Are We Really Managing This HIV Patient?
SUKHIT PHAOSA VA SDI, M.D.*, SURASAK TANEEPANICHSKUL, M.D.*, YUEN TANNIRANDORN, M.D.*, HENRY WILDE, M.D.**, CHUMSAK PRUKSAPONG, M.D.***
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkom University, ** Queen Saovabha Memorial Institute, The Thai Red Cross Society, *** Surgery Department, Police Hospital, Bangkok 10330, Thailand.
Not so long ago, a newly diagnosed HIV behavior and that he would continue unprotected positive expatriate was referred to one of us for sex as often as he desired. This was not our first further evaluation and counseling. He was a middle such experience and it is one that infectious disease aged, tough-looking heterosexual oil drill worker physicians see often worldwide. Many promiscuous who lived in Thailand when off duty. He had been heterosexual and homosexual habitual travelers have promiscuous on several continents for years and few if any close personal relationships, little respect had used condoms rarely. He was usually drunk at for their sex objects and rely on a series of casual the time of contacts, which was almost always with contacts for their gratification. There is very little commercial sex workers. When seen for the first incentive for such an individual to reduce his plea few times, he had become increasingly hostile and surable experience by donning a condom once he blamed everyone except himself for his predica knows he is HIV positive. He may not even expe ment. His viral load was high and his CD4 count rience any guilt feelings about infecting others. It had started to drop. He needed to start on medica is, after all, such a prostitute, like the one he might tions and could afford HAART. Slowly, we managed have just infected, who gave him AIDS! to establish a reasonably productive but never This kind of patient does create an ethical pleasant doctor-patient relationship with the man. dilemma for physicians. In North America, Australia He first blamed Thailand for his predicament and or Europe you can warn him sternly that he not told us that the Thai government should pay for his only has a moral responsibility not to infect others HAART; "they do not screen their sex wokers". He but also a legal one. People like our patient are, was counseled about his life style and the respon occasionally, tracked down by the law in these sibilities that he now had towards others. This was countries and may be sentenced to lengthy prison done on 3 different occasions but we were left terms. This, however, is not much of a threat to an each time convinced that he would not change his itenerant worker or sex tourist who has no real fixed
Keywords : Ethics, HIV
