By 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.
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