Patient/Doctor Confidentiality: Dealing with HIV/AIDS that is Acquired through Alcohol Abuse - Term Paper Example

PATIENT/DOCTOR CONFIDENTIALITY: WHEN DEALING WITH A TRANSMITTABLE DISEASE ACQUIRED THROUGH SUBSTANCE ABUSE PATIENT/DOCTOR CONFIDENTIALITY: Dealing with HIV/AIDS that is acquired through alcohol abuse A productive patient-doctor relationship is affected by confidentiality following acquired immunodeficiency syndrome (AIDS). AIDS is common in Kibera slums, Nairobi, Kenya; that is characterized by low income earners living below a dollar a day. A high number of the screened residents, 64 % are alcohol users and 90 % of the alcohol users are HIV/AIDS victims. A doctor’s confidentiality level is a factor that an HIV/AIDS patient question as they seek medical care. The aim of this paper is to illustrate the effects of confidentiality in management of HIV/AIDS; to examine the role of exposing the results of a patient’s HIV/AIDS status to future management of the disease; to analyze the impact of an exposed HIV status and finally to examine if a patient is likely to disclose details of their own livelihood if there is a guarantee of confidentiality. Intake of alcohol is a strategy for female single mothers in Kibera towards getting a ‘client’, a man who needs emotional satisfaction. 40% of the men are youth with multiple sexual partners1. 35 % are married men who don’t live with their family or wife and the remaining portion is men who have already attained the age of marriage but have not done so due to poverty1. 64% of the men’s population drink traditionally prepared beer that is cheap and easily available in make-shift structures. 39% smoke bhang and inject themselves with drugs like cocaine and morphine. The needles they use are shared among group of friends1. The majorities of the alcoholics are folate deficient due to six possible mechanisms; decreased nutrient ingestion, absorption, and utilization; and increased nutrient requirements, destruction and excretion.4 The HIV patient requires their details on their status to be known only by themselves. HIV/AIDS is associated with a lot of victimization. A patient whose HIV status is known is isolated1 by family members and friends because they know the victim of HIV is not economically productive, is likely to spend family finances on a disease that will never respond positively to medication and is a ‘shame’ to the family social status. In some companies, exposure of a HIV victim’s details can lead into automatic sacking2. The HIV victims are considered as ‘health risks’ to the company because the company doesn’t want to take medical responsibility of an employee who at last will not be in a position to plough back medical investment they make on the patient. The information of a patient HIV status could decrease the number of friends a victim is likely to have2. Information on HIV status of an individual has led to cessation of marriages. The couples can not marry because of the stigma associated with the disease. The marriage requires that the couples must understand their HIV status before they commit themselves to any sexual activities. This means that the priests and church elders are in a position to demand the HIV status of the bride and the bridegroom. The couples are supposed to produce a valid stamped certificate on their HIV status. This is totally against the principle of confidentiality between the patient and the doctor with regard to HIV/AIDS2. In the family circles, exposure of the victim’s HIV status may make the patient not to benefit from inheritance of family assets like land and plots or buildings. The family members look down on the HIV patient and expect the patient not to live for long. House hold isolation of patients has led to the HIV patients having their own eating utensils, separated sleeping quarters from the rest of the family. This leads into psychological stress and may predispose ulcers, the stress affects eating habits, the victim develops low profile on life – why live if they are going to die and in many instances, the victim could misappropriate family resources because they feel they got tired as they sought the wealth, they feel they don’t deserve to die alone and use the funds they have accumulated in their banks to spread the disease. All this happens when the information on the patient’s HIV status leaks out. Many persons don’t go for HIV test and treatment within their residential areas although the medical centers within their territory may be one of the best in the region. They are familiar with the health professionals and don’t want their status to affect their relationships which may be more worth than the test of HIV. They visit dispensaries far away so that even though there may be confidentiality, if they don’t want to meet with the health professionals outside the hospital, because they would always remember their status. This could be a source of stress as it may mean the HIV/AIDS victim has to remain indoors and fail to interact with the environment in a positive way2. Alcohol intake is common in colleges3. The alcoholics don’t use any contraceptives like female of male condoms. Multiple partners are common. Students have committed suicide after realizing they are HIV positive and their peers have knowledge about the same. 85% commit suicide when their HIV status is known to their friends3. Students who took part in the study suggested that few students are not likely to have HIV test in the college medical facilities. A nursing student might be in charge and may know the status and pass the information to friends who might take initiative to counsel the student on need for a behavioral change3. The students acknowledged that in the event the college requests medical records, the students are more likely to bribe the medical officers to give them a clean bill of health. This is done as a measure towards peaceful existence in an environment that may be repelling the presence of a HIV/AIDS victim’s psychologically3. The students make jokes to encourage their peers to ‘prove that they can pass any test by testing negative for HIV!’3 The students may not want their parents to get information on their HIV status because the parents may fail to pay their fees. In other instances, the parents disown their own children because in some tribes, there is a culture and tradition concerning terminal illnesses like HIV/AIDS or cancer. These terminal illness diseases are associated with a ‘community curse’ and the victims are isolated from the other ‘healthy ones’1. Many college birthday parties and come together parties have beer as the main ingredient of the menu. Alcohol consumption in colleges is considered one if it is above average3. They are attended by both male and females regardless of the religious background. Peer pressure may lead a religious friend to indulge in alcohol consumption that may lead into unprotected sexual activities. If the student contracts HIV, the HIV status of the religious friend who had abstained for long may affect the family and relative relationship. Student’s Trust is lost. A person feels at ease to disclose or discuss details about their sexual lives if confidentiality is assured and there is no possibility of the information getting to a third party. It is easy for a person to disclose why they need for instance an HIV test. From the test, they are able to plan their lives because there will be no more fear of death. And even if the results are positive, there are counselors who would inform the victim on better approaches into a productive life that is sandwiched in HIV dilemma2. One is able to make concrete decisions on future because they are assured of their health status. Confidentiality also helps to maintain the dignity of a person as an active member in the society. HIV positive person who learn that their HIV status is in the public domain live a difficult life. It takes a lot of efforts to assure them that it is good that it has been known. If there is a person out there who can help can contact you! It can also make the victim be used in medical tests of retroviral drugs. The members of the society may question the moral standards of the words of advice the victim may have had. This affects the output of a person in the society and is a potential source of isolation2. People would not be interested in the advice that the victim might give because the same advice failed to be of value to the victim1. HIV patients take long to speak out that they are actually HIV victims. These are people who have had enough counseling on the HIV/AIDS and understand they can live a healthy life even when they have HIV/AIDS. Lack of confidentiality could lead into a patient’s HIV status being known. This can interfere with family by bringing in a ‘blame game’ that finally may lead into divorce2 or separation. Alcohol intake is associated with a decrease in precautions. According to Kamau, G. N. et al, during grieving periods, when family members mourn for the deceased, many are men who engage in unprotected sex with married women in the spirit of trying to replace their deceased friend. They don’t seek to know if the deceased died as a result of HIV/AIDS. This is a taboo and drunken men don’t make a choice to determine who they are going to be engaged with. This further increases incidences of contracting HIV. Drug abuse for instance, injection of heroin and cocaine by ‘friends’ may be a pathway through which HIV may be transmitted. If one of the friends who use the syringe is a victim of HIV, there is a high probability for transmission of HIV within the group3. Many drug abusers don’t practice safe sex3. They don’t care about the lives they lead. The syringe is not sterilized and can also be a source of other bacterial diseases. The doctor should inform the HIV patient that continuous use of alcohol does affect his general health like increasing the cholesterol levels but alcohol increases the rate of HIV infection. It can also affect availability of other nutrients. Alcohol leads into ethanol-induced free radicals4 as well as ethanol-mobilized catalytic iron that cleave folate into inactive metabolites. These free radicals impair glucagons’ receptor function and affect the blood glucose homeostatic function. High intakes of alcohol exacerbate growth of esophageal tumors that are enhanced by retrovirus infection. Alcohol is a health risk in the presence of HIV/AIDS. The patient is the one who is supposed to break news about HIV status. This could be after a discussion with family members or wife. Informing a spouse or family members of the HIV/AIDS status prepares them to understand and be able to seek more information regarding the HIV/AIDS and how it can be managed. This enables the patient and family to change attitudes on HIV/AIDS and start living positively. The patient or family is made aware of opportunistic infections and is prepared well on the management of the opportunistic infections. This has an effect of shifting the ‘blame game’ on irresponsible behavior. In conclusion, the patient-doctor relationship is more productive if the confidentiality levels of HIV/AIDS are maintained. Confidentiality ensures that a patient is free to discuss health issues concerning HIV status. There is need for the doctor-patient relationship to be strengthened in order for proper medical counseling to be effective. The doctor should prepare the patient psychologically so that the patient could be able to see that HIV/AIDS was as a result of lack of enough personal care owing to alcohol intake or peer pressure. The patient is able to plan and implement a recovery path to stop further alcohol intake because alcohol itself is a threat to functional immune system that is already impaired by presence of Retrovirus. The patient should see the effects of HIV/AIDS and the pain of living in a drug infested society as a threat to the future generation and be prepared to come out and become a crusader on drug abuse. Campaigns on drug abuse are more effective if they involve people who have been involved in drug abuse and know the negative effects on health of the practice. In this case, alcohol abuse could lead into behavioral changes that could predispose HIV infection. The process of drug abuse rehabilitation should first be geared towards making the drug addict to accept they have a problem, and the problem has no positive effect in their lives and overall health. They need to understand drugs control people’s lives and to rise above the drug abuse condition, the addict need to be educated on how to take control of their lives that have been made worse by their addiction. The counselor should inform the addict that in all cases where drug abuse is rampant, it is children that suffer. Children feel abandoned by their parents because their needs are not met or the parents are no longer there for the children. The drug addict need be told that anybody makes a mistake, and acknowledges they have a mistake and seek how to avoid the mistakes in future. Problems happen because the drug addict doesn’t acknowledge they have a mistake. They cover their mistakes instead of learning from them for their own good and others who would be inspired to quit their habits following their resolutions. There is need for drug addicts and abusers to leave behind their mistakes and failures and focus into the positive side of life. It is more rewarding to do so. REFERENCE 1. Kariuki, J.G., Health education: Alcohol Abuse and Rampant Prostitution in the Spread of HIV, Kenya institute of education, Kenya, 1992. p. 9-13 (Longman) 2. Kamau, George Njoroge, Murithi Titus Kithaka, Drug Abuse: Relationship of Alcohol Intake and HIV Pandemic; social education and ethics for secondary schools, top mark series. 1993, Page 21-3, (Patel) 3. Waititu Jane Wambui, Njuguna Caroline Nderitu, Wainaina Gerald Kamau; social trends and behavioral changes, Alcohol Abuse and HIV Incidence Rates in Colleges, social education and ethics for secondary schools, revised edition, gateway series, 1993, p.12-13. 4. Shaw, S., Jayatilleke, E., Herbert, V., Department of Medicine, V.A. Medical Centre, Bronx, New York 10468 And Mount Sinai School Of Medicine, New York 10029, USA, The Effect of Ethanol-Induced Free Radicals on Hepatocyte Membrane-Bound Folate Binding Protein (M-FBP) Read More