Commentary: The HIV-Positive Resident: Questions and More Questions

The resident physician who is infected with the human immunodeficiency virus (HIV) faces unique problem s. In addition to the diffi culties caused by a chronic and lethal disease, HIV-infected physicians-in-training face e thica l, educational and practical problems that are unique to th e interplay between residency training and the infectio n . To date, physicians who have been found to be infect ed with HI V have faced public discrimination, many with devastating results. Dr. Hacib Ao un, a Venezulean-born cardiologist who contracted AIDS from a boy with leukemia while he was a resident at Johns Hopkins, overcame rumors about how he had contracted the disease only to be faced with possible deportat ion. Despite being married to a U.S. citizen , Dr. Aoun was confronted with an immigration law th at stated that foreign citizens who have AIDS cannot become U.S. residents (1). Dr. Robert J. Huse was forced to close his Texas pediatrics practice wh en irate parents learned he had tes ted positive for HIV (2). Newspaper headlines from the November 16th issue of Today, an English newspaper, proclaimed "A I DS Doctor Who Died"; the pape r provided a photograph of th e doctor and a one-page report, noting that his wife and children were " in hiding" (3). While the issue of patient safety has been raised with aweso me regularity in these and other reports on physicians with AIDS, public h ysteria usually centers around patients contracting AIDS from ph ysicians. Despite numerous reports that casual contact does not spread AIDS (4), even health ca re professionals are often ignorant about AIDS and how it is transmitted (5). Few people would disagree with the American Medical Association position that a physician who knows th at he or she is seropositive should not engage in any activity that creates a risk of transmitting the disease to others (6). However, fear of this disease is so intense, that what constitutes "safety" has sometimes been differently defined for A IDS than for other diseases, even more prevalent diseases such as Hepatitis B which can also have letha l consequences (7). More recently, however, the safety issue has shifted to AIDS dementia . Infected physicians might fail to treat patients safely, according to this reasoning, not because of the possibility of infecting th e patient but because th e dementia could prevent the physician from practicing good medicine (3). As