HIV/Aids stigma is putting patients at risk

FRETTING about rejection, people suffering from HIV/Aids naturally hide their secret, even from other people. To doctors, this is putting medical staff at risk and could hamper the effectiveness of treatment.
Thai Network of People Living with HIV/Aids (TNP+) chairman Apiwat Kwangkeaw said many HIV-positive patients ended up the last persons to receive dental services when they spoke up about their infection. A specialist at a medical school also suggested that some dentist interns were reluctant to provide services to HIV-positive people.
Yet Medical Council president Dr Somsak Lolekha has firmly defended the latest Patient Rights Declaration that requires patients to disclose their health information, such as HIV status, to doctors.
“Rights must come with responsibility,” he said, emphasising that HIV-positive people cannot exercise rights without showing their responsibility for others.
He said without knowing that their patients carry the human immunodeficiency virus that can cause Aids, doctors risked making a wrong diagnosis and prescribing the wrong drugs. “If damage is done, will doctors be held responsible?” he asked, emphasising that patients should show their responsibility too.
Launched in September, the latest Declaration of Patient Rights has caused uproar among HIV/Aids activists but support from medical workers.
“No matter if they have HIV or not, we will treat them. It’s just that if they inform us about their infection status, we will be able to diagnose their symptoms more accurately,” a female doctor said.
She also pointed out that HIV-positive patients sometimes needed different treatment than others. People in general could recover from shingles, for example, on their own, but HIV-positive people might need the help of medicinal injections.
Another doctor said that although universal precaution was the norm among medical workers, patients should understand that cleaners at medical facilities could face an infection risk if they did not know some items had been used for HIV-positive patients.
Under universal precautions, all patients were considered to be possible carriers of blood-borne pathogens. The guidelines recommended wearing gloves when collecting or handling blood and body fluids contaminated with blood, wearing face shields when there was danger of blood splashing on mucous membranes and disposing of all needles and sharp objects in puncture-resistant containers.
Universal precautions were designed for doctors, nurses, patients, and health care support workers who were required to come into contact with patients or bodily fluids. This included staff and others who might not come into direct contact with patients.
Thai Aids Society president Dr Winai Rattanasuwan emphasised that HIV-positive patients benefited from disclosing to their doctors that they had the virus.
“Some drugs may affect the efficacy of antiretroviral drugs. And if HIV is not a factor, their symptoms may be diagnosed in a different way.”
Speaking on condition of anonymity, a woman who is not HIV-positive feels it would be safer for others to know if a patient had the Aids virus.
“Please don’t think just about your rights, please think about others too,” she said.
Apiwat, however, believes universal precautions should already be enough to protect others.
A 25-year-old woman who has contacted HIV from her parents said she usually did not tell a nurse at a pre-screening counter that she had the infection.
“The nurse will usually ask loudly if I have any underlying illness. With so many other patients around, I have never had the courage to disclose such information,” she said.
She believes she would feel more comfortable if the question was asked behind closed doors when she met face-to-face with her doctors.
She reckoned she was always worried that if she ever disclosed her HIV status to medical workers, they might not keep it confidential.
“I have a fear they may tell others and I will be discriminated against,” she said.
A lecturer at a medical school admitted that his interns had refused to treat a patient after learning of a kid’s infection. He in the end had to provide the services by himself but without going back to preach his students about ethics.
“They may be worried about the risk because dental services involve blood. But I have always taught students under my care that they must have ethics and do their best in delivering services to patients. When they know about infections, they can take precaution and minimise risks,” he said.
Stigmatisation against people living with HIV/Aids continues, even though every year on December 1 the world celebrates World Aids Day with the mission of improving the quality of life for Aids/HIV patients.
 
This is the final report in a three-part series to mark World Aids Day.