Dr. Thompson's Scenarios - HIV/AIDS

From IKE
Jump to: navigation, search

Contents

Disease

Is everyone susceptible to HIV/AIDS? If not, why not?

  • Susceptible - If in contact with the virus, and it enters the blood, you would develop the infection, then you are susceptible
  • Point is to tell people that everybody is susceptible
  • 1% of caucasian people are heterozygous for the gene
  • Increased susceptibility in alcoholic monkeys
  • non-susceptible are missing certain cytokines

Why is HIV so hard to treat? Discuss the therapeutic basis of the 'drug cocktails' used to treat HIV/AIDS. What are some side effects? What are obstacles that researchers have encountered? What is focus of drugs of the future?

  • Try to stop it from binding
  • Try to stop it from replicating
  • See HIV Lecture
  • Hard to treat because of the high mutation rate
  • Not all of them are viable
  • Drugs of the future: RNA interference?

How is HIV diagnosed? What is the history and the future of these diagnostics?

  • Eliza: Lots of false positives (i.e., will catch you if you are positive, but it may also pick you up if you are negative)
  • Next test is a confirmatory test (Western blot test?)
    • Overrides the ELISA if it is negative

Illness

What types of social supports are available to patients diagnosed with HIV in London? In Canada? How does this differ from patients in sub-Saharan Africa and Thailand (areas with highest prevalence of HIV infection)?

London and Canada

  • See below
  • HIV Care program (St. Jo's)

Thailand

  • Thailand has cut their rate of HIV transmission by 83%
  • They did so by destigmatizing the issue, mostly through grassroots community-based activism
  • Also by seeking to control illicit activities (e.g., the sex trade in Thailand has a 100% condom policy now)
  • Opened facilities for the education of HIV workers and people from other countries

Africa

  • Focus seems to be more on the treatment of people who are left, not the AIDS patients..
  • Example: the teachers, orphans, etc
  • Circles of care project

Are HIV patients treated differently by peers / society depending on the mode of infection, for example blood transfusion vs. needle sharing vs. sexual behaviour vs. risky sexual behaviour?

  • 1 in 5 people fear people with aids; 1 in 6 admit disgust towards people with AIDS
  • Three cateogories: instrumental, symbolic, and courtesy

Person

What are some of the social-employment implications of being diagnosed with HIV? Do all HIV patients go on 'disability'? What are guidelines / requirements for continuing to work - as a ________ (pick a job)?

  • Psychological effects of disability and unemployment
  • Those who can reenter the workforce experience an improved quality of life, self-esteem, etc.
  • Healthcare workers should not be required to inform patients of their HIV status

Sexual activity is just one of several risky behaviours. Discuss behaviours that are a health risk and discuss the documented risks of such behaviours. Are there rewards to taking health risks? What will be your approach to dealing with risky behaviour in patients?

  • Laissez-faire approach to risky patients
  • Primarily, the doctor must uphold the Dr-patient relationship
  • Doctor must advocate for the patient first and foremost
  • A patient without a doctor is much riskier than a patient with a doctor
  • HIV sucks, but doctors can address chlamydia, etc..
  • Legal regulations help Doctors displace responsibility


Whom must a patient inform of her/his HIV status? What are a physician's responsibilities in this regard?

  • Must report it


Consider some unique issues in paediatric HIV patients, for example disclosure and compliance, in developed and undeveloped countries?

Is mandatory HIV screening for insurance purposes ethical?

How is patient competence determined? How much control should patients have over when / how they die? How much involvement should physicians have? What are the legal / ethical responsibilities of hospitals and physicians??

Context

How can the spread of HIV be controlled, particularly in developing countries?

Discuss stances of various cultures and religions on sexual practices, including condom use, and effects on the HIV pandemic/epidemic

  • Vietnam vs. central asia vs. namibia
  • lots of spread is due to sex workers
  • 5-60% of men are involved with the sex trade
  • In central asia, lots of it is related to iv drug use

Document and discuss the debate about drug availability, pharmaceutical research and profit, scarce resources and governmental responsibility. Can / should government regulation work in a fundamentally capitalistic economy (for example, the recent production of HIV drugs by Brazilian and Indian generic drug companies in defiance to international patents)?

  • Fun facts:
    • 1 660 000 people die of [tuberculosis] each year (1 per 19 seconds)
    • 1 080 000 people die of [malaria] each year (1 per 29 seconds)
    • 2 943 000 people die of AIDS each year (1 per 11 seconds)
  • Companies are protecting the larger patent system
  • Brazil is not currently in violation of any patents due to WTO agreement on manufacturing drugs in national emergencies
  • The WTO agreement forbids export, and thus makes it exceedingly difficult for nations in emergencies to get cheap drugs
  • Links of scarce resources to war to armies to HIV
  • Bill C56 - generic exports to other governments

How has Canadian Blood Services changed from the old Canadian Red Cross to prevent the tragedies that caused HIV and Hep C infections from blood products?

Resources

Background

HIV Support

Local (London, Ontario)

Provincial (Ontario)

National (Canada)

International

Miscellaneous