Mail & Guardian (Johannesburg) - July 28, 1995

I am a doctor employed in one of the public hospitals in Johannesburg. One of my duties is to consult with patients in the hospitals' so-called HIV clinic, counsel them, monitor their disease and, where possible, anticipate or, if too late, attempt to treat the complications that may develop. Medical complications are often less devastating and easier to manage than social complications.

Patients are referred to the clinic from a variety of sources. Probably the most common source is from the hospital's own ante-natal service, where screening is routine. Another source is from the general medical and surgical wards, where the HIV test would have been done as part of the diagnostic work-up of a patient who has been admitted with an acute illness.

Where possible, prior to actual taking of the blood specimen to be tested, the patient's informed consent is obtained and pre-test counselling is given. This is not always possible because, occasionally, the condition of the patient is such that he or she is too ill to communicate effectively and the test may be necessary to confirm or exclude certain diagnoses, and to treat the patient effectively.

EM was a young woman who I had seen previously and who had known her condition for some time. On the occasion of her recent visit, as on the previous occasion, the patient's employer accompanied her to the consultation. This employer was fully aware of her maid's diagnosis and showed great concern about EM's general state of health. (How EM's employer came to know about her diagnosis was not clear.)

EM had recently developed "full-blown" Aids, and was requiring regular treatment to stay as well as possible. She in fact happily reported that she was strong enough to work a couple of days a week, which was very important to her. The madam, although concerned about the possibilities of the virus being transmitted to herself or her family, is very keen to allow EM and her family to lodge with them as long as is necessary and, while she has employed an additional maid, she still allows EM to work. This relationship seems as important to EM as any medical help that can be offered to her. I find this situation personally very encouraging, as we as doctors often feel helpless in the face of this devastating disease and, if the illness is compounded by impossible social circumstances, the entire situation becomes very

Having said that, my very next patient illustrated the other side of the coin. This was TK's first visit to our clinic. She had been referred to us by a GP in private practice with a note: "Dear Colleague, Mrs TK has been tested HIV-positive. Please could you take over management." He kindly included the laboratory report with the serology result. He did not state what his clinical reason for suspecting HIV infection was.

TK was not accompanied by her employer. TK claimed that she did not know why she had been sent to the hospital. On further questioning, it transpired that her employer had taken her along to her GP for a blood test. TK said that she had felt well and did not know why this test was done and that no one had explained anything to her; neither had her permission for the test been obtained. TK's employer had then contacted the GP, who gave her the result and the referral note and TK was then given five days' notice to leave her room to make way for her replacement. My own clinical examination of TK did not reveal any obvious reason why HIV infection should have been suspected.

If TK's story is true, as it most likely is, the implications of this are very worrying. How many madams and their GPs are colluding to perform pre-employment screening on their prospective maids? How many doctors are performing the test without informed consent or giving pre-test counselling? How many doctors are disclosing the results of confidential information to third parties without the permission of the person concerned? How many maids are being summarily dismissed from their jobs for being HIV-positive, even though they are in excellent health and still able to perform a full day's work?

This situation constitutes a gross abuse of basic human rights, from what is essentially an assault on the part of the doctor, through to unfair dismissal on the part of the employer.

The stark contrast between these two maid-and-madam relationships reveals the immense gulf that still exists between needing to learn to live with this disease in our midst and what is really happening to those suffering, both from the physical effects of this desease and from the terrible ignorance that prevails, both within the medical profession and among the general public.

950728
MG950702

Always watch for outdated information. This article first appeared in 1995. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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