20 October, 2020

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Minister’s Disclosure, HIV & Our Social Responsibility

By Niroshan Muwanwella

Dr. Niroshan Muwanwella

Dr. Niroshan Muwanwella

HIV and AIDS has long been a topic that polarises society, be it western or eastern. While scientists are still coming up with theories as to the origin of this retrovirus, what is clear about it now is how it’s transmitted. The most well known methods of transmission are unprotected sexual intercourse, blood contamination, especially through intravenous needle sharing at drug abuse. All of these methods are associated with social vices hence the stigma attached to the patients infected with the virus.

In the 60s and 70s, when HIV infection first became an epidemic, the western world reacted the only way it knew how. The society insulted the patients, sidelined them and berated them citing their vices. This was an era when medical ethics was unfortunately still in its puberty thus there was no defence mechanism against this social injustice.

The societal and medical landscape has heavily evolved since those dark times, at least in the west. The patients, even those with HIV infection are treated with respect, dignity and most importantly, with confidentiality they require. One of the advantages of this shift in thinking was that the under-reporting of cases due to the stigma attached with it slowly waned and the true magnitude of the problem was recognised. And eventually it paved the way to understand the disease fully and implement prevention programmes along with proper research into treatment. Story of HIV has therefore come a long way from the era of a poor life expectancy of 4-5 years to an era where more people die with HIV than of HIV/AIDS.Ranjan - Kuliyapitiya

Unfortunately, the same cannot be said of the present situation in many of the eastern countries including Sri Lanka. The stigma attached to the patients with HIV or in fact, persons rumoured to be having HIV, is stinging to say the least. In Sri Lanka, the HIV/AIDS prevention programmes have done so much to raise awareness on this topic, nevertheless the society does not seem to have fully comprehended the basics of the disease.

It is in this context where the responsible professionals, be it doctors, lawyers and educators have to be extremely sensitive and cautious when dealing with this delicate issue. A good example would be the recent saga of the little boy who was not only left without a school to attend to but also, was shunned by a whole village. This demonstrated clearly that the wider Sri Lankan society may not yet be ready for the mainstream path that the west has taken when dealing with these situations.

This emphasizes the importance of practicing a few of the fundamental principles when dealing with patients “labelled” with HIV infection. One, and the most important principle is privacy of the person. This goes all the way into doctor-patient confidentiality. Recent comments in the mainstream media from a particular minister sadly highlighted this issue. He mentioned that the information about the involved persons being HIV positive came from a zonal education officer. Therein lies the blatant disregard for the above principle. Most importantly, the doctor-patient confidentiality has been broken if the mother was in fact tested by a medical professional and secondly her privacy was heinously violated by the said minister.

In addition, during a very sensitive time in the middle of volatile situation, a lot of assumptions were made and released to the media, which was very unprofessional from a responsible minister. During this very publicized media release even misinformation regarding the routes of transmission of HIV was released.

Second principle is the basic human rights of the mother and the child. It is the right of every child to be with his/her parents. The only instance that that right can be overridden is when there is clear evidence that the child is deliberately subjected to physical or emotional abuse.

The third principle, which is not very well understood in some of the eastern countries including unfortunately Sri Lanka, is ethics. While there are different aspects of ethics governing medical professionals which majority of the public is aware, same cannot be said of the other professionals. It is not to say that no ethical codes exist in other professions such as legal professionals-in fact there are-however the same degree of publicity or attention is not given to these codes. This could be as a result of the fact that by nature medical professionals deals with human lives. However what we fail to realise here is that whenever we deal with a human live, be it at the doctor’s clinic, the court or day-to-day life, there is some aspect of ethics involved. Sometimes it can be loosely terms common sense as well.

In the west, where I have been practicing medicine for the past eight years, HIV infection has become just another communicable disease and the stigma attached to has waned. The patients infected are treated with dignity and as a result patients are not hesitant to reveal their HIV status in the knowledge that the will not be discriminated against.

In a society that has not yet reached the same liberal stance, the professionals who deal with HIV patients have to be vigilant as to the duty of care they owe to the patients. If the three principles are adhered to, namely patient confidentiality, human rights and ethics, the best interests of the patient is preserved. Disregard of these principles not only damages the psyche of the patient but also damages the sheer fabric of trust of these patients towards the wider society. The results would have long lasting implications even on whole the HIV prevention programme itself.

*Niroshan Muwanwella -Gastroenterologist. Currently Advanced Therapeutic Endoscopy Fellow at the Department of Gastroenterology in St Michael’s Hospital, Toronto

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    Good piece Niroshan.

    You said, “In Sri Lanka, the HIV/AIDS prevention programmes have done so much to raise awareness on this topic, nevertheless the society does not seem to have fully comprehended the basics of the disease”. Quite true. The dilemma is when a Minister of Education in this blessed Sinhala Buddhist country himself is an ignoramus, a total fool, what better can you expect from the populace?

    You said, “This demonstrated clearly that the wider Sri Lankan society may not yet be ready for the mainstream path that the west has taken”. How could we be ready? We are still a myopic people subject to intense sculduggery by the Mahanama myth induced army of saffron robed rogues.

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      HIV can be transmitted though a blood transfusion too – if blood is not properly screened.

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      HIV can be transmitted though a blood transfusion too – if blood was not properly screened.
      Good article. We all have a social responsibility to EDUCATE OURSELVES and others.
      We should stop blaming victims. HIV and AIDS patients need Metta, Karuna and understanding – Buddhist values seem to be absent when it comes to HIV and AID patients!

      Sri Lanka is a rather puritanical society, what with couples not allowed to hold hands at independence square!

      People need better EDUCATION, including the Minister, about learning to live with difference!

  • 1
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    Dr Muwanwella, It is not only in Sri Lanka, that HIV/AIDS was an Issue. When I had to have an Operation in 1983 in Perth, Australia, I had to sign a document, for Hospital Admin, that I was willing to have a Blood Transfusion if Necessary.

    When I refused to do so, I was insulted as a Religious Bigot! (Some Religions forbid Transfusions or Organ Transplants). At that Point in Time, AIDS and its various Methods of Transmission, including Blood Transfusion, was not Known to most People.

    However, the Understanding Surgeon promised to ensure that the Blood Donor was HIV/ AIDS free, and carried out the Operation Successfully. I am still alive 33 years later.

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      Not long ago a Sydney dental practice was found not putting in place safety practices that allegedly exposed hundreds of patients to the risk of HIV and Hepatitis B infection. The problem is if we know that a person is infected, then we have to take necessary precautions. We may be surrounded by HIV infected people. As long as we know it and there are risk reduction measures that is all we can do.
      But in this particular case what is evident is not the lack of education, but the lack of trust. The kid is not infected, but no one is ready to accept that guarantee from the government officials.

  • 0
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    A very good piece of article ,however it would be unfair to politicize this whole issue and blame the Minister of education solely , again ignorance on the part of the Minister is no excuse , he should have been more informed , but he is not the first to expose the story ,so again not fair to hit below the belt,( a very cowardly Sri Lankan Culture) at the same time there are so many ,so-called well educated who are still ignorant, not just about HIV but almost everything under the sun, most Sri lankans are used to cram to obtain a certificate, diploma or degree, that is it , beyond that they are all frogs in the well ,this is why you will see so much hatred and racism among the most so-called educated ,not to forget to mention especially those who come out of Universities from the villages.

    This shows how much prejudice runs in the veins of such people as a whole community .

    Besides can you then imagine those uneducated,ill informed, zero general knowledge, zero tolerance reaction when in possession of the new era smart phones and on Facebook media ,?(who I must firmly admit these are akin to monkeys with The Razor ), it is these lot who spread rumors and cause havoc ,not understanding the implications.

    It is time for a very strong media ethics rules to be introduced and first to educate the masses about how to use responsibly the social media and give the lot at-least six months of learning ,make it available on all the TV channels and then follow it with the strictest punishment and the best punishment is to hit the purse and they will learn fast.

    In the past we even had a very sad case of a school girl who committed suicide over a facebook incident and the criminals got away Scot-free,, that was during the rule of the lawless , so let us see now what good governess will do with the matter, if you confiscate 10 smartphones ,( even if they delete it or remove the memory chip there is still away to recover old data and even easier to monitor the social media users to tract them) you will definitely have 09 out of 10 with enough evidence to punish them with the law , but that would be not fair in a country where ignorance and in-sensitiveness prevalence is rather very high , so first educate them , provide them an opportunity to reform and if they still continue, then they deserve to be taken to task.

    Hope the President ,The Prime Minister and the entire Parliament will bring in such an act to protect the victims of injustice immediately.

  • 1
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    Our social resposibility includes facing the truth. Go to a search engine and search for how aids is transmitted.

    “… body fluids must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to occur.”

    Where are the mucous membranes located?

    “It is continuous with the skin at various body openings such as the eyes, ears, nose and mouth…”

    Suitable precautions must be taken, that is our responsiblity, in line with the recommendations of the (truth-telling) medical professional.

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    Our concern is not about the society. When Ceylon was getting freedom it was next to Japan in education in Asia. It was one of the most decent and civilised society. After the freedom, it has little by little descended and has come to current fully ripen Wildlife Sanctuary of SinhaLE. Still one can not react overly for the society’s responses for the treatment of the mother and the child. The ones, mainly the politicians, who cannot considered as the ordinary people or the society has to take responsibility of the current ignorance of the society. Unless this minister is punished in this circumstances, sense of impunity going root deep into every part of the society. Doctors not going to believe that “patient confidentiality, human rights and ethics” are the essential elements of their practice.

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