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Material by Professor Omar Hasan Kasule Sr. for Year 2 semester 1 med PPSD session on 17th September 2008
Background
Airwan Ahmad presented with clinical tuberculosis. Radiological and laboratory investigations were carried out including a battery of blood tests. An HIV epidemiologist in the TB Clinic used to ask for a sample from any blood tested in the clinic to carry out routine HIV tests for epidemiological purposes. The epidemiologist found Airwan’s blood positive for HIV but could not disclose the findings to Mr Airwan. He instead advised clinic staff to counsel him properly and do another test after proper consent. The epidemiologist had found out during casual conversations with clinic staff that Mr Airwan had a pregnant wife. The epidemiologist then visited Mrs Airwan’s ante-natal clinic and asked for a sample of her blood which he tested without her knowledge. When the test was found positive, the epidemiologist told them to advise her to go to the HIV clinic for a routine test. He advised that they could tell her that the test was for malaria. When it tests positive they advise her to go to the HIV clinic for a routine test. A new test done at the HIV clinic after proper counseling and consent was positive for HIV. Mrs Airwan agreed to start treatment with an anti-retroviral drug in order to protect the fetus. When she developed reactions to the drug she stopped being compliant. The clinic staff were eager to continue the treatment for the sake of the fetus but had only one type of anti-retroviral drug. They pretended to stop the treatment and to restart with a different drug which was the same drug but with pills of a different size and color.
Discussion issues:
1. Discuss ethico-legal issues in HIV testing without consent in a patient suspected of being infected. 2. Discuss the ethico-legal issues in disclosing HIV status to the spouse. 3. Discuss legal issues in forcing an HIV +ve patient to take medication;