Qualified HIV physicians

[Guest guest]

Dear members,

This is in regard to issues on HIV care and who is

qualified to provide care. First it is encouraging to

note that people are discussing care in a more

comprehensive manner rather than care being limited to

ARV only.

We all are aware that HIV care includes a whole gamut

of clinical, psychological and social interventions.

Lets take clinical care at the first instance.

On one side is the suggestion that ‘HIV medicine’ be

made a separate specialty. Sounds good, but in a

country like ours where stigma and discrimination has

been the bane of HIV prevention and care strategies,

would it not amount to patients being more

stigmatised, particularly in low prevalence states.

Then there is the issue of confidentiality. We still

have trouble motivating people for STI treatment. Such

a strategy will only impede the integration of

HIV/AIDS into the general health system.

But yes, with a separate specialty for HIV, it may

enhance the experience of a group of doctors in

managing HIV/AIDS. And it would certainly help in

monitoring and keeping a check on indiscriminate ARV

therapy. I would not like to dwell on who may be

qualified to offer specialized HIV care, since we do

not have such a faculty as yet.

On the other hand, would it not be worthwhile to have

HIV care provided by trained medical officers and GPs

for minor ailments and specialized care for different

illness be it tuberculosis, CMV retinitis or

Neuro-toxoplasmosis. (This calls for specialists from

three different disciplines) Similarly, qualified

counselors can take care of the psychological and

social needs.

The advantages of such a system are manifold. That

such a good integrated system with a good referral is

lacking is a different story altogether.

Instead of ‘specialized HIV medicine’ and starting

another parallel system, one needs to develop a good

networking among motivated care providers in the

existing disciplines and a good referral system in

place.

It is a personal opinion on the subject and further

debate is always welcome.

Dr. S. N. Misra

E-mail: misranaco@...

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