HIV Related Discrimination by Healthcare Professionals

I’ve just got back from the Assembly, where Dr Tony Calland and I gave evidence to the Equality of Opportunity Committee on discrimination against people living with HIV by healthcare professionals.

This by its very nature is a difficult issue.

But it’s compounded by the fact that there is no real evidence base in Wales from which to work from – at the moment the evidence of discrimination (by doctors and other health care professionals) is anecdotal.

And therein lays the problem. This lack of comprehensive evidence base is what the committee is working from; and as Jonathan Morgan AM points out they well struggle with this particular inquiry.

Advances in medicine and the ‘normalisation’ of how the HIV virus is treated have challenged much of the stigma previously found in healthcare settings.

That is not to say that discrimination is not occurring. I accept that unfortunately it may well be.

As we said in our paper, discrimination of people diagnosed with HIV by any healthcare professional is unacceptable, and is a breach of fundamental human rights – rights that are central to the practice of medicine.

Discrimination - whether actual or perceived - has a negative impact on health outcomes, and contributes to both a reduced use of prevention services and perhaps a higher rate of onward transmission. I suspect, however, that this point is obvious to most people.

Surprisingly perhaps, what’s less obvious to many people is what actually constitutes stigma and discrimination – and the effect that it can have.

Any drive to combat this should be directed at the whole healthcare team (managers, doctors, nurses, receptionists, social workers, clerks).

Non-HIV specialists may feel a lack of confidence in treating HIV patients – even if they present with common complaints. I would argue that for these clinicians, a tendency to refer HIV patients to specialist clinics or consultants arises from a lack of specialist knowledge and a desire to do right by the patient, to ensure they get the right care, rather than a reluctance to treat HIV patients on the basis of prejudice or discrimination.

This applies to many other conditions, such as diabetes and cancer, not just HIV.

It’s also important to remember that clinicians employ universal cross contamination measures for all patients (e.g. see 1000 lives campaign), because every patient could potentially have, for example, a blood borne virus or transmissible infection and are so far undiagnosed.

Precautionary measures which may seem to be over-the-top are often standard clinical practice.

A lack of knowledge about HIV, and misconceptions about onward transmission, fuels stigma and discrimination. As Dr Calland told the Committee this morning – ignorance may be the problem not prejudice.

I will follow the Committees inquiry with interest, and in the meantime we are planning to meet with the various organisations and representatives in Wales to see how we can improve on this agenda, jointly.

ARM - day three - medical ethics

So, to the motions on Medical Ethics which saw some of the liveliest debates in ARM history - not surprising I guess, given the content of the motions and the fact that they apply to all branches of the profession across the UK.

Opening this section was Wales’ own Dr Tony Calland, Chair of the BMA Ethics Committee, who outlined the issues that the Committee continues to work on: top-up payments; pandemic flu; presumed consent; compulsory vaccinations; assisted dying and Clause 152 of the Coroners and Justice Bill, which relates to the sharing of patient records (after a successful campaign the BMA recently managed to get this clause removed from the Bill).

On to the motions:

The first relates to spiritual care in the NHS – it follows this story. The motions which passed recognised that the NHS is committed to providing spiritual care to patients and noted guidance from the GMC on the inappropriate discussion of faith issues. Faith is obviously a sensitive and highly personal subject which would explain the heated debate which followed. While recognizing the importance of faith as a part of holistic health care, conference fell short of supporting doctors initiating the issue with patients.

Next up, a motion objecting to the proposed use of TV advertising for abortion services. The motion, proposed by the Yorkshire Regional Council, stated that the adverts will give the wrong message to young women and promotes sex as a values-free activity with a quick medical fix. For many different reasons, the motion fell and in my view, rightly so. It is important that patients receive as much information as possible, particularly women in a situation where they have to consider the complex and distressing decision of whether to continue with a pregnancy or not. As doctors, we have a duty to ensure that our patients have as much information as possible while exercising their right to choose.

Finally in the Medical Ethics section: assisted dying. This motion called for those people accompanying the patient in an assisted death, but not actively participating, be exempt from prosecution; and for patients who are terminally ill but who have full mental capacity to be allowed to make a choice on assisted death. Baroness Ilora Finlay spoke eloquently against this motion drawing on her particular expertise; and indeed both parts of the motion fell – although it was an extremely close vote with very convincing accounts from both sides.

So far it’s been a highly interesting, topical and emotive session.

More to follow...

ARM – day two - Chair of Welsh Council addresses conference

Dr Andrew Dearden, Chair of Welsh Council has opened day two of the ARM, in Liverpool.

In his address, Dr Dearden has just delivered an update of BMA Cymru Wales’ work over the last year, outlining the new-look Welsh NHS. He views the last twelve months as a success for the BMA in Wales, in engaging with both the profession and the public as well of course, as representing members.

A packed conference hall loudly applauded at the mention of the Welsh Assembly Government’s commitment to free accommodation for junior doctors, and at the wise and more enlightened approach the WAG has taken "to build a health service free from commercial pressures, free from competition and free from private, profit driven provision."

As Dr Dearden adds "We are also now beginning to see real benefits of political devolution. The health service in Wales remains true to the ideals of its founder, even if they have been forgotten or deemed irrelevant elsewhere".

But, it doesn’t end there. As we know the health service in Wales is far from perfect, and those working within it are facing fresh and difficult challenges. The historic legacy of under funding health in Wales, coupled with higher levels of disease and deprivation, is hard to overcome. That is why the current NHS re-organisation has to work, we can’t afford for it not to. And with proper and constructive clinical engagement, it will.

Our current focus is on the plight of Junior Doctors and Medical Students in Wales which we will be doing a lot of work on over the next year and beyond if necessary.

Dr Dearden told conference: "We will drive home our message to both hospital managers and politicians, that the effective training of junior doctors and medical students is not a luxury – it is not an optional extra, expendable in the face of targets, it is one of the most critical components for the future success of the NHS in Wales and the UK".

Dr Tony Calland, former Chair of Welsh Council, followed Dr Dearden’s address, putting forward a motion on IT in the Welsh NHS - another area where we seem to be leading on (it’s not often that a BMA Council proposes a motion praising Government – a fact that Dr Calland also recognised in his speech!) He states that WAG has taken a thoughtful and pragmatic approach to modernizing medical IT systems, and has worked closely with the profession to develop it – which is the key to its success, I’m sure.

It’s time for a lunchtime break and a quick walk around the Albert dock, preparing for this afternoon’s agenda which includes community care, mental health, safeguarding children and forensic medicine.

More to follow...