Thursday, January 31, 2008
The statement’s headline point says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”
It goes on to say that this statement is valid as long as:
- the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
- the viral load has been suppressed for at least six months, and
- there are no other sexually transmitted infections.
The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system.
The Commission states that an HIV-positive person in a stable relationship with an HIV-negative partner, who follows their antiretroviral treatment consistently and as prescribed and who does not have an STI, is "not putting their partner at risk of transmission by sexual contact."
"Couples must understand," they write, "that adherence will become omnipresent in their relationship when they decide not to use protection, and due to the importance of STIs, rules must be defined for sexual contacts outside of relationship."
"The same goes for people who are not in a stable relationship," they add. However due to the importance of STIs, use of condoms is still recommended.
They add that heterosexual women will have to consider eventual interactions between contraceptives and antiretrovirals before considering stopping using condoms.
"People who are not in a stable relationship must protect themselves," they note, "as they would not be able to verify whether their partner is positive or on efficient antiretroviral therapy."
Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuel
Vernazza P et al.
Bulletin des médecins suisses 89 (5), 2008.
Wednesday, January 30, 2008
Was anyone in WA State Government not aware of the slang term or even the dictionary definition of Certified.
It may be tempting fate to use Certified Counselor for the repackaging of the few Registered Counselors who may survive the Governess' purge. But once they went Through the Looking Glass and claimed that psycho belonged only to psychologists then all bets were off.
On the basis of their findings, the investigators recommend that patients with hepatitis C should be counseled that regular cannabis consumption is associated with severe fibrosis. This information is especially important for HIV/hepatitis C coinfected patients as HIV is already associated with accelerated hepatitis C disease progression. Furthermore HIV-positive patients in the study were significantly more likely to be regular users of cannabis and to use the drug for medicinal purposes.
Hepatitis C virus infection is a major public health concern, and it is thought that the amount of illness caused by hepatitis C-associated fibrosis and cirrhosis will increase significantly in the near future.
Factors associated with the progression of hepatitis C disease and the development of cirrhosis include male gender, older age at the time of hepatitis C infection, heavy alcohol consumption and coinfection with HIV.
Cannabis is widely used for recreational and medicinal purposes. The drug contains 60 active cannabinoids and cirrhotic livers are more receptive to cannabinoids. Earlier research suggests that cannabinoids have an important, but yet to be identified, role in the progression of liver fibrosis.
Given the prevalence of cannabis use and the suggestion that it could worsen liver disease, investigators from the University of California San Francisco designed a study to determine the effect of cannabis on the severity of fibrosis in patients with chronic hepatitis C virus.
Patients coinfected with HIV were significantly more likely to report daily use of cannabis and to have the drug prescribed for medicinal purposes, note the investigators. They therefore suggest “the recommendation to avoid cannabis use might be especially important for hepatitis C virus- HIV coinfected persons, given that fibrosis progression is already enhanced in this group.”
The investigators conclude, “we would advise that individuals with chronic hepatitis C virus infection be counseled to reduce or abstain from cannabis use.”
Influence of cannabis use on severity of hepatitis C disease.
Julie H. Ishida et al
Clinical Gastroenterology and Hepatology 6: 69 – 75, January 2008.
Last week, police in Gurgaon, a suburb of the capital
Gurgaon is an affluent suburb of
In the raid four people were arrested but the main person alleged to be behind the racket, a doctor, is missing.
Despite banning the trade in human organs
Amelia Gentleman also covers this story in today’s (
Since the late 1990s numerous outbreaks of syphilis have been recorded amongst gay men in industrialized countries. There are concerns that these outbreaks could have implications for the spread of HIV amongst gay men. This is because syphilis infection can be a marker of risky sexual behavior and because syphilis can facilitate the transmission and acquisition of HIV.
Some research from the
Consistent with other research, the investigators found a high prevalence of HIV infection amongst men with primary and secondary syphilis.
The investigators work supports earlier research from the
“In these sexual networks, HIV-uninfected men acquiring syphilis are simultaneously at a high risk of HIV acquisition for multiple reasons”, suggest the investigators. They go on to explain “recent syphilis infection…facilitates HIV acquisition because syphilitic ulcers disrupt epithelial and mucosal barriers and local inflammation may lead to the recruitment of CD4 target cells to the site of ulceration.”
Furthermore, because these HIV-negative men are sexually active within networks that have a high prevalence of HIV-positive men “their probability of encountering an HIV-infected partner is increased.” Finally, HIV-positive men in these networks with syphilis are more likely to transmit HIV because their “viral load may be elevated in early syphilis infection.”
The investigators recommend that HIV-negative men diagnosed with syphilis should have follow-up appointments at sexual health clinics three and six months after their treatment for syphilis to verify that this treatment was successful and “for repeat HIV antibody testing, risk reduction education, and linkage to HIV care in the event of seroconversion.”
HIV Incidence Among Men Diagnosed With Early Syphilis in
Buchacz, Kate PhD, MPH et al
(JAIDS) Journal of Acquired Immune Deficiency Syndromes. 47(2):234-240,
Link to JAIDS abstract
Tuesday, January 29, 2008
Now, the online magazine Salon.com has weighed in on the controversy. In a humorous essay, the magazine makes a serious point — it’s not just gay men who are at risk for methicillin-resistant Staphylococcus aureus, or MRSA, a potentially fatal bacterial infection that killed two schoolchildren last fall.
The article starts by quoting a 2005 study in The New England Journal of Medicine. According to the medical journal, MRSA affects men who had “frequent contact” with others and “often did not shower before using communal whirlpools.” The article blames factors such as “compromised skin” and “close skin-to-skin contact.'’
But then Salon delivers the punch line.
When it comes to spreading the bacteria, it is not homosexuals we have to worry about….The medical researchers were not studying gays, they were studying the St. Louis Rams. That is correct: football players; in particular, linebackers.
The article goes on to quote the
In our investigation, infection occurred only among linemen and linebackers, and not among those in backfield positions, probably because of the frequent contact among linemen during practice and games….All MRSA skin abscesses developed at sites of turf burns.
The magazine points out that “all football people are not that clean.'’ The New England Journal researchers “observed a lack of regular access to hand hygiene for trainers who provided wound care; skipping of showers by players before the use of communal whirlpools; and sharing of towels — all factors that might facilitate the transmission of infection in this setting.”
While it is true that clusters of MRSA have been identified among men who have sex with men, it has also been found in areas where people share close quarters, such as military barracks and prisons. Athletes also are at risk. In 1998, The Archives of Internal Medicine published a report on MRSA among high school wrestlers. Last fall, The Clinical Journal of Sports Medicine published a report calling MRSA “the latest sports epidemic.” According to that report:
Clusters of cases in various athletic teams, particularly contact sports, have been reported since 1993 in the
and more recently in United States . Community-associated MRSA infections are not limited to Canada North America, and all athletes are considered high risk. Skin-to-skin contact appears to be the primary mode of transmission.
This doesn’t mean athletes should panic about MRSA; nor should gay men or anybody else for that matter. The bottom line is that everyone needs to pay attention to hygiene, wash hands often, limit the sharing of personal items and seek medical attention when a blemish or pimple seems to get worse quickly.
The Columbia Journalism Review has a review of the media’s handling of the MRSA story.
Link to CJR article.
A Clone of Methicillin-Resistant Staphylococcus aureus among Professional Football Players
Sophia V. Kazakova et al
President Bush in his final State of the Union address called for an additional $30 billion over the next five years to fight HIV/AIDS in Africa - an amount AIDS activists say is less than he has already pledged and far less than what is needed.
"Our Emergency Plan for AIDS Relief is treating 1.4 million people. We can bring healing and hope to many more. So I ask you to maintain the principles that have changed behavior and made this program a success. And I call on you to double our initial commitment to fighting HIV/AIDS by approving an additional $30 billion over the next five years," Bush told the joint session of the House and Senate Monday night.
But New York's Gay Men's Health Crisis, one of the biggest HIV/AIDS organizations in the country, said Tuesday that that Bush's commitment actually is $30 billion less than Bush has committed to the G-8 and at the United Nations.
Additionally the State of the
GMHC said that $59 billion is needed if the
"It is unconscionable that the President would seek to under-fund at the current level, especially at this moment time," said Marjorie J. Hill, Chief Executive
Officer of Gay Men's Health Crisis.
"Just when new treatments are radically changing life chances for people with HIV, under-funding will effectively slam the door on millions of others.
In contrast to the 2003 PEPFAR authorization, when the U.S. pledged to provide treatment to two million people in fifteen countries by the end of fiscal year 2008, the Presidents current proposal would extent treatment to only half a million additional people over the next five years Hill said.
"This represents an alarming abandonment of PEPFARs goals and of the administrations promises to the international community," said Hill.
Advocates say they will now turn to Congress to ensure full funding for PEPFAR.
Congresswoman Barbara Lee (D-Calif.) was critical for the lack of any mention of domestic HIV/AIDS spending in the State of the
"Even more incomprehensible, President Bush has flat-lined funding for the Minority AIDS Initiative and our domestic HIV/AIDS programs, even as data shows communities of color are increasingly bearing the brunt of the disease," said Lee.
"Over 188,000 African-Americans were living with AIDS at the end of 2005, representing 44 percent of all cases in the
AIDS Healthcare Foundation, the nation's largest non-profit HIV/AIDS healthcare, research, prevention and education provider, also criticized the President for not mentioning new domestic HIV/AIDS funding.
"AHF was saddened to see President Bush miss an opportunity tonight to take a real leadership position in the fight against HIV/AIDS in the
"The CDC has not yet publicly released its newest US HIV numbers, but AIDS researchers, medical providers and advocates nationwide are expecting these latest numbers to show an alarming 35% to 50% increase in US HIV rates--between 54,000 to 60,000 new infections identified annually."
According to CDC officials, that data is currently under "peer review" and will not be officially released to the public until later this year.
"The delay in providing the information closed the door on an opportunity to halt this trend, as the President did not confront the challenge in his address, nor is the necessary increased funding for stepped up HIV prevention and testing in the domestic fight against AIDS in his Administration's 2008 budget," said Engeran.
Monday, January 28, 2008
More Hitting Cost Limit on Health Benefits
reports a small but growing number of American families beset by major medical problems are learning the hard way that simply having health insurance is sometimes not enough.
Those who need organ transplants or who have hemophilia, or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies.
That has left some very sick people facing health-care tabs of hundreds of thousands of dollars or more, prompting their families to seek help from the government, or to scramble to change jobs or even divorce for no other reason than to qualify for new health insurance. And it has led some advocates for the chronically ill to plan a new lobbying effort in hopes of persuading Congress to require that insurers increase lifetime caps to as high as $10 million.
Statistics on how many people exceed the lifetime caps are hard to come by, but advocates note that the amount of many caps hasn't changed in decades, or at least has not kept up with health-care inflation and the sky-high cost of lifesaving new therapies, making it more likely that people will reach the limit.
An annual survey by the Henry J. Kaiser Family Foundation found that 55 percent of workers with employer-based coverage had a lifetime limit in 2007, including 23 percent with a cap of less than $2 million. That was up from about 50 percent who faced a cap in 2004.
Why bird flu has been kept at bay
So far, the H5N1 flu strain has mainly infected birds and poultry workers, but the fear is the virus could mutate to pass easily from human to human.
A study, published in the journal Nature Biotechnology, at Massachusetts Institute of Technology found that to enter human respiratory cells the virus must first pick a very specific type of lock.
Flu viruses attack by binding sugar chains, called glycans, that line the airways and lungs. The chemical linkages between the sugar molecules in these chains differ between humans and birds. Until now it has been assumed that bird flu viruses would be adapt to humans simply by acquiring mutations that enable them to attach to the human types.
Dr Ram Sasisekharan and colleagues found this step depends on the shape assumed by the flexible sugar chains rather than the type of linkage. Bird flu viruses currently require cone-shaped glycans to infect birds, so the umbrella shape found in humans has protected most of us from avian flu. This suggests that for the H5N1 bird flu virus to become pandemic it must adapt so that it can latch onto the umbrella-shaped glycans of the human upper respiratory tract.
Dr Jeremy Berg of the National Institutes of Health which funded the work said: "Sasisekharan's team has changed our view of flu viruses and how they must adapt to infect us. "The work may also improve our ability to monitor the evolution of the H5N1 virus and thwart potential outbreaks."
Glycan topology determines human adaptation of avian H5N1 virus hemagglutinin
Aarthi Chandrasekaran et al
Nature Biotechnology 26, 107 - 113 (2007)
But you cannot expect a revolution without a few innocent casualties! Think of it ! Aren’t you stirred by my slogan “keeping patients safe by building an effective, efficient health care system. “ Doesn’t it sound cool? Our new system will look so much better. And if there are any flaws, they won’t show up until after the November Election. And think of all those lovely credentials --- Ooh! Doesn’t it make you feel tingly?
Sunday, January 27, 2008
'On Being Sane
In Insane Places'
In the 1970s David L. Rosenhan published his study recounting the experiences of healthy researchers (‘pseudo-patients’) who were admitted as patients in mental institutions. The study concluded "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" It also warned the dangers of depersonalization and labeling. It suggested that the use of concentrating on specific problems and behaviors rather than psychiatric labels might be a solution . The preamble to Rosenham’s paper sums it up:
How esoteric, you may say. But it has no impact on daily life. Just a momenent, grasshopper. The Washington State Legislature has just started its 2008 session. The pundits warned that we should not expect too much. They say that after her very narrow win in 2004 Governor Gregoire is primarily concerned about this November's reelection bid. The same goes for the Democratic majority. So with budgetary control and fiscal responsibility as the mantra, even essentials may fall by the wayside.
It is ironic that the Senate and House Bills have the seemingly innocuous title “Modifying credentialing standards for counselors". I suppose The Abolition of Registered Counselors and the Discouragement of Private Practice might have set people wondering. Its difficulty to appreciate that the intent (or unintended consequences --- nobody is all that sure) is a major shift in 'counseling' or mental wellness in
Many other consequence will not be apparent until well after the legislation is passed. A significant reason is that the bill is set up for the Secretary of Health to formulate rules about its operation. This will include decided who will be “supervisors” and how they will operate. We are not talking about some management structure. The State is going to determine who will be the third party in (what used to be) the sacrosanct relationship between client and therapist. But I don’t think I am allowed to say the word “therapy” any more! I suppose at least makes it clear just how flimsy the notion of “confidentiality” has become.
The practice of counseling by a person under the auspices of a religious denomination, church, or organization, or the practice of religion itself”
Link to On being Sane In Insane Places [pdf]
Originally published: Science, Vol. 179 (Jan 1973) 250 - 258
WA State Legilsature SB 6456 - 2007-08
Modifying credentialing standards for counselors
Link to the Senate Bill
The Other Side: A Queer History
This documentary about gay history in Los Angeles, including the practice of entrapment by the LAPD in the 50s, 60s and 70s is currently seeking distribution. Any offers?
Larry Grayson's Final Appearance The Royal Variety Performance - 1994
Saturday, January 26, 2008
I grew up in Leicestershire, and the north-eastern part is full of rocks full of fossils. Every time you put a rock under a hammer there was a chance you'd see something new, and yours were the first human eyes ever to see that. The notion that there's a sea creature in the rocks beneath the ground on which you walk which was alive 100m years ago I find romantic and amazing.
Every society that's ever existed has felt it necessary to have creation myths. Why should I believe one? People write to me and say: 'You show us birds and orchids and wonderful, beautiful things - don't you feel you should give credit to He who created those things?' My reply says: what about a parasitic worm that's boring through the eye of a four-year-old child on the bank of an African river? It confuses me that I should believe in a god who cares individually for each and every one of us and could allow that to happen.
My next project is about Charles Darwin. He says in a letter to Emma, his wife, something like: 'I sat down on a bench and saw a bird singing in the trees and saw a wide mass of life going on around me, and I thought I didn't care what the process was that brought this into place because it's so wonderful.' If I lost that feeling, I'd go and do something else.
Friday, January 25, 2008
Even though the dose of hormones in the 1960s and 1970s pill was roughly double the amount in today's versions, this did not seem to make a difference to the level of protection offered, the researchers said.And they said protection against cancer can continue decades after a woman has stopped taking the pill.
The relationship between the contraceptive pill and cancer is not all good news - there have been fears about short-term increases in the risk of breast and cervical cancer.But researcher Sir Richard Peto said that young women did not have to worry about this risk.
"The eventual reduction in ovarian cancer is bigger than any increase in other types of cancer caused by the pill," he said.
Lancet editor Richard Horton said that the new evidence was a compelling reason to make it easier to obtain the pill."There are few drugs available that confer powerful and long-lasting protection against a highly lethal malignancy after such a short exposure."
"We strongly endorse more widespread over-the-counter access to a preventive agent that can not only prevent cancers but also demonstrably save the lives of tens of thousands of women."
Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23 257 women with ovarian cancer and 87 303 controls
Collaborative Group on Epidemiological Studies of Ovarian Cancer
The Lancet - Vol. 371, Issue 9609, 26 January 2008, Pages 303-314
Piecing Together the Dark Legacy of East Germany's Secret Police
Thursday, January 24, 2008
The PBS series American Experience is currently showing the program
It explores the work of the Neurologist Dr. Walter Freeman and his development of lobotomy as a treatment for mental illness
The large numbers involved come as a shock and the impact of the story does not allow us to dismiss it as the distorted influence of a single player. Indeed, Walter Freeman began with a study by Portuguese neurosurgeon Egas Moniz, who cored into the brains of mentally ill patients and removed small portions from the frontal lobe. Moniz observed a positive change in his patients' behavior, although he did not understand the mechanism. He believed that he was removing "fixed ideas" from the frontal lobes.
Moniz was eventually awarded the Nobel Prize.
The god-like Freeman was hailed by authorities and patients. Juxtaposed to that was his "simplification" of the operation to the quick and easily-reproduced process of using ice picks.
"In our home on
Connecticut Avenue, we didn't have a refrigerator," says Freeman's son Franklin. "We had an ice box. The first ice picks came right out of our kitchen drawer."
As we watched we were tempted to lull ourselves with the notion that this could not happen today. But then he did visit
Maybe we should keep that in our thoughts as WA's Governor moves to narrow the field of mental health practitioners and ratchet up State Conrol.
That has done so well in the past --- hasn't it?
The new rules represent one of the most profound changes of the past 16 years to regulations governing drug development. But since the F.D.A.’s oversight of experimental medicines is done in secret, the agency’s shift has not been announced publicly.
Makers of drugs to treat obesity, urinary incontinence, epilepsy, smoking cessation, depression and many other conditions are being asked for the first time by the drug agency to put a comprehensive suicide assessment into their clinical trials.
The concerns are consistent with a growing body of research confirming that behavior is heavily influenced not only by genes but also by seemingly innocuous changes in body chemistry. Drugs not reaching the brain were once thought to be largely free of mental effects.
“One lesson from pharmacology is that you can see effects on emotion and cognition without the drug entering the brain if a drug leads to peripheral changes in” other chemicals that enter the brain, said Dr. Thomas R. Insel, director of the National Institute of Mental Health.
Some drugs cause depression so often that doctors prescribe antidepressants prophylactically with them.
There are two reasons that the F.D.A. for years was inattentive to the psychiatric effects of new medicines. First, distinguishing between mental problems that spring from a disease and those that result from its treatment is often difficult. For antidepressants, many researchers suggested that suicidal behaviors resulted because, as patients’ depression lifted, they suddenly had the energy to carry out previous suicidal thoughts.
Second, drug side effects are often first identified in clinical trials when multiple doctors treating hundreds of patients record similar problems in trial notes. But terms to describe depression or suicidal thoughts can vary widely, making them hard to discern.
“The whole spectrum of suicidal thoughts, ideation and attempts is much more difficult to define and study than” other drug problems, said Dr. Eric Colman, deputy director of the drug agency’s division of metabolic and endocrine products.
Indeed, the agency’s initial review of the effects of antidepressants in children was plagued by inconsistent and erroneous observations by investigators. A 10-year-old boy who tried to hang himself was listed only as having a “personality disorder,” an overdose of 11 tablets was called a “medication error” and a girl who slapped herself in the face was labeled as having attempted suicide.
Researchers from Columbia University’s department of psychiatry, led by Kelly L. Posner, who were commissioned to reanalyze drug clinical trials, spent months reclassifying these events as either a suicidal symptom or not.
The questionnaire has been translated into 80 languages, and Dr. Posner has trained scores of teams of investigators from around the world on how to use it.
Child mortality toll dips below 10 million - UNICEF
Nearly 9.7 million children die each year before their fifth birthday from diseases like pneumonia and malaria, but simple affordable measures could save more lives, the U.N. Children's Fund (UNICEF) said on Tuesday.
While the annual toll is below 10 million for the first time, it still means that more than 26,000 young children die each day, most from preventable causes.
UNICEF warned that despite recent advances,
The toughest climb lies ahead -- attempting to boost children's life expectancy in countries ravaged by the HIV/AIDS epidemic and plagued by weak governance and poor health systems, UNICEF said.
Children in the developing world frequently succumb to respiratory or diarrhoeal infections that no longer threaten lives in rich countries. Many also die from measles and other diseases that can be prevented through vaccines.
Unsafe water and poor sanitation also cause extensive disease and death, especially among malnourished children.
Simple, affordable measures such as breast-feeding, vaccinations and insecticide-treated bed nets can dramatically reduce child deaths, according to UNICEF.
Link to Reuters article
Wednesday, January 23, 2008
The 33 Things That Make Us Crazy
that includes a piece by Erin Biba
Why Things Suck: Medical Records
Most medical records are about as orderly as an ER on Saturday night. Because they're mainly confined to paper, they can't be easily transferred from one physician or hospital to another. And because they're not subject to any standards (or even legibility requirements), they're nearly impossible to compare and combine.
Improving the system is possible, but it would take the cooperation of a bunch of interest groups that have no interest in working together. The Health Insurance Portability and Accountability Act, passed by the federal government in 1996, was supposed to fix things, but massive lobbying turned it into porridge. For example, HIPAA lets states make their own rules; now some states say doctors should keep records for 20 years, some for two.
You'd think electronic records would solve the problem, but no. Because the software vendors selling electronic record-keeping systems are competing, their systems are proprietary and incompatible. Oddly, that's OK with many physicians. Another name for an all-knowing, all-seeing, all-compatible electronic system is database, and physicians don't want people mining theirs — not because of patient-privacy concerns, but because the info could be used for doctor-on-doctor performance stats. Plus, docs already hate filling out charts; you think they want to learn data entry?
A fix may be on the way. Google and Microsoft are both working on software that will appeal to physicians and patients alike. (Kind of gives new meaning to "blue screen of death," don't it?) But a word of advice: Pressure your docs into accepting a more transparent system. If you don'tunderstand your chart, ask. You want some surgeon to cut the wrong leg off of you someday?
Wired’s The 33 Things That Make Us Crazy
Link to Why Things Suck
Tuesday, January 22, 2008
The qualitative research involved 50 HIV-positive men who obtained their HIV care through the US Department of Veterans’ Affairs. Although some of the men reported receiving excellent care, others said that the demeanor of healthcare staff made them feel stigmatized. Some patients also reported that they received poorer quality care, were refused care, or were insulted or even assaulted by healthcare personnel because they had HIV.
The investigators hope that their research leads healthcare staff to be more ‘mindful’ of their actions towards HIV-positive patients. They also call for further research to explore behavior that increases the confidence of HIV-positive individuals in healthcare staff.
It is estimated that there have been over one million cases of HIV in the
Stigma can damage the health of HIV-positive individuals and it is therefore particularly troubling that people with HIV often experience discrimination from healthcare staff. Previous studies have found that a quarter of HIV-positive patients in
The investigators describe behavior and demeanor that patients perceived to convey discomfort, fear, contempt or exclusion on the part of healthcare staff. This included a lack of eye contact, with one participant commenting that a specialist physician “never looked me in the eye. I still don’t know what his face looks like.”
Some patients reported that the tone of voice implied unease on the part of healthcare staff. Communicating in a brusque, flat or clipped manner was commented upon. One individual explained to the investigators the manner in which a nurse had informed him of his AIDS diagnosis: “It was so callous and cold…she said, ‘You have AIDS.’ And I said, ‘What?’ The way she said, ‘Whenever you go below 200 you got AIDS.’ It was just the coldness in it – there wasn’t no feeling. It’s almost like a stone-faced warden or something. No concern.”
Reluctance by healthcare staff to be in physical proximity to patients was also interpreted as stigmatizing by some participants. One man told the investigators he had had a doctor “who wouldn’t even come into the room.”
Standoffish behavior by receptionists was also reported, and other participants recalled instances when healthcare staff had expressed anger when they’d learnt of their patient’s HIV-infection status. Other times healthcare staff appeared nervous, with one man reporting a “nervous vibe” from his dentist.
Panicked behavior by healthcare staff was also reported, with one patient telling the investigators of a trip to a hospital emergency department: “As I’m sitting there and we’re talking and [the assistant] comes running over. I could tell it was a big emergency. He says, ‘wait a minute!’ and grabs the manila folder…I can tell what he’s writing across the front…and he’s writing the word, ‘AIDS!.’”
In some instances healthcare staff changed their attitudes or behavior towards a patient after learning that he was HIV-infected. One patient explained, “I went to this office and the lady asked me what my disability was. When I told her, it seemed like her whole attitude changed.”
Some participants also reported that their healthcare staff took unnecessary precautions. One man said that these made his doctors look like “Roman gladiators!”
Healthcare staff sometimes used language to scare their patients. A participant recalled an encounter with his physician shortly after his diagnosis. The patient asked the doctor what his next step was, the doctor replying “you’re gonna die.”
Other patients reported being mocked by healthcare staff because they were HIV-positive and other patients said that they felt that healthcare staff blamed them for having HIV. An encounter with a phlebotomist was recalled: “She had a really hard time drawing my blood…she kept poking me and I told her it hurt…and she said, ‘if you hadn’t gone and done this to yourself, we wouldn’t have to be going through this!’”
“Patients reported being sensitive health care personnel’s demeanor” comment the investigators. Although this made patients feel “resentful and unsatisfied” it did not always compromise the delivery of healthcare.
But in other instances such stigma did adversely affect healthcare.
One patient reported being repeatedly ignored by his treating physician. He told the investigators “I was here for a week and there was a doctor who was attending. He came into my room – he didn’t say a word to me. When I caught his attention, it was as if I hadn’t said anything.”
Substandard care was also reported, with one patient telling investigators that a dentist had refused to offer adequate anesthetic because of his “condition.”
Overt stigma and discrimination also took the form of a refusal to provide care. An incident quoted by the investigators once again involved dental care: “Once I went to a county hospital to have a tooth pulled. I guess the dentist was a student or an intern or whatever. He refused to do it once he realized I was HIV-positive. They sent for another doctor.”
It wasn’t just clinical staff who refused to provide services to HIV-positive patients. One individual commented on the behavior of a cleaner: “I was a patient at a
Abuse from healthcare staff was also reported, with one patient saying that he was defamed in an attempt to ensure that he received less favorable treatment from other healthcare staff. Another patient told investigators that he was roughly handled by paramedics who had learnt he was HIV-positive.
“These findings offer healthcare personnel a tangible list of behaviors what should either be avoided or further explained to HIV-positive patients, as they may be interpreted as stigmatizing,” conclude the investigators. They add, “this study reveals that patients are sensitive to such behaviors being performed by a variety of healthcare personnel, indicating the need for all such personnel to be mindful of their actions towards these patients.”
Male patient perceptions of HIV stigma in health care contexts.
Lance S. Rintamaki, et al
AIDS Patient Care and STDs. 2007, 21(12): 956-969. doi:10.1089/apc.2006.0154.