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pos med student
Nov 16, 2008

Dear dr. Bob, Let me start by saying that your story and the way you deal with your HIV by helping other people the way you do, is very inspiring to me. I hope my question wont be too long, well see :-)

Last summer a guy used a lambskin condom, without one of us knowing it and the risk it involved. Thirty hours post exposure, I found out the risk (by reading the small print on the condom pack), went to a doctor and followed 28 days of PEP. As opposed to day one, I was tested positive on day 28. I included this part to make clear to all the guys and gals that you can actually get infected by using the INfamous NaturaLamb brand (lambskin) condoms.

Besides the obvious health issues Ill have to start dealing with, heres whats bothering me most and I would like to hear your experience on the issue: as the title suggests, Im a med student and thats kind of concerning me. The first thing that went through my mind, after hearing the bad news, was the fact that I might had to stop my studies as it would be irresponsible towards the future patients. Ive talked with two HIV specialists and read about the subject so I now know theres no heath-risk for my patients as long as I strictly follow the guidelines. Knowing that, I still cant shake off this eerie feeling that its not 100% ok for me to practice in the future. I want to add to that the great importance of doctors like you that actually know what its like to be a patient and provide great support to so many people.

My question is how you dealt with the issue regarding the patients as well as your colleagues; Among my fellow students, Ive noticed great and unrealistic fear of becoming HIV infected. Even though your story is so inspiring, I feel like I need to get into the closet again because of the infection. Im quite a candid person so thats actually very difficult for me.

Let me finish by stating again- how inspiring your approach is. Besides a newly sparked research-interest in the disease (its actually very interesting disease and fun to learn more about its workings), I now see that Ill have to use it to be a better doctor. Im just not there yet.

Thank you so much,

........ (you just pick a nice name for me)

Response from Dr. Frascino

Hello Stud-Doc (short for student doctor),

There is no reason for you not to pursue your career in medicine. "Universal precautions" were established long ago to prevent the transmission of bloodborne pathogens from patients to physicians and vice versa. I know quite a number of practicing HIV-positive physicians. Similarly, there are physicians actively practicing with other chronic viral illnesses, such as hepatitis B or hepatitis C. You will not be any more of a risk to your patients than they are to you. Disclosure of your HIV status is up to you. Most HIV-positive professionals use a "need to know" criterion.

Your statement about your fellow studs having "great and unrealistic fear of becoming HIV infected" is concerning, considering we are 27 years into the pandemic! I sincerely hope their mentors address this problem.

Finally, I should mention your concern for your future patients' safety is laudable. This type of selfless compassion is a key component to becoming an effective and caring physician. I believe you're well on your way to becoming an excellent physician whom I would be pleased to call a colleague.

Be well.

Dr. Bob

Discrimination against HIV+ medical student Oct 12, 2006

Hello Dr Bob,

I am a third year medical student who recently found out I was HIV+. I stupidly disclosed this to the school who is now considering throwing me out of the program. That's almost 7 years down the drain. I read that you were HIV+ and still practising until you retired to focus more on charity work and awareness. I became postive in my wilder college days through heterosexual sex, however I do not see this as relevant in any case. Do you? I am seeking legal advice and intend to pursue to the end. I was wondering if you know of any laws regarding practice for HIV+ physicians? I actually want to go into a less blood contact procedure based speciality like psychiatry or diagnostic radiology since I am not that dextrous. Any advice is greatly appreciated.

Chase.

Hello,

If you are writing from the United States, you cannot be thrown out of medical school solely because you tested HIV positive. I'm confident your lawyers have told you this already. Universal precautions were established long ago to prevent the spread of bloodborne pathogens from patient to health care worker and vice versa. Yes, there are a number of HIV-positive health care workers at all levels who continue to work. The same laws apply for HIV, hepatitis B, hepatitis C and other bloodborne illnesses.

Good luck in your career!

Dr. Bob



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