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Student Education

Holistic HIV care with HAART

BMJ 2007; 335 doi: https://doi.org/10.1136/sbmj.0712458 (Published 01 December 2007) Cite this as: BMJ 2007;335:0712458
  1. Alison Bradley, third year medical student1,
  2. Anthony J France, consultant physician2
  1. 1University of Dundee
  2. 2Dundee DD1 9SY

Highly active antiretroviral therapy has transformed the management and prognosis of patients with HIV. Alison Bradley and Anthony France wonder if doctors are stepping up to their new role

Highly active antiretroviral therapy (HAART) has redefined HIV in industrial countries as a chronic rather than a terminal illness, changing the doctor's role from carer to treatment manager.1 But patients are more than their CD4 and T cell counts. Why should increasing technology in HIV care replace and not complement holistic care? By exploring stigma, psychosocial factors, palliative care, and the controversy surrounding certification of death, this article considers the holistic role of doctors caring for patients with HIV in the HAART era.

New treatment, old stigma

In this information age many in the general public would prefer a diagnosis of cardiac failure with impaired left ventricular systolic function (five year survival 25.2%)2 or non-small cell lung carcinoma (eight month survival with chemotherapy)3 rather than HIV, despite its better prognosis (three year survival up to 50%).4 This shows the unremitting stigma surrounding HIV that has penetrated the HAART era because of several perceptions.

Firstly, one perception is that HIV is a moral judgment passed on through avoidable and socially unacceptable behaviours.5 Just as a lawyer representing a serial killer is deemed to share in the evil of the accused so a health professional caring for patients with HIV faces stigmatisation for condoning this “evil.” Secondly, HIV is perceived to be lethal and incurable, with patients posing a risk to others.5

Why should this be a concern of doctors? Stigma perpetuates fear that prevents people from seeking HIV testing and that prevents affected people, including families, from accessing services. This prevents access to education and empowerment to follow advice to reduce risk. Stigma reduces health status by increasing stress …

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