35. The Physician’s Dilemma: To Treat or Not to Treat

Author: Sara Galinko, First Year

In the country of South Africa, HIV/AIDS is one of the deadliest viruses a individual could come into contact with. It’s sweeping the nation and leaving a trail of mass destruction behind. The difference between HIV/AIDS and other diseases is that there is no cure, but instead a plethora of preventative drugs one can take in order to control the spread. However, a large proportion of South Africa’s population is living at the poverty level, making it nearly impossible for the majority of patients to afford the care they’ll need for the rest of their lives. Many doctors, both local and abroad, don’t have the resources or education to properly protect themselves against HIV/AIDS while treating these patients, making them fearful to assist them with other medical issues in addition to HIV. These patients are denied a basic human right- undiscriminated care and treatment, thus endangering their lives and making them oppressed. However, through educational programs for physicians on HIV/AIDS safety and expansion of non-governmental organizations such as Doctors Without Borders, these individuals will have access to best standard of care and will not be limited by their medical conditions.

In 1981, five gay men who were previously healthy presented a number of unexplainable infections, all leading to the conclusion that their immune systems were shutting down little by little (AIDS.gov). This event would start the worldwide epidemic that our modern society knows as HIV/AIDS. HIV is a deadly virus only found in humans. Normally, one’s body uses a certain kind of defensive cells to eliminate the virus. HIV is resistant to these cells’ mechanisms, meaning the body can’t eliminate it. The virus engulfs all the cells your body needs to fight the infection, and instead replicates them into more HIV cells (AIDS.gov). Over time, without the proper medication to control the virus, it will turn into AIDS and eventually death. Currently in South Africa, 5.6 million people are infected with HIV/AIDS, and 270,000 HIV/AIDS related deaths have occurred since 2011 (AFSA). HIV is transmitted from person to person through bodily fluids such as unprotected sex, dirty needles from drugs or medical purposes, rinse water, breast milk, blood transfusions or even eating food that has also touched the saliva of someone with HIV (CDC). In South Africa, some other human rights issues are “poverty, inequality and social instability, low status of women, sexual violence, high migrant labor, limited and uneven access to medical care, and a history of poor leadership in response to the epidemic.” (AFSA) When you combine all these factors, it makes the exposure rate to HIV much higher, in turn making the contraction rate of HIV much higher as well.

Even though HIV cannot be cured, it can be controlled to prevent spreading and death through responsible use of antiretroviral medications. Antiretroviral medications do not eliminate the virus from your body, but instead prevent it from spreading and making your vital organs shut down (Narins). In order for these medications to work, the individual must take them for the rest of their life. However, in South Africa, 48.5% of people are living in poverty, which makes it impossible for them to pay for their medication (Linnemayr). In addition to living in poverty, the lack of socioeconomic resources also contributes to the large population of HIV/AIDS patients in South Africa (Linnemayr). For example, minimal education on safe practices for South Africans and unstable housing leads to risky sexual behavior (APA). Another large obstacle South African HIV/AIDS patients face is the peculiarity of their virus. Africa has it’s own specific strain of the virus, making it even more difficult and costly to treat with generic drugs (Heimer). In turn, socio-economic status greatly effects the outcome of HIV/AIDS patients in a negative way. Because of their low economic status, they’re unable to receive necessary treatment, thus making the chances of spreading the virus to their physicians a lot greater (Linnemayr). This is the reason many physicians are turning away HIV/AIDS patients from their clinics, despite the Hippocratic oath binding them to always provide the best medical care they can.

The fact some physicians in South Africa will not treat HIV/AIDS patients that aren’t taking antiretroviral medications is a violation of human rights in and of itself. Many people view them as ‘low lifers’, and they’re discriminated against and not allowed basic necessities such a substantial housing, jobs, and most importantly- medical care (UNHR). There are a number of reasons why doctors won’t treat these patients. The most understandable is the fear that they will contract the virus while treating a patient with HIV/AIDS (Hirsch). Because physicians work so closely with their patients, their risk of contracting HIV skyrockets. Another reason correlates to the current economic status of most of South Africa. A lot of clinics in South Africa are suffering economically as well, and they don’t have the proper resources to protect themselves such as gloves, masks, sterile needles, clean water and basins, and sterile operating equipment (Narins). Also, when it comes time for the clinics to allocate their scarce medicine and materials, they’re typically given to patients with a predicted survival rate higher than that of a HIV/AIDS patient (Elbe). Without the proper precautions and materials, it’s very likely that the doctors will be exposed to the virus and the terminal AIDS patients will be given sub-par treatment. Another theory proposed by new doctors is that “people with AIDS require time-consuming medical treatments, the likelihood of complications, and fear of losing young and vital patients.” (Hirsch) These brand new doctors fresh out of medical school are afraid of tarnishing their image by losing patients to a virus that has no cure, so instead they “choose to migrate to developed countries and work where conditions are much better and they have access to medicines that allow them to save peoples’ lives.” (Elbe) At an international conference on AIDS, a study revealed that only 17% of over 1,000 medical residents surveyed would treat patients with HIV (Hirsch). This situation is basically a deadly cycle: when doctors refuse to treat these patients, it essentially feeds the epidemic of the virus (UNHR). The patients are uneducated and unhealthy, which could be helped by the knowledge and direction of their physicians. The whole situation is unfair, not only to the general population who in turn has a greater exposure rate to the virus, but mostly the people suffering with this death sentence.

When looking at possible solutions, the most important place to begin is at the physician level. Since most HIV/AIDS patients can’t afford care, it would be counter-productive to raise and spend money and materials to create new antiretroviral drugs or provide mass amounts of them to areas like South Africa. Patients will need these drugs  and medical attention for the rest of their lives, not just a one month supply. The smarter solution would be to intervene at the physician level. If you can educate the physicians on safe practices when treating these patients, they’re more likely to accept the idea of opening their clinics to those with HIV/AIDS. Ed Narins elaborates on some of these practices, emphasizing good hand washing and handling of instruments, “Good hand washing practices are essential. It is necessary that sharp instruments and contaminated materials are handled and disposed of in a proper manner.” (Narins) Once the physicians are more educated on the virus, they can provide screening for the virus at their clinics, and give the right advice to those who tested. For example, those who tested negative should be aware of the prevalence HIV/AIDS holds in South Africa and the proper ways to protect themselves against the virus (Heimer). Contrarily, for those who tested positive, they can be directed to centers such as Doctors Without Borders who partner with pharmaceutical companies that sell generic brand antiretroviral medications for an astonishingly low price in order to distribute to patients residing at their clinic (Constantine).  Another way that groups such as college students can get involved is to have fundraisers and create partnerships with local hospitals and clinics in order to provide more materials like, “gloves for one-time use, goggles, and disposable protective clothing. These function as preventive barriers when there is the possibility of coming in contact with infectious materials.” (Narins) It is imperative to provide these clinics with the resources they need, since that is the main fear when treating high-risk patients. When the doctors and nurses are protected, they will in turn treat large masses of patients with HIV/AIDS.

South Africa has a huge population, most of which is suffering from HIV/AIDS. The worst part is, they won’t be treated by doctors simply because of this medical condition that is out of their control. Their low socio-economic status makes it nearly impossible for them to afford the necessary medication, and their living conditions and normal practices makes it difficult for them to prevent the spread of the virus. This makes them a site of the oppressed, and a example of blatant discrimination of human rights. The best way to prevent this kind of discrimination from happening is to educate the doctors on ways to protect themselves against the virus and help to provide them with the resources they need to protect themselves. In turn, the doctors will help the epidemic from spreading across even more of Africa.

Works Cited
CDC.gov. “HIV Basics.” Center for Disease Control and Prevention. Ed. CDC.gov. USA.gov, 3 June 2013. Web. 17 Nov. 2013. <http://www.cdc.gov/hiv/>.
Constantine, Greg. “Generic Competition Pushing Down HIV Drug Prices...Also Extends to HIV Diagnostic and Monitoring Tools.” Medicens Sans Frontieres. Ed. Doctors Without Borders. Doctors Without Borders, 2 July 2013. Web. 20 Nov. 2013. <http://www.doctorswithoutborders.org/press/release.cfm?id=6844&cat=press-release>.
Elbe, Stefan. “HIV/AIDS: A Human Security Challenge for the 21st Century.” Orbis: A Journal of World Affairs: 108. Print.
Heimer, Carol A. “Old Inequalities, New Disease: HIV/AIDS in Sub-Saharan Africa.” The Annual Review of Sociology (2007): n. pag. Print.
Hirsch, Melanie. “AIDS Patients Face Epidemic of Doctor’s Fears.” The Post-Standard [Syracuse] 4 July 1990, Metro ed.: n. pag. Print.
“HIV/AIDS and Socioeconomic Status.” American Psychological Association. Ed. American Psychological Association. American Psychological Association, n.d. Web. 17 Nov. 2013. <http://www.apa.org/pi/ses/resources/publications/factsheet-hiv-aids.aspx>.
“HIV/AIDS in South Africa.” AIDS Foundation South Africa. Ed. AIDS Foundation of South Africa. AIDS Foundation of South Africa, n.d. Web. 17 Nov. 2013. <http://www.aids.org.za/hivaids-in-south-africa/>.
Narins, Ed Brigham. “HIV Preventative Measures.” The Gale Encyclopedia of Nursing and Allied Health. Ed. Aliene Linwood and Gale Cengage Learning. 3rd ed. Vol. 3rd. Detroit: Gale Cengage Learning, 2013. 1642-46. Print.
United Nations Human Rights, ed. “HIV/AIDS and Human Rights.” United Nations Human Rights. Office of the High Commissioner for Human Rights, 2011. Web. 17 Nov. 2013. <http://www.ohchr.org/EN/Issues/HIV/Pages/HIVIndex.aspx>.
U.S. Department of Health and Human Services. “HIV/AIDS Basics.” AIDS.gov. Ed. U.S. Department of Health and Human Services. U.S. Department of Health and Human Services, n.d. Web. 17 Nov. 2013. <http://aids.gov/hiv-aids-basics/hiv-aids-101>.
US Government. USAID. Economic Status and Coping Mechanisms of Individuals Seeking HIV Care in Uganda. By Sebestian Linnemayr, Brooke Stearns Lawson, and Peter Glick. N.p.: n.p., 2013. EBSCO Host. Web. 20 Nov. 2013. <http://ehis.ebscohost.com/conn/node104/891521/jae.oxfordjournals.org/content/20/3/505>.

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