Table 2 Examples of Triggers of Disability

Receiving news of an HIV diagnosis marked a severe episode of disability. Participants reflected how this one-time episode was a life-changing event that initiated life with HIV and its uncertainty.

   "From the point of diagnosis you deal with depression... coming to grips with realizing that the virus is attacking your body...And how that changes your life completely." (INT-11)

Initiating or Changing Antiretroviral Medications

Participants described the complexity of weighing the physiological benefits of medications with the potential adverse effects. Some were fearful of how they might react to antiretrovirals, specifically the physical effects that could result, identifying them as HIV-positive, and making them vulnerable to stigma and discrimination:

   "I've gone through the whole process of choosing my medications...And there's still a lot of uncertainties...Is this going to cause body side effects, which I'm terrified about because that will change my life drastically. Because I think the only reason that I've felt in a sense somewhat normal – I wouldn't say whole normal at all – is that I don't look any different..." (INT-11)

Experiencing a 'Serious Illness'

These included illnesses related to HIV or co-morbidities participants were living with prior to being diagnosed with HIV. Examples included osteoarthritis, osteoporosis, Hepatitis-C co-infection, lipodystrophy, diabetes, stroke, myocardial infection, and pneumonia.

Suffering a Loss of Others

Losing a family member, friend, or partner (regardless of whether attributed to HIV) sparked uncertainty as participants began worrying about their own health and survival.

   "it actually does cause me a bit of a dip when I notice a neighbor getting sick. I live in a building of all people with HIV and in the past few years 4 or 5 people died... and I went for a dip each death, even if I didn't know people...what happens to them matters and it actually affects me... I feel like my immune system is touched when that happens, I just get so down...that weighs on me." (INT-10-VCFG-1)