We need to start dispelling myths surrounding HIV in the healthcare workforce, but in larger society too.
Mrs Safia Saifuddin (not her real name) refused to take her husband of 10 years back home from the hospital when she found out that he had tested positive for the dreaded Human Immunodeficiency Virus (HIV).
While he suffered from the devastating symptoms of immune deficiency, she told him off incessantly for bringing shame to the entire family.
She called him immoral, accused him of going to ‘bad women’ and being a drug addict.
Mr Saifuddin vehemently denied these accusations, himself baffled and shocked about his newfound HIV-positive status.
Specialists at the hospital sat down with Safia and explained to her that besides sexual encounters, there were other plausible reasons her husband could have acquired HIV.
However, Safia refused to listen.
Perhaps the stigma of a husband with HIV was so profound that rationality had abandoned her.
This scenario brings into sharp focus to the societal view about HIV and its outcome, the horrifying Acquired Immune Deficiency Syndromes (AIDS).
The stigma surrounding this disease is so profound that those living with this virus are often abandoned and ostracised by their families.
A major reason for this is that the virus is poorly understood among the general population with respect to the way it is acquired and transmitted.
Although there are no nation-wide studies with respect to knowledge about HIV among the Pakistani public, a survey in Lahore with 580 educated respondents — most of whom were highly qualified, with 16 or more years of education — brought out some of the misconceptions.
While a significant majority of the respondents knew that HIV is transmitted through sexual contact, sharing of needles and transfusion of contaminated blood, there were at least 35 percent who erroneously also believed that it can be transmitted through exchange of saliva.
Another 14 percent stated that, in their mistaken opinion, even sharing utensils could also lead to transmission of the virus from the infected to the healthy.
One can only assume the extent of misinformation among the less educated amongst us.
Editorial: HIV/AIDS and stigma
However, the picture is grimmer. Given the lack of open discussion regarding HIV and AIDS in our society, one can perhaps understand lack of awareness among the general public.
But it is difficult to comprehend the fact that often even those who are part of the medical community demonstrate not only limited information about the virus, but also a lack of empathy towards those stricken by this disease.
Meet Khuda Bux (not his real name). He is admitted in the general ward of a tertiary care hospital for pneumonia.
He is being provided routine care but there is something different about this patient.
His file has a red tape attached to it.
All the healthcare professionals know that this means he is HIV-positive.
Some of the patients are also smart enough to pick this up. Consequently, they stay away from Khuda Bux, and do not talk to him, occasionally whispering about him when they think he is sleeping.
One night after dinner, as the dishes are being cleared, a junior doctor comes and yells at the cleaning staff.
“Why are this patient’s dishes being kept with other patients’ dishes? Don’t you know this patient is HIV-positive? This will spread the infection to other patients,” the junior doctor scolds, not only demonstrating his own lack of knowledge, but also reinforcing the stigma and unfounded fear associated with caring for such patients.
An infection control specialist standing nearby hears this and says to the junior doctor. “Where is your information coming from? HIV does not spread through sharing utensils!”
The cleaner looks from one doctor to the other, not knowing whom to believe. Khuda Bux, feeling exposed to a ward full of people, looks embarrassed, eyes downcast.
This real-life case illustrates the manner in which HIV patients are often treated at some hospitals.
Not only are these patients made to stand out from the others, but they are also treated differently.
Labeling is quite common, a process which can be psychologically damaging for the patient suffering from the disease.
And this happens within the confines of an environment that is supposed to provide respite from suffering, often at the hands of healers, their messiahs.
Special report: The making of an HIV catastrophe
Consider the case of 32-year-old Arif Ali (not his real name) suffering from an infection due to stones in the gallbladder, necessitating an emergency surgery.
The surgeon, once he discovers his HIV-positive status, refuses to operate on him.
His concern rests on the fact that he may acquire the infection while operating and simply does not want to take the risk.
Acquiring the infection, for example through a needlestick injury, is a real fear among medical professionals, and perhaps not a completely misguided one.
However, is the fear justified?
After all, physicians are duty bound by their oath to provide healthcare to patients, particularly in times of emergency.
But how far does this duty extend? Does it extend to putting their own lives at risk?
There are no easy answers to these questions but very often the typical “fright and flight” reactions of the care providers are out of proportion to any real risks they may be facing.
The issue is not merely at the level of individuals, but rather reflects a much broader systemic issue.
It is also the callous disregard to established protocols that contributes significantly to this problem.
We saw evidence of this two years ago during an HIV outbreak at a hospital in Larkana.
This serious and unconscionable outbreak, which was caused by unscreened tainted blood provided by unscrupulous blood banks with poor infection control practices for dialysis, not only increased the infection’s already notorious reputation, but also further eroded public trust in the healthcare system.
Following standard guidelines and procedures for safe blood transfusion practices and adequate cleaning of dialysis machines through proper infection control methods could have easily prevented the outbreak.
While one can hope that the healthcare system becomes better equipped by providing better infection control facilities and enforcing stronger regulatory mechanisms, it is also equally important to tackle societal attitudes among medical professionals.
We realise that medical professionals do not practice in a vacuum and dominant social beliefs will also influence their behaviour but they have a higher moral responsibility to treat patients in an unbiased fashion.
We need to start with dispelling the myths surrounding HIV among the healthcare workforce primarily but also within the larger society.
Acquiring HIV is not a death sentence and with proper treatment, those living with the condition can lead almost normal lives.
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