Not patients, just people

In medical internship we had a term for it: “ICC” or “immunocompromised patient,” which meant someone with a high chance of being infected with HIV. Behind closed doors we spoke freely about how they “fit the same mold” of gaunt and sickly young persons burdened with several complex infections and diseases. We speculated casually about sexual preferences and drug use. We cringed every time we had to do blood extractions or insert IV lines, and when we went into their isolation rooms, we held our breath and didn’t exhale until we exited. It was unfair and inhumane, but we justified it by saying we were just being rightly cautious.

It seems callous to talk of it in this way, but this is the bare bones of how we, as health professionals, have often dealt with HIV/AIDS. We know more about the disease and how it’s transmitted, but this hasn’t translated to a more compassionate way of dealing with it or talking about it. If you are reading this paper, it is likely that educational materials regarding transmission of HIV—often the paramount concern—are also at your fingertips, so we won’t repeat them, but as recent events have revealed, it’s important to remember that our casual discussions on HIV and AIDS have legal implications as well.

These are taught cursorily in medical school, and most of what we discuss comes from the Philippine AIDS Prevention & Control Act of 1998. The law is a fairly merciful one, a reaction to the 1980s AIDS stigma. Among other things it declares compulsory HIV testing as unlawful, protects the right to privacy of infected persons, and decries any form of discrimination. It also defines “medical confidentiality”—a relationship of trust and confidence between a patient with HIV and any health professional in charge of their care. The law isn’t perfect, and some of its imperfections are supposedly addressed by the Philippine HIV & AIDS Policy Act recently approved by the House of Representatives. From a medical professional’s perspective, it would be nice if we could be told about whether a patient in our care has HIV/AIDS so we can take extra precautions, but there is no law that says we should always be privy to this information, and given the way we have handled this knowledge in the past, maybe there shouldn’t be one.

The situation has reached alarming heights. HIV rates are climbing daily. But poorly received awareness campaigns and stigma are only making things worse. While there is currently no way to kill or reverse HIV infection, the advent of antiretroviral therapy (ART) allows suppression of the virus and gives patients more years and a higher quality of life. ART can also prevent transmission. Still, even with the benefits of ART, only one-third of diagnosed cases come forward for treatment due to the stigma surrounding HIV/AIDS. Many go undiagnosed because many are not aware that anonymous and free testing is possible, and to make matters worse, once diagnosed, a large number will not seek treatment out of fear or inconvenience. No law or decree can shape public opinion into the compassionate, understanding force that it should be when faced with HIV/AIDS. The way we treat it like gossip, exemplified by the way the Philippine Drug Enforcement Agency recently outed an infected person, isn’t just unhelpful; it’s also harmful.

The stigma is complex, tied to our religious foundations and the casual homophobia of even the most educated groups, plus the biggest factor of all—fear of transmission and its consequences. But here’s another fact about HIV: In several countries, it’s viewed as a chronic disease, since modern medicine is able to slow and even prevent progression to AIDS. We can manage it. It might be a far-off goal in the Philippines, but there are options available for patients, and we should be helping them take advantage.

The HIV and AIDS Policy act can only do so much. Lawmakers can stipulate a “relationship of trust and confidence,” but to make this a reality, that’s on us. It should be a collective mission, built on every individual’s effort to see persons at risk as no longer “ICCs” or patients, but people.