HIV/AIDS- Disclosure bill may undermine doctor-patient relationship
Mar 07, 2010
JANE, aged two has been taking anti-retroviral drugs (ARVs) for 18 months. Recently her health became unstable and I advised Jane’s mother to disclose her HIV-positive status to her partner, but she refused. She said her first husband abandoned her when she was pregnant after revealing her status.
By S.N. Mubokyi
JANE, aged two has been taking anti-retroviral drugs (ARVs) for 18 months. Recently her health became unstable and I advised Jane’s mother to disclose her HIV-positive status to her partner, but she refused. She said her first husband abandoned her when she was pregnant after revealing her status. Months later, her child passed away.
Two years ago, she started a new relationship with a married man (Jane’s father). She says he takes care of all their needs and disclosure of her status would ruin their relationship.
Recently, he insisted on accompanying Jane and her mother to the clinic because he was suspicious of their monthly visits but the woman asked the health worker to lie to him that the woman and child were sicklers.
Disclosing your status
Failure of patients to disclose their status to their sexual partner is one of the problems affecting health professionals.
Disclosing your HIV-positive status is difficult because of the stigma that surrounds the infection.
A review of articles published in a World Health Organisation document notes that the disclosure rate in developed countries is between 42% to 100% and 17% to 86% in developing countries.
The lowest rate is in sub-Saharan African women attending antenatal clinics. The disclosure rate in one antenatal clinic in Uganda is 25%, according to the study.
The report adds that the most common barriers to disclosure were fear of abandonment, blame, loss of economic support, rejection, violence, upsetting family members, anger, stigma, depression and accusation of infidelity, while the factors that motivate people to be open about their status are a sense of ethical responsibility and the need for social support to cope with the infection.
The HIV/AIDS prevention Bill
The Bill states that a medical practioner may notify the sexual partner of the HIV-positive person when he believes the person risks infecting his/her partner.
It also encourages HIV-positive people to follow prevention and treatment measures to prevent transmission of the virus.
Alternative solution
An intervention that will help HIV-positive people reveal their status to their partners without forcing the health workers to do so should be sought.
The Government should get a list of all clients accessing treatment, telephone numbers and contacts from clinics that handle HIV cases in Uganda and then inform their partners that they have been exposed to HIV in the past (without disclosing the client receiving care) and should, therefore, go for testing.
Setting up home-based counselling and testing programmes at all HIV clinics as well as providing care that targets partners of their clients could be the way forward.
A surprise visit can be made in the area a client resides and testing and counselling services provided without indicating that one of the people you are testing is your patient.
These interventions, if well thought out, may be cheaper, more efficient and cost-effective, as part of the preventive strategy.
It will also be a better way of increasing the number of people who seek counselling and testing than the expensive billboards that people rarely read or understand.
The writer is a fellow MUSPH-CDC HIV/AIDS Fellowship Programme
Makerere University
JANE, aged two has been taking anti-retroviral drugs (ARVs) for 18 months. Recently her health became unstable and I advised Jane’s mother to disclose her HIV-positive status to her partner, but she refused. She said her first husband abandoned her when she was pregnant after revealing her status. Months later, her child passed away.
Two years ago, she started a new relationship with a married man (Jane’s father). She says he takes care of all their needs and disclosure of her status would ruin their relationship.
Recently, he insisted on accompanying Jane and her mother to the clinic because he was suspicious of their monthly visits but the woman asked the health worker to lie to him that the woman and child were sicklers.
Disclosing your status
Failure of patients to disclose their status to their sexual partner is one of the problems affecting health professionals.
Disclosing your HIV-positive status is difficult because of the stigma that surrounds the infection.
A review of articles published in a World Health Organisation document notes that the disclosure rate in developed countries is between 42% to 100% and 17% to 86% in developing countries.
The lowest rate is in sub-Saharan African women attending antenatal clinics. The disclosure rate in one antenatal clinic in Uganda is 25%, according to the study.
The report adds that the most common barriers to disclosure were fear of abandonment, blame, loss of economic support, rejection, violence, upsetting family members, anger, stigma, depression and accusation of infidelity, while the factors that motivate people to be open about their status are a sense of ethical responsibility and the need for social support to cope with the infection.
The HIV/AIDS prevention Bill
The Bill states that a medical practioner may notify the sexual partner of the HIV-positive person when he believes the person risks infecting his/her partner.
It also encourages HIV-positive people to follow prevention and treatment measures to prevent transmission of the virus.
Alternative solution
An intervention that will help HIV-positive people reveal their status to their partners without forcing the health workers to do so should be sought.
The Government should get a list of all clients accessing treatment, telephone numbers and contacts from clinics that handle HIV cases in Uganda and then inform their partners that they have been exposed to HIV in the past (without disclosing the client receiving care) and should, therefore, go for testing.
Setting up home-based counselling and testing programmes at all HIV clinics as well as providing care that targets partners of their clients could be the way forward.
A surprise visit can be made in the area a client resides and testing and counselling services provided without indicating that one of the people you are testing is your patient.
These interventions, if well thought out, may be cheaper, more efficient and cost-effective, as part of the preventive strategy.
It will also be a better way of increasing the number of people who seek counselling and testing than the expensive billboards that people rarely read or understand.
The writer is a fellow MUSPH-CDC HIV/AIDS Fellowship Programme
Makerere University