Educating physiotherapy students on HIV and rehabilitation: An investment for the future

At present, thanks to advances in medicine, the life expectancy of people living with HIV continues to rise. However, as these patients begin to live longer, they are more likely to suffer complex health-related challenges of the infection, associated physical and physiological co-morbidities and potential adverse effects of treatment. The amount of education physiotherapy students receive on HIV and rehabilitation remains to be minimal. This editorial presents an interesting overview of this condition in relation to how future physiotherapists are going play a key role in the management of patients with HIV.


HIV within physiotherapy practice
HIV (Human Immunodeficiency Virus) is a prominent feature modern society. Presently, an estimated 36.7 million people live with HIV globally, with 103,800 of those in the UK (PHE, 2020) and current projections indicate by 2028 more than half of those living with the condition within the UK will be over 50 (NAT, 2016;Brown, 2018). The relevance of this to the future practice of the physiotherapist is crucial as there is strong indications within the literature showing that, as these patients begin to live longer, they are more likely to suffer complex health-related challenges of the infection, associated physical and physiological co-morbidities and potential adverse effects of treatment (Brien et al., 2014;Simonik et al., 2016). However, little research has been done on the implications of HIV rehabilitation training within the university setting and the associated benefits to future care of these patients within a multi-disciplinary approach, in addition to the key transferable skills within other chronic conditions. HIV does not have the level of distinction compared to the big five conditions named within the NHS England strategy for sustainable long term condition services (cancer, diabetes, dementia, learning disabilities and mental health) (NAT, 2016). However, managing HIV should be considered a priority within this strategy as there is so much emphasis concerning prevention and early intervention, to diminish the probability of the progression of Lyndon I, Alexanders J MedEdPublish https://doi.org/10.15694/mep.2020.000177.1 Page | 2 serious long term conditions within the current literature (NAT, 2016;BHIVA, 2019). It could be purported that future strategic planning regarding this unique long-term condition would benefit from a review as this may have serious future implications financially, as well as at an individual point of contact level (NAT, 2016;BHIVA, 2019, Brown, 2018. Moreover, HIV is within a unique category of chronic long term conditions. Care for HIV patients has been considered to have championed the patient centred approach to health care so widely embraced within the NHS however, complications arise due to the absence of knowledge within the general population, and the influence of stigmatisation on HIV positive individuals (NAT, 2016). Much of the emphasis towards treatment and effective long term care for these patients has deviated away from the responsibilities once held by the primary care physician, with a more holistic approach being sought after in terms of self-management, treatment-literacy and education, in addition to more regional level of peer support (NAT, 2016).
Financial constraints, alongside stigmatisation, continue provide an effective barrier to streamlined service -service user interaction however, current projections show promising developments within this area. As stated, emphasis is shifting to a more regional support network, with many CCG's (County Commissioning Groups) gaining more devolved autonomy over financial distribution (PHE, 2020), owing to more targeted interventions at an early stage in the disease' progression. This is a financially viable strategy that is more uniquely tailored to the demand of specific localities. However, many patients continue to show avoidance behaviours towards attending primary care physicians due to an over-emphasis on HIV diagnosis, rather than patient outcomes (NAT, 2016). Taking the above into account, an auspicious example of this shift in HIV management can be seen from the Living Well CIC 'Positive Self-Management Programme' (PSMP) (Well, 2019) which has provided a base for the introduction of the Expert Patients Programme (EPP) (NAT, 2016). Both of these schemes aim to provide pathways between HIV and generic health, raise awareness amongst the general public and provide a platform for discussion regarding medication, management of emotion, exercise and wellbeing, thus helping to break the cycle of stigma and discrimination and help to normalise the lexis surrounding HIV management (NAT, 2016).
Looking at the above, in combination with the current literature surrounding HIV management, it is clear that the need for widespread MDT influence into the management of these chronic-condition patients is growing, with physiotherapy showing tremendous potential to assist these patients both at a point of first contact post diagnosis, but also throughout the disease progression. This is evidenced by key developments such as the HIV Disability Questionnaire (HDQ) and the Episodic Disability Framework (EDF) used by physiotherapists which tracks the episodic nature of disability of HIV positive patients, taking into account six domains ranging from physical disability to impact on everyday life, giving constant feedback to the clinician whilst building a relationship with the patient (Bruce et al., 2017).
However, education within the university setting surrounding the management of HIV is non-existent. This is troubling when it is now known that physiotherapy has a positive impact on the progression of many of the physical and emotional problems, and quality of life, experienced by those suffering from the disease (O' Brien et al., 2020). Furthermore, currently research is well underway to explore the impact of disability experienced by HIV positive patients within in the UK which may highlight future impacts on healthcare provision (O' Brien et al., 2020;Brown, 2018).

Take Home Messages
The introduction of HIV education and management to the curriculum for future physiotherapists will benefit future healthcare for, not only these patients, but those suffering from a range of chronic conditions.

Notes On Contributors
Mr Iain Lyndon BSc; Physiotherapy Student; Teesside University. Iain has an interest in infectious diseases. His previous degree explored the social stigmatisation influenced by the media in relation to HIV. His other research includes HIV education for healthcare students and the importance of physiotherapeutic interventions for patients with HIV.
Dr Jenny Alexanders; Senior Lecturer in Physiotherapy ORCID: https://orcid.org/0000-0001-5519-3311 Jenny has a wealth of experience working in the clinical and academic sector. Jenny's research interests surround psychological education within physiotherapy training, goal setting practices and therapeutic alliance within ACL rehabilitation.