Won’t I lose clients if I tell them I am positive?
Jan 02, 2007
Dear Doctor, <br>I am an HIV-positive midwife, but because I am on ARVs, my health is good and no one would know I have HIV. Sometimes I get patients who have HIV and would like to encourage them by sharing my experience, but I fear that if people know my status, they may shun my clinic fearing I m
Dear Doctor,
I am an HIV-positive midwife, but because I am on ARVs, my health is good and no one would know I have HIV. Sometimes I get patients who have HIV and would like to encourage them by sharing my experience, but I fear that if people know my status, they may shun my clinic fearing I might infect them or their babies. How have you managed to go public without fearing to lose your clientele as a doctor?
Rose
Dear Rose,
Thank you for this question on stigma against HIV-positive health care givers. It is possible, though unfortunate, that people may hold that kind of attitude towards you after learning that you are HIV-positive.
HIV affects all people and health care professionals are no exception. I had a similar experience some years back, when I performed a small operation on a lady. Her husband was not happy and asked why I did that, knowing that I am HIV-positive. My response was a question, that if his wife had gone to another doctor, would he have demanded to know his HIV status before allowing him to carry out the operation? I am glad he saw the point that being silent about one’s status does not mean that one is negative. It also reveals the futility of stigmatising health care givers since you cannot know the HIV status of every doctor, nurse etc before you seek medical care from them. However, I have noticed now that many of my clients even feel safer with me than they would be with someone whose HIV status they do not know.
I chose to go public to give a face to HIV, especially among professionals, to let them know that with good care and ART, one can still enjoy a good degree of health and even continue practicing their profession in spite of having HIV/AIDS. Health care givers who have the advantage of having more knowledge about the disease need to be in the forefront of fighting HIV related stigma, which mainly stems from ignorance.
Ensure that you follow the universally-accepted methods of infection control to protect both yourself and the patients you work on, just like all health care givers do. Lastly, if you would like to go public about your HIV status, see a counsellor so that you are helped to make an informed decision.
Remember, you are in a privileged position to help the expectant mothers receive information about prevention of mother-to-child transmission. The way forward is for everyone to know their HIV sero-status and protect themselves plus others from being infected with the HIV.
Dear Doctor,
I am a clinical officer working in one of the upcountry clinics. We have been encouraging people to come for voluntary counselling and testing at our centre and the response has been good. However, we are faced with a problem: We do not have access to a CD4 count machine and therefore, cannot advise our patients whether they are due for Antiretroviral Therapy (ART) or not. What can we do? Our patients are getting frustrated and others are even being discouraged from coming for VCT? Please, advise.
Jude
Dear Jude,
Thanks for encouraging people to come for VCT because most Ugandans (over 75%) do not know their HIV sero-status. Of the estimated 200,000 Ugandans who need ARVs, only about 80,000 are getting them. As you rightly noted, this discourages others from going for VCT.
It would be good if we could do CD4 counts for all patients before initiating ART. It also makes for easy monitoring. Unfortunately, this is not possible though the situation has improved and several centres nation-wide can now do the tests. It is recommended that all patients with a positive HIV test be staged using the World Health Organisation (WHO) staging which depends on clinical assessment using symptoms and opportunistic infections one has had. The method puts all patients with HIV in four stages and those in stages three and four should be put on ARVs.
However, it must be stressed that initiating ART using WHO staging should be encouraged only where CD4 count machines are inaccessible.
The use of this method is likely to leave out people who are immune-suppressed, with very low CD4 counts, but do not have the symptoms used as criteria for WHO staging. Such people will be put in HIV stages one or two, when their CD4 count is low and they need to be on ART. Health care givers should ensure that they access these services through networking if they cannot afford them at their centres.
Remember, HIV/AIDS care is not all about ARVs. Many people are doing well by being counselled and helped to live positively with the disease while using the basic care package. for people with HIV. This includes: septrin prophylaxis, provision of safe water plus improved hygiene, good nutrition and provision of insecticide treated mosquito nets. I have seen people’s CD4 counts go up by only being on the basic care package. You can do a lot for people with HIV/AIDS without using ARVs. This period should also be used to counsel and prepare patients for ART because it has been found that people who adhere to septrin and keeping appointments tend to adhere on ARVs which as you know should not be stopped once initiated.
Send your question on HIV to Health Editor,
The New Vision,
P. O. Box 9815, Kampala
oR
health&beauty@
newvision.co.ug
I am an HIV-positive midwife, but because I am on ARVs, my health is good and no one would know I have HIV. Sometimes I get patients who have HIV and would like to encourage them by sharing my experience, but I fear that if people know my status, they may shun my clinic fearing I might infect them or their babies. How have you managed to go public without fearing to lose your clientele as a doctor?
Rose
Dear Rose,
Thank you for this question on stigma against HIV-positive health care givers. It is possible, though unfortunate, that people may hold that kind of attitude towards you after learning that you are HIV-positive.
HIV affects all people and health care professionals are no exception. I had a similar experience some years back, when I performed a small operation on a lady. Her husband was not happy and asked why I did that, knowing that I am HIV-positive. My response was a question, that if his wife had gone to another doctor, would he have demanded to know his HIV status before allowing him to carry out the operation? I am glad he saw the point that being silent about one’s status does not mean that one is negative. It also reveals the futility of stigmatising health care givers since you cannot know the HIV status of every doctor, nurse etc before you seek medical care from them. However, I have noticed now that many of my clients even feel safer with me than they would be with someone whose HIV status they do not know.
I chose to go public to give a face to HIV, especially among professionals, to let them know that with good care and ART, one can still enjoy a good degree of health and even continue practicing their profession in spite of having HIV/AIDS. Health care givers who have the advantage of having more knowledge about the disease need to be in the forefront of fighting HIV related stigma, which mainly stems from ignorance.
Ensure that you follow the universally-accepted methods of infection control to protect both yourself and the patients you work on, just like all health care givers do. Lastly, if you would like to go public about your HIV status, see a counsellor so that you are helped to make an informed decision.
Remember, you are in a privileged position to help the expectant mothers receive information about prevention of mother-to-child transmission. The way forward is for everyone to know their HIV sero-status and protect themselves plus others from being infected with the HIV.
Dear Doctor,
I am a clinical officer working in one of the upcountry clinics. We have been encouraging people to come for voluntary counselling and testing at our centre and the response has been good. However, we are faced with a problem: We do not have access to a CD4 count machine and therefore, cannot advise our patients whether they are due for Antiretroviral Therapy (ART) or not. What can we do? Our patients are getting frustrated and others are even being discouraged from coming for VCT? Please, advise.
Jude
Dear Jude,
Thanks for encouraging people to come for VCT because most Ugandans (over 75%) do not know their HIV sero-status. Of the estimated 200,000 Ugandans who need ARVs, only about 80,000 are getting them. As you rightly noted, this discourages others from going for VCT.
It would be good if we could do CD4 counts for all patients before initiating ART. It also makes for easy monitoring. Unfortunately, this is not possible though the situation has improved and several centres nation-wide can now do the tests. It is recommended that all patients with a positive HIV test be staged using the World Health Organisation (WHO) staging which depends on clinical assessment using symptoms and opportunistic infections one has had. The method puts all patients with HIV in four stages and those in stages three and four should be put on ARVs.
However, it must be stressed that initiating ART using WHO staging should be encouraged only where CD4 count machines are inaccessible.
The use of this method is likely to leave out people who are immune-suppressed, with very low CD4 counts, but do not have the symptoms used as criteria for WHO staging. Such people will be put in HIV stages one or two, when their CD4 count is low and they need to be on ART. Health care givers should ensure that they access these services through networking if they cannot afford them at their centres.
Remember, HIV/AIDS care is not all about ARVs. Many people are doing well by being counselled and helped to live positively with the disease while using the basic care package. for people with HIV. This includes: septrin prophylaxis, provision of safe water plus improved hygiene, good nutrition and provision of insecticide treated mosquito nets. I have seen people’s CD4 counts go up by only being on the basic care package. You can do a lot for people with HIV/AIDS without using ARVs. This period should also be used to counsel and prepare patients for ART because it has been found that people who adhere to septrin and keeping appointments tend to adhere on ARVs which as you know should not be stopped once initiated.
Send your question on HIV to Health Editor,
The New Vision,
P. O. Box 9815, Kampala
oR
health&beauty@
newvision.co.ug