Aug 28, 2005
Wow David...I was a bit disappointed by your response to an inquiry from a recently seroconverted patient. First, you had no knowledge of the circumstances of his infection. Second, even if his infection was the outcome of a particularly "bad decision, your response seemed to be somwhat blind to the unfortunate intricacies of human nature that perhaps none of us understand. Wow...if only all of my patients acted with complete rationality in all of their decisions that they make day to day. If only all of may patients who smoke and knew better just stopped smoking. My alcoholics stopped drinking. What if all of my patients who ever watched an evening news report on a terrible car accident learned not to speed.
Do I understand this human nature? not a chance! What I do understand is that well meaning educated people often inadequately gauge the risks of their behaviors on a daily basis. Daily we all make decisions in one way or another based less on reality and more on an imagined sense of imortality. Ask yourself "why" the next time you rush to a meeting speeding in your car, speak on a cell phone while you driving or bite into a particularly delicious steak. Of course you know the risks...but are you weighing them at each moment? Do you deserve an "I told you so" lecture if you suffer a negative outcome? YES, it is difficult to understand, but it is unfortunately part of what makes us human and deserving of compassion regardless of the outcomes of our faulty choices.
That said...I have truly appreciated this site and your input. you provide an invaluable service. Keep up the good work!
Response from Dr. Wohl
I appreciate your post and it helps address the substance of what I was asking. I am certainly aware that there are countless ways people become infected with HIV and I make no assumptions regarding the individual who was brave enough to write in.
However, to take one of your analogies a bit further, if this was a forum regarding lung cancer, how many posts should I answer before adding a note of concern regarding the links between smoking and this malignancy. Not so much for the soul sending in the post but for the many others who read it.
The inability to appreciably change the rates of HIV acquisition in this country (where we enjoy access to information and media that did not exist when this virus first started spreading) has frustrated prevention specialists. In my own clinic I have come face to face with 'the shrug'. That is the response I not infrequently get from a well dressed, attractive individual with newly acquired HIV when asked how he got infected when he states he knew about safe sex and risks for becoming HIV +. Add to this data that suggest recently infected individuals are most likely to transmit the virus to others during the first few weeks after becoming infected and this goes way beyond any moralizing or lecturing on my part.
I am aware many people who become infected never imagined they were at risk for HIV and that others make one of those all too human slips we all are capable of. But, you know there are people who habitually place themselves and others at risk for HIV infection. Should we not try to understand such individuals better as part of our efforts to halt the spread of HIV rather than chalking them up as victims of their human nature?
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