Introduction

Everybody ‘self-manages’ all the time. In terms of health self-management might include: eating well, taking exercise or taking steps to manage stress. This ‘self-management’ can be almost unconscious, particularly when we are otherwise healthy.

Most people will also seek to self-manage minor illness. Sales of non-prescription remedies bear this out and it is clear that the majority of responses to illness are some form of self-management behaviour.

Not surprisingly self-management is even more important to people living with complex, serious long-term conditions. This is as true of HIV as it is of Diabetes, MS or heart disease.

Historically self-management has been important to people living with HIV. In pre-HAART days many of the health strategies and much of the activism around HIV were a form of self-management. As early as 1987 the Frontliners book “Living With HIV” advocated an approach strongly rooted in self-management. This continues, the recent NAM book also called “Living with HIV” is very much about “taking control” for yourself and self-managing the consequences of living with HIV.

For a person living with HIV today self-management will be about the social and emotional consequences of living with the condition as much as the medical consequences. It will be as much about dealing with the fears and frustrations of living with HIV as it will be about dealing with side effects or planning meals around medications.

Medical management and self-management compliment each other and there is no conflict between them. A person who self-manages their condition well will make the very best use of the resources offered by the health care system. Health is often described as a “co-productive process” and self-management is part of this.

Everybody has self-management skills but their level, and how we use them, will vary from person to person and at different times during our lives. In addition at times we may lose confidence in our ability to self-manage – people often express this as a “loss of control.” Fortunately it is possible to learn, or relearn, self-management skills and there are many interventions that seek to achieve this.