HIV Exceptionalism Is Alive and Well -- and That's Too Bad

January 9, 2013

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

Email exchange with a colleague who works at one of our community health clinics:

Guy: Hi Paul, your patient 17432862 [that's a made-up medical record number] came to our walk-in clinic with a rash on her hand. OK that I gave her a week of topical steroids? I know how inhaled steroids interact with some meds -- wasn't sure about the creams.

Me: Could be, good thought. Regardless, a short course should be fine. Tell me, who is the patient? What meds is she on?

Guy: I didn't want to put her name or meds in the email, what with her disease state, HIPAA, etc.

At which point I entered the medical record number into our electronic medical record, figured out who the patient was, and let out a big sigh.

Hey, any sensible clinician understands the importance of patient confidentiality, but at some point these mysterious messages get kind of ridiculous. (I should emphasize that we have a secure internal email system.)

Furthermore, there are several reasons why the above brief email communication is a prime example of how HIV is still treated differently from the rest of the diseases -- infectious or otherwise:

  1. It's a patient well known to me, yet there's no identifying information except for the medical record number. Not a first name, not even initials! Hey, we both know her, right? This will not be a disclosure of her diagnosis!
  2. The clinician correctly identifies a possible drug-drug interaction with HIV meds, but doesn't actually mention any of the antiretrovirals. Too incriminating?
  3. When I ask for the patient's name, he cites as the reason for not including it her "disease state" -- wonder if that state votes red or blue? -- with no mention of HIV.
  4. There's a reference to "HIPAA, etc.", as if HIPAA was created way back specifically for HIV. Wrong.

If we imagine that my patient had diabetes, or hypertension, or even HCV, then none of this covert communication would have occurred, I guarantee it. The implied message in all of this clandestine language, even though we both know the patient, is that there is something shameful about her being HIV positive, something that even health professionals need to communicate about in hush-hush terms.

Could this and related behaviors perpetuate the stigma associated with HIV? You bet.

Because privacy is one thing. But this is different, and kind of sad.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.
See Also
Spotlight Series: HIV Stigma & Discrimination


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