional difficulty. One is at the initial diagnosis of infection with HIV: people feel uncertain about what the diagnosis means, about whether they will infect other people, how long they will live, what their lives will be like. The next difficult period comes with the first illness that defines a diagnosis of AIDS: people begin to face the reality of a disease that includes an array of illnesses, hospitalizations, medications, and medical procedures. The third period comes with the second AIDS-defining illness: people are troubled by feelings of hopelessness, dependency, and awareness of death.
With time, people come to deal with each period, using the same strategies that have worked for them in all their previous periods of difficulty. Their strategies for dealing with their problems are usually effective and usually different. Many of their strategies contradict those used by others. Some people talk out their problems, others work them out alone. Some people immerse themselves in work, others quit and go to Tahiti. Some people refuse to think of themselves as sick, others make out their wills. Some contemplate, some act. Some go to mental health professionals, others rely on their friends and themselves. Strategies can be opposite and still be equally effective. People tend to use whatever strategies have worked best in handling past problems. In fact, they use whatever strategies work at all.
Mental health professionals who deal with people affected by HIV infection agree that the best strategies are whatever works. Nevertheless, mental health professionals recommend a few general guidelines. The first is to protect your physical health. That includes eating healthful foods, cutting alcohol and smoking down or out, and exercising. Take good care of your body, give it a chance to fight the infection. In addition, protect the health of others: practice safer sex; don’t share needles; avoid passing blood, semen, or vaginal fluids to another person.
The second guideline is to cultivate emotional health. Value yourself and be around others who value you. Try to see accurately who you are and what you feel. Enlist your sources of support and try to communicate with them truthfully and thoughtfully. If a problem seems too severe or does not go away, or if you are seriously considering suicide, or if you simply want someone to whom you can talk freely, see a mental health professional. Therapy may concentrate on the overwhelming problems people must face and feel they cannot solve: How can I face rejection How can I deal with my anger Can I come to feel less guilt Are there ways to have sex without hurting myself or anyone else Why me Why now What will I do with the rest of my life What will happen to my kids My parents The people I love Will I die How will I die Am I a good person
The third guideline is to take control of your life. In spite of much that is unavoidable or unchangeable, the decisions about your life are yours to make. Consider and accept the consequences of your actions. Once that’s done, you know what’s best for you. You are in charge.
Satisfy these and any other principles you hold yourself to. Then trust yourself and live the way you feel you must. People affected by HIV infection say the same thing this way: be kind to yourself and others, come to terms with yourself, love yourself, trust yourself.
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