I saw one of my HIV+ patients last week. He has had a rough few months. He ended up homeless, and he was staying with a "friend." The friend's sons found out he was HIV+ and beat him up. I had no idea this sort of thing still happened in America.
The rest of his difficulties have been self-inflicted. He is an alcoholic, although he had not been willing to accept this diagnosis. He kept surrounding himself with people who would take advantage of him. He kept putting himself in situations where he'd end up losing his money or sometimes the shirt off his back (literally). He would ride his bicycle drunk and break his arm. He'd black out and have a seizure. He'd lose his HIV meds and be without them for days a time. He would talk about how he has bad luck or about how other people are terrible. I would try to bring up that perhaps it was the choices he was making that was putting himself in these bad situations. He never really saw it. His eyes would glass over, and I could see that he wasn't getting it.
Last week he came in and said he recognized that he was an alcoholic. He said he realized this after he spent 12 hours at a bar that he didn't want to go to with people he didn't want to see. He spend $40 he didn't really have. Some guy asked for his favorite hat, and he just gave it away. He said he realized he was doing all of these things that he didn't really want to do, and the reason he was doing them was because of the alcohol.
I could see that he had a moment of clarity. He was 2 weeks sober when I saw him, and he really seemed committed. Whether he can stick with it remains to be seen, but I this is the first step in what could be his recovery.