premed and HIV?

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beponychick

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Hello everyone,

A good friend of mine is dating a guy who is HIV positive. They are very serious (she is constantly talking about getting married to him, blah blah blah)She is currently a premed student and will be applying to medical school next year. She told me that she wants to write her personal statement about this and how it changed her life. However, for some reason, I really dont think it is a good idea. I feel that there is still so much stigma associated with HIV, that it may reflect badly on her when she is applying to medical school. What do you guys think? Do you suppose the med school admissions people reading this, will somehow view her in a negative light? I feel that we make our choices of who or not we want to be with, and with her, making the decision to be with a man who is HIV+ may somehow reflect negatively on her.

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Forget mentioning it in her personal statement; I think she needs to get her head on straight first. No matter how much she may be in love with this person, she is going to be posing a definite risk to her own health, her children, etc.
 
im not gonna pass any judgement, cuz who's to say that this isnt actually her soul mate. i dont think theres that much of a risk involved in the relationship, seeing as how she can avoid sexual transmission of the virus, plus HIV is actually not that easy to contract (low probability rate). however, i dunno about putting it into her personal statement. one, cuz u dont know how people will react, and two, i dont think that would be enough material to cover 3 pgs .
just my fitty cent
 
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beponychick said:
Hello everyone,

A good friend of mine is dating a guy who is HIV positive. They are very serious (she is constantly talking about getting married to him, blah blah blah)She is currently a premed student and will be applying to medical school next year. She told me that she wants to write her personal statement about this and how it changed her life. However, for some reason, I really dont think it is a good idea. I feel that there is still so much stigma associated with HIV, that it may reflect badly on her when she is applying to medical school. What do you guys think? Do you suppose the med school admissions people reading this, will somehow view her in a negative light? I feel that we make our choices of who or not we want to be with, and with her, making the decision to be with a man who is HIV+ may somehow reflect negatively on her.

Wow :scared: , that’s a can of worms I would leave closed. You could question her judgment, not for dating him but for writing about it in a statement read by complete strangers. Granted she won’t mention his name but if she matriculated at a school and then introduced her boyfriend to someone who read her application you would technically be breaching his right to privacy. If I was interviewing her i would say, who gave you permission to write about his condition? More than an issue of a HIV neg person dating an HIV
+ person, it calls into question her sense of respect and dignity for the for those with HIV and their right to privacy thus her ethical standards.
 
I don't think that anyone should be looked upon negatively if they choose to be with someone who is HIV-positive. It broke my heart to read those words "making the decision to be with a man who is HIV+ may somehow reflect negatively on her." Do people still think like that? I guess people just think differently here in San Francisco. I'm currently working on a research project to discover ways to improve the health of the HIV+ population in the Bay Area and it's amazing to see many of the patients who have been positive for over 20 years-- living life, working, raising families.

But with regards to mentioning it in her applications, I don't think she should make it the story of her life, but perhaps it has affected her significantly.
 
beponychick said:
Hello everyone,

A good friend of mine is dating a guy who is HIV positive. They are very serious (she is constantly talking about getting married to him, blah blah blah)She is currently a premed student and will be applying to medical school next year. She told me that she wants to write her personal statement about this and how it changed her life. However, for some reason, I really dont think it is a good idea. I feel that there is still so much stigma associated with HIV, that it may reflect badly on her when she is applying to medical school. What do you guys think? Do you suppose the med school admissions people reading this, will somehow view her in a negative light? I feel that we make our choices of who or not we want to be with, and with her, making the decision to be with a man who is HIV+ may somehow reflect negatively on her.

Why does she need to include the detail that this man is her (hope-to-be) fiancee? Why not simply describe him as a good friend. She could still talk about how watching his struggle has affected her.

I would think that would be a better solution for describing the situation without hurting her in her med school process.
 
It really depends on how she wants to spin it in her personal statement. How does her relationship with this man have anything to do with her desire to practice medicine? If it's just a personal epiphany, then it's not enough for a strong medically-related essay.

On the low transmission rate, that's true for single exposure. However, if a person is constantly exposed (say, in the context of a relationship), then the probability of transmission increases, especially if barrier protection during intimate moments isn't used. And barrier protection extends to shields during oral as well. If your friend is seriously thinking about marriage, I only hope she realizes the type of life she'll be voluntarily entering into. Her husband will be on meds all his life, with all the side-effects (lipodystrophy, liver problems, psychological issues) and that have strict adherence regimens. There's the possibility of his developing drug resistance. Having a child introduces a host of concerns: how to impregnate her without the chance of her becoming HIV+ as well, how to avoid birthing an HIV+ child (there are drugs that prevent mother-child transmission, but I've never heard of research in the prevention of father-child transmission field), etc.

People live with HIV every day. But it's not an easy life and, if you can help it, you shouldn't go into it blindly.
 
Do people think like that? Of course!!! It is a natural reaction of many people (check the second post above). She actually even told me that when she went to see her doctor and told him about the situation, he definitely did not look at her favorably. He practically asked her what she was doing with the guy!!! Thats crazy in my opinion, especially coming from a physician! She loves him, and will probably end up marrying him, but there is STILL a lot of stigma out there. She made a conscious decision and many people will probably not look too favorably upon that.
 
Heavens No! By all means, have her just drone on about her research on some receptor molecule OR about some trite clinical experience working as a candy striper in a children's hospital. That way she can blend in with all the other applicants and offer nothing substantive to the incoming class. Mundanity is precisely what attracts adcoms to particular applicants.


"Opening up a can of worms"? Are we still living in the f.ucking 80's? Grow up people -- you are going to be physicians. Thousands die everyday from HIV/AIDS. Don't let the vestiges of AIDS-related discrimination/stigmatism carry on with this generation of physicians. Open up and speak out on AIDS. Write about it in your personal statement. Be an advocate for the HIV+ children in Botswana suffering on a daily basis without access to anti-retrovirals. Be a voice for the thousands of HIV+ African Americans in our own country who have been marginalized by their families, communities, and churches due simply to their HIV status.


ACT UP! Fight AIDS!

*end PSA*
 
If they marry, will she be having sex with that man? Isn't that attempted murder? That guy belongs in jail if he would risk anyone's life like that and that girl needs to get her **** together. It's okay to be friends with someone who has HIV, but marrying one!!!? I wonder what her parents are thinking.
 
Mateodaspy said:
Heavens No! By all means, have her just drone on about her research on some receptor molecule OR about some trite clinical experience working as a candy striper in a children's hospital. That way she can blend in with all the other applicants and offer nothing substantive to the incoming class. Mundanity is precisely what attracts adcoms to particular applicants.


"Opening up a can of worms"? Are we still living in the f.ucking 80's? Grow up people -- you are going to be physicians. Thousands die everyday from HIV/AIDS. Don't let the vestiges of AIDS-related discrimination/stigmatism carry on with this generation of physicians. Open up and speak out on AIDS. Write about it in your personal statement. Be an advocate for the HIV+ children in Botswana suffering on a daily basis without access to anti-retrovirals. Be a voice for the thousands of HIV+ African Americans in our own country who have been marginalized by their families, communities, and churches due simply to their HIV status.


ACT UP! Fight AIDS!

*end PSA*


Basically it boils down to how she spins it, and yes if it is done wrong you will open up a can of worms. I love people like you who live in a rosy idealistic world where people can say whatever they want and not face discrimination. I whole heartedly agree with you that we need to be advocates for the treatment HIV but if you are addressing HIV in a personal statement it needs to be done carefully because there are people out there, even physicians, who could take offence to such a topic in a PS.
 
Homer Doughnuts said:
Basically it boils down to how she spins it, and yes if it is done wrong you will open up a can of worms. I love people like you who live in a rosy idealistic world where people can say whatever they want and not face discrimination. I whole heartedly agree with you that we need to be advocates for the treatment HIV but if your are addressing HIV in a personal statement it needs to be done carefully because there are people out there, even physicians, who could take offence to such a topic in a PS.

Would I even want to attend a school that would discriminate against me based on my fiance's HIV status?

Probably not.

She should be honest about who she is and the people in her life who have touched her. If her partner's HIV status was one of the reasons that is leading her into a career in medicine, she should by all means include it in her PS.
 
First of all, how could her choosing to be with him ever be looked upon negatively? She obviously loves him to be thinking about marriage(a marriage based on love and not financial incentives or her parents' preference or any of that crap that goes on still). How would a scenario where you are dating someone that you care about and then they became paralyzed effect you? Would you say, "Sorry, but you have a disability now, that's gross. See ya." It doesn't matter what disease or disability the person has.

Secondly, it's been suggested on this thread that she tailor her words to the adcoms in order to adhere to "ethical standards". If that's her future husband, I'm sure she would ask him to write about him, but that's not the issue. The issue is whether his disease is irrelevant to her classmates in the first place, and therefore doesn't need to be told if it bears no purpose, or if they would view him in a negative light because he has HIV/AIDS. She has a purpose to tell adcoms, however, and that makes her personal statement more personal, and quite frankly, more honest, as well. The secondary effect of others knowing about irrelevant information shouldn't be important, and shouldn't change their views of either of them(at least not negatively). Why would it be important? I second Mateodaspy in saying this isn't the f*cking 80's.
 
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Will Ferrell said:
If they marry, will she be having sex with that man? Isn't that attempted murder? That guy belongs in jail if he would risk anyone's life like that and that girl needs to get her **** together. It's okay to be friends with someone who has HIV, but marrying one!!!? I wonder what her parents are thinking.

umm...have you heard of safe sex? i work at an AIDS Center in the bay area and am part of a program helping hiv positive youth to engage in safe activities (i.e. cutting down on risky behavior with drugs and sex). responsible hiv+ people make sure to use condoms (at a minimum) to protect themselves (just cause you have hiv doesnt mean that you still cant get stds like warts if you dont use protection) and their partners. did you know that even if both partners are hiv+ that they should still use condoms so as not to contract the partner's hiv strain? i'm sure that this friend and her boyfriend take proper safety precautions. and whether she should talk about this in her personal statement, i would say definitely. if this is what makes her want to practice medicine, then she should talk about it.
 
Mediculous said:
First of all, how could her choosing to be with him ever be looked upon negatively? She obviously loves him to be thinking about marriage(a marriage based on love and not financial incentives or her parents' preference or any of that crap that goes on still). How would a scenario where you are dating someone that you care about and then they became paralyzed effect you? Would you say, "Sorry, but you have a disability now, that's gross. See ya." It doesn't matter what disease or disability the person has.

Secondly, it's been suggested on this thread that she tailor her words to the adcoms in order to adhere to "ethical standards". If that's her future husband, I'm sure she would ask him to write about him, but that's not the issue. The issue is whether his disease is irrelevant to her classmates in the first place, and therefore doesn't need to be told if it bears no purpose, or if they would view him in a negative light because he has HIV/AIDS. She has a purpose to tell adcoms, however, and that makes her personal statement more personal, and quite frankly, more honest, as well. The secondary effect of others knowing about irrelevant information shouldn't be important, and shouldn't change their views of either of them(at least not negatively). Why would it be important? I second Mateodaspy in saying this isn't the f*cking 80's.



Well, she knew he was HIV+ when they first got together. He was very honest with her and told her from the beginning. From what she tells me, this guy is really great. He is sensitive, educated (he is a lawyer), and an all-around nice guy. However, I still feel that telling the adcoms that you are with an HIV+ man (and you knew he was HIV+ from the start), no matter how it changed your life, may be looked upon in an unfavorable light. It is definitely not like telling someone your fiancee has the flu, or cancer, or just about any other ailment. HIV is different, and I still feel people perceive it that way.
 
btowngirl said:
umm...have you heard of safe sex? i work at an AIDS Center in the bay area and am part of a program helping hiv positive youth to engage in safe activities (i.e. cutting down on risky behavior with drugs and sex). responsible hiv+ people make sure to use condoms (at a minimum) to protect themselves (just cause you have hiv doesnt mean that you still cant get stds like warts if you dont use protection) and their partners. did you know that even if both partners are hiv+ that they should still use condoms so as not to contract the partner's hiv strain? i'm sure that this friend and her boyfriend take proper safety precautions.


Btown... you and I and almost anyone with any sort of biological/medical education knows this.

For whatever reason, Will has no common sense. Do not waste your time. You will not be able to educate him, unfortunately. I just truly hope, if he does become a doctor, that he does not ever have contact with a patient who is HIV+... I feel sorry for that person.
 
beponychick said:
Well, she knew he was HIV+ when they first got together. He was very honest with her and told her from the beginning. From what she tells me, this guy is really great. He is sensitive, educated (he is a lawyer), and an all-around nice guy. However, I still feel that telling the adcoms that you are with an HIV+ man (and you knew he was HIV+ from the start), no matter how it changed your life, may be looked upon in an unfavorable light. It is definitely not like telling someone your fiancee has the flu, or cancer, or just about any other ailment. HIV is different, and I still feel people perceive it that way.

all she has to do is talk about what her relationship with him has meant to her in terms of her goals in medicine. she now has first hand experience in dealing with a serious medical disease. everything she has dealt with because of it has given her a wealth of perspectives that the typical medical school applicant hasnt had to deal with. not only will she stand out for this, but also because she is clearly an open person willing to accept all people for who they are, something i am sure adcoms will not miss.
 
Will Ferrell said:
If they marry, will she be having sex with that man? Isn't that attempted murder? That guy belongs in jail if he would risk anyone's life like that and that girl needs to get her **** together. It's okay to be friends with someone who has HIV, but marrying one!!!? I wonder what her parents are thinking.

Oh no you din't! This post is 37 kinds of wrong. How dare you talk about people with HIV as if they are animals, sub-humans not deserving of being considered regular people who want to be in relationships? Who made these rules that it is "okay" to be friends with someone with HIV but UNFORGIVABLE to think about marrying one? Are you really as closed-minded and prejudiced as you come across in your post? I am scared for your patients and colleagues if you ever get into medical school.
 
beponychick said:
Well, she knew he was HIV+ when they first got together. He was very honest with her and told her from the beginning. From what she tells me, this guy is really great. He is sensitive, educated (he is a lawyer), and an all-around nice guy. However, I still feel that telling the adcoms that you are with an HIV+ man (and you knew he was HIV+ from the start), no matter how it changed your life, may be looked upon in an unfavorable light. It is definitely not like telling someone your fiancee has the flu, or cancer, or just about any other ailment. HIV is different, and I still feel people perceive it that way.

Any adcom that thinks that people with HIV are so sub-human as to be separated from the pool of "dateable people in this world" is a dirty adcom that doesn't deserve a sensitive, committed individual at their school.
 
beponychick said:
Well, she knew he was HIV+ when they first got together. He was very honest with her and told her from the beginning. From what she tells me, this guy is really great. He is sensitive, educated (he is a lawyer), and an all-around nice guy. However, I still feel that telling the adcoms that you are with an HIV+ man (and you knew he was HIV+ from the start), no matter how it changed your life, may be looked upon in an unfavorable light. It is definitely not like telling someone your fiancee has the flu, or cancer, or just about any other ailment. HIV is different, and I still feel people perceive it that way.

I dunno if this helps or not, but my PI is on the Yale med admissions committee, and he told me that essentially everything in the PS is fair game during the interview--if your friend does write about it, then she should be prepared to field some questions from the ad committees.....and they might ask some personal questions in a way that's tough to answer.
 
writing about her relationship doesn't have any place in a personal statement. It would bring up alll sorts of questions of judgement. Most physicians these days don't discriminate against the HIV+ population; but they don't date them either. In the context of a romantic relationship, transmission is virtually unavoidable.

if she wants to date this dude -- that's her business. but sharing this in a personal statement won't go over too well with most readers on that adcom.
 
I'm actually sort of shocked by some people's responses. I wonder if they know what it is to love somebody? I would love my husband the same if he had HIV, or if he was paralyzed, or had cancer. I know a girl who got married when her fiance was in a probably losing battle with brain cancer. When you love somebody, these things become secondary. As far as how these people will protect themselves, that is personal and entirely up to them. It's not our business to comment on it (unless we are, as doctors, specifically asked for advice by a patient, or some such similar situation).

As far as the PS, I agree it might be a bit risky, but in general small risks with PSs seem to be good. I agree that if this girl can discuss this situation in the context of how it has affected her desire to be a doctor, she should definitely include it. A thoughtful PS on this issue would probably be interesting to read, and it would make her stand out.
 
Unfortunitely you have all lived in the years where HIV and AIDS have become a chronic illness that can be treated fairly well with anti-virals. Its great to see people like Magic J doing well, but the reality is that people still die from AIDS and once your strain becomes resistent to current methods of treatment you are screwed. Even with retrovirals you are prone to cancer and infections that can kill. You also have to deal with the terrible consequences involved with this therapy -- heart failure and liver damage to name a few. SO THE PICTURE OF GETTING HIV IS NOT A SUNNY WONDERFUL DAY, it still sucks and it will still end your life MUCH earlier than expected. Great, people have been living 20 years with HIV -- so they got infected at say 20 and are now 40 and I will bet my house that they wont make 60.

NOW, all these thing being said this girl is obviously not mature enough to realize that ramafications of her decision. SHE IS AN IDIOT AND EXPOSING THIS FACT TO ADCOMS WILL ONLY GET HER A REJECTION. She has little future with this person if she wants to get married, sex will have to be perfectly sterile and she would not be able to conceive without infecting herself. If she does infect herself she can have a child and have a really good chance of that child being born HIV negative, but what happens when mommy and daddy die? This person may be the love of her life and that is great for now, but she is taking alot of dangerous risks by continuing her relationship and pursuing this dilusion. I am not saying she will get HIV by kissing him or whatever, but if she continues a sexual relationship with this man she will ultimately infect herself. If this is a risk she is willing to take then I would question her sanity.
 
In my humble opinion, the issue with putting her relationship into the personal statement has little to do with a HIV- person dating a HIV+ person, questions of judgment in personal decisions, or descrimination surrounding these patients.

The real issue is that the applicant is and will remain throughout her education and career at a significantly higher than usual risk of contracting the disease and being positive for six months or more undetected. While there are specialties where there is no risk of transmission, I don't feel it's possible to complete a medical education without risking transmission to patients (surgical, EM, OB rotations, for example). It is a serious ethical delimma whether a HIV+ applicant should apply, or even whether a sexual partner of an HIV+ person should apply. The only way to be rid of those issues is to not consumate the relationship until after med school and she can enter a non-transmission specialty.

Surgeons don't operate for several months after a needlestick from an HIV+ patient because it would be unethical to put the next patients at that risk. The applicants friend is exposing herself everytime she has sex with her partner, even if it's with a condom and she takes the cocktail prophilactically. ADCOMs definitely have addressed this issue and I am pretty sure that they would come down around where I have. The OPs friend shouldn't be asking whether or not to divulge the information, she should asking whether it's ethical to attend med school while sexually active with a positive partner.

Please don't hate me.

-dope-
 
Patient confidentiality is a huge part of being a doc. This information about a boyfriend should absolutely not be disclosed in a personal statement.

However a more general discussion about HIV is appropriate.
 
Will Ferrell said:
If they marry, will she be having sex with that man? Isn't that attempted murder? That guy belongs in jail if he would risk anyone's life like that and that girl needs to get her **** together. It's okay to be friends with someone who has HIV, but marrying one!!!? I wonder what her parents are thinking.
oh my gosh!!! how dare you say such a thing. how do you know how he got the virus? he can be an innocent victim himself. and who said he wasn't going to protect her from the virus? you know nothing about their situation
 
doc05 said:
writing about her relationship doesn't have any place in a personal statement. It would bring up alll sorts of questions of judgement. Most physicians these days don't discriminate against the HIV+ population; but they don't date them either. In the context of a romantic relationship, transmission is virtually unavoidable.

if she wants to date this dude -- that's her business. but sharing this in a personal statement won't go over too well with most readers on that adcom.

That is super, super risky to write about in your PS....it can either really help or really hurt your chances....I dont know, I wouldnt risk it...
 
dopaminophile said:
In my humble opinion, the issue with putting her relationship into the personal statement has little to do with a HIV- person dating a HIV+ person, questions of judgment in personal decisions, or descrimination surrounding these patients.

The real issue is that the applicant is and will remain throughout her education and career at a significantly higher than usual risk of contracting the disease and being positive for six months or more undetected. While there are specialties where there is no risk of transmission, I don't feel it's possible to complete a medical education without risking transmission to patients (surgical, EM, OB rotations, for example). It is a serious ethical delimma whether a HIV+ applicant should apply, or even whether a sexual partner of an HIV+ person should apply. The only way to be rid of those issues is to not consumate the relationship until after med school and she can enter a non-transmission specialty.

Surgeons don't operate for several months after a needlestick from an HIV+ patient because it would be unethical to put the next patients at that risk. The applicants friend is exposing herself everytime she has sex with her partner, even if it's with a condom and she takes the cocktail prophilactically. ADCOMs definitely have addressed this issue and I am pretty sure that they would come down around where I have. The OPs friend shouldn't be asking whether or not to divulge the information, she should asking whether it's ethical to attend med school while sexually active with a positive partner.

Please don't hate me.

-dope-

wow!! so people think it's actually unethical for people to even attend medical school when they are in danger of contracting a virus? do you have any idea how many people are harboring the HCV virus and don't even know about it? pretty soon there won't be any physicians ethically permitted to do invasive procedures. there are ways of protecting patients.
 
Psycho Doctor said:
wow!! so people think it's actually unethical for people to even attend medical school when they are in danger of contracting a virus? do you have any idea how many people are harboring the HCV virus and don't even know about it? pretty soon there won't be any physicians ethically permitted to do invasive procedures. there are ways of protecting patients.
It's all about levels of risk. Medical students who know they have an exposure to HIV or HEP C or a number of other diseases have an obligation not to put their patients at risk. Once they are confirmed not to carry the disease, then they can practice. The problem with HIV is that a person can carry and transmit the virus up to six months after exposure while testing negative. Certainly there are ways of protecting patients, but accidents happen. If a physician has even a small possibility (1/300 after a needlestick from a positive patient) of carrying the virus, they have an obligation to abstain from procedures where accidents are even possible.

If I were to find out that I'd had protected sex with an HIV positive partner, I wouldn't engage in any procedure where patients could possibly come into contact with my blood for six months after the exposure.
 
I don't care if I get flamed or not for writing this, but I completely agree with W222; s/he took the words right out of my mouth. The original poster's friend is obviously not thinking about the potential consequences of having a (sexual) relationship with this man. I seriously doubt she has thought through her what her experiences will be like when she finds her husband at the fate of his disease; unfortunately, he will most like pass away within the next 10-20 years. No matter how many antiviral cocktails the pharmaceutical industry is creating, inevitably this particular disease will expose its full-fledged share of symptoms, whether with old age or with a general trend of lacking immunity. Point is, not only will she come to outlive him, and have to bear through such a disheartening experience (read: multi-system failure) through the years of marriage with this man, she is also posing a risk to herself and to her children, which I am assuming she wants to have.

She is illogical for not reasoning this through completely. I would question anyone that would indeed voluntarily put themselves in this situation; she knew from the beginning that he was HIV+, so please, do not tell me a scenario in which a person develops an infection, disease, or disability years later, but is already married, in a relationship, etc - it is not the same type of analogy.

I also question this man's conscience; how could anyone knowingly, even amid permission from the other partner to engage in sexual activity, actually ever go through with it? He knows he will be full well responsible for transmitting it to her, and he himself will have to live through the rest of his own life bearing this guilt (hopefully this never happens).

Why is it so crazy that her own physician was against this? Hello? He is trying to protect her health. Your friend is irrational and immature. Although love is the single most critical component of a relationship/marriage, many other variables are also involved - including being realistic.

I don't know how anyone, any friend, could let a person knowingly go out with someone who is HIV+. It would be in my natural instincts to prevent my friend from harm, whether direct or indirect; I know I definitely would try to provide her any information I had about any possible worst case scenarios that could happen (partner-to-partner transmission, mother-to-infant transmission, etc.), as well as the likelihood of those occurances happening.

Medicine is a conservative profession, and I am fairly sure there will be at least a few prying eyes on the admissions committee table when they read over this person's statement. I think she really needs to forget about her personal statement at the moment, and concentrate on what she is about to step into.

Now, I want to leave you all with a little information. Manufacturers of condoms do not need to recall their products unless there is over a 4% defect rate. It has been shown that on average, the failure rate is 2% of each batch they distribute. Latex and polyurethane condoms are also the only ones that have a decreased permeability for HIV. According to studies, some of which are shown below, there is only an 87% level of protection against HIV transmission using a condom; in other studies, this has been expanded upon as ranging anywhere from 60% to 96%. There is a very good chance of being infected with HIV even when using condoms; there are also many other mechanical factors which could increase this rate (improperly using one, tearing, leakage as the result of excessive strain during use and pore expansion, etc.).

Fam Plann Perspect. 1999 Nov-Dec;31(6):272-9.

The effectiveness of condoms in reducing heterosexual transmission of HIV.

Davis KR, Weller SC.

Department of Preventive Medicine and Community Health, the University of Texas Medical Branch, Galveston, USA.

CONTEXT: It is not established whether the condom is as effective at preventing heterosexual transmission of HIV as it is for preventing conception. An overall estimate of condom effectiveness for HIV prevention is needed. METHODS: Information on condom usage and HIV serology was obtained from 25 published studies of serodiscordant heterosexual couples. Condom usage was classified as always (in 100% of acts of intercourse), sometimes (1-99%, 0-99% or 1-100%) or never (0%). Studies were stratified by design, direction of transmission and condom usage group. Condom efficacy was calculated from the HIV transmission rates for always-users and never-users. RESULTS: For always-users, 12 cohort samples yielded a consistent HIV incidence of 0.9 per 100 person-years (95% confidence interval, 0.4-1.8). For 11 cohort samples of never-users, incidence was estimated at 6.8 per 100 person-years (95% confidence interval, 4.4-10.1) for male-to-female transmission, 5.9 per 100 (95% confidence interval, 1.5-15.1) for female-to-male transmission and 6.7 per 100 (95% confidence interval, 4.5-9.6) in samples that specified the direction of transmission. Generally, the condom's effectiveness at preventing HIV transmission is estimated to be 87%, but it may be as low as 60% or as high as 96%. CONCLUSIONS: Consistent use of condoms provides protection from HIV. The level of protection approximates 87%, with a range depending upon the incidence among condom nonusers. Thus, the condom's efficacy at reducing heterosexual transmission may be comparable to or slightly lower than its effectiveness at preventing pregnancy
 
dopaminophile said:
It's all about levels of risk. Medical students who know they have an exposure to HIV or HEP C or a number of other diseases have an obligation not to put their patients at risk. Once they are confirmed not to carry the disease, then they can practice. The problem with HIV is that a person can carry and transmit the virus up to six months after exposure while testing negative. Certainly there are ways of protecting patients, but accidents happen. If a physician has even a small possibility (1/300 after a needlestick from a positive patient) of carrying the virus, they have an obligation to abstain from procedures where accidents are even possible.

If I were to find out that I'd had protected sex with an HIV positive partner, I wouldn't engage in any procedure where patients could possibly come into contact with my blood for six months after the exposure.

protected sex??? come on! use standard precautions with patients!!!! so you're saying someone with HIV or Hep C should not be a medical student??
 
Let her do what she wants. She knows the risks and she knows what parts of a married relationship she has to give up in order to stay safe. I don't think I could handle knowing my wife was dying but perhaps she knows a better way to deal with it than I do.

Would I put it on my PS? hmm, perhaps. It is pretty ballsy to enter a relationship knowing ahead of time that you will have your heart crushed by witnessing the withering death of your spouse. If you want your PS to be original this might be the way to go since pretty much everyone has cured at least one disease and volunteered somewhere and did something that "changed their lives". Anyway, whatever.





Side note: Should a family practitioner be required to disclose his or her HIV+ status to patients?
 
Any HIV-infected medical student is going to have some serious trouble being accomodated in clerkships; medical students or physicians that are HIV-infected should be restricted to practice in which they will not be exposed to bodily fluids.

There is only one mechanism that medical staff can use if accidentally exposed to HIV in the workplace. It is called Post Exposure Prophylaxis, and has a 79% rate of success in preventing infection within 24-36 hours post-exposure. I have no problem with any hospitalist that chooses to use PEP if accidentally infected. The problem is when a person is knowingly infected and chooses to practice in an area where they can do real damage to others.
 
LVDoc said:
I don't care if I get flamed or not for writing this, but I completely agree with W222; s/he took the words right out of my mouth. The original poster's friend is obviously not thinking about the potential consequences of having a (sexual) relationship with this man. I seriously doubt she has thought through her what her experiences will be like when she finds her husband at the fate of his disease; unfortunately, he will most like pass away within the next 10-20 years. No matter how many antiviral cocktails the pharmaceutical industry is creating, inevitably this particular disease will expose its full-fledged share of symptoms, whether with old age or with a general trend of lacking immunity. Point is, not only will she come to outlive him, and have to bear through such a disheartening experience (read: multi-system failure) through the years of marriage with this man, she is also posing a risk to herself and to her children, which I am assuming she wants to have.

She is illogical for not reasoning this through completely. I would question anyone that would indeed voluntarily put themselves in this situation; she knew from the beginning that he was HIV+, so please, do not tell me a scenario in which a person develops an infection, disease, or disability years later, but is already married, in a relationship, etc - it is not the same type of analogy.

I also question this man's conscience; how could anyone knowingly, even amid permission from the other partner to engage in sexual activity, actually ever go through with it? He knows he will be full well responsible for transmitting it to her, and he himself will have to live through the rest of his own life bearing this guilt (hopefully this never happens).

Why is it so crazy that her own physician was against this? Hello? He is trying to protect her health. Your friend is irrational and immature. Although love is the single most critical component of a relationship/marriage, many other variables are also involved - including being realistic.

I don't know how anyone, any friend, could let a person knowingly go out with someone who is HIV+. It would be in my natural instincts to prevent my friend from harm, whether direct or indirect; I know I definitely would try to provide her any information I had about any possible worst case scenarios that could happen (partner-to-partner transmission, mother-to-infant transmission, etc.), as well as the likelihood of those occurances happening.

just curious do you feel this way just for HIV or also for Hep B and Hep C or other communicable diseases?
 
LVDoc said:
Any HIV-infected medical student is going to have some serious trouble being accomodated in clerkships; medical students or physicians that are HIV-infected should be restricted to practice in which they will not be exposed to bodily fluids.

There is only one mechanism that medical staff can use if accidentally exposed to HIV in the workplace. It is called Post Exposure Prophylaxis, and has a 79% rate of success in preventing infection within 24-36 hours post-exposure. I have no problem with any hospitalist that chooses to use PEP if accidentally infected. The problem is when a person is knowingly infected and chooses to practice in an area where they can do real damage to others.
is it mandatory that a med student disclose that?
 
Psycho Doctor said:
protected sex??? come on! use standard precautions with patients!!!! so you're saying someone with HIV or Hep C should not be a medical student??
Cmon Pscho, don't go nuts. Accidents happen, gloves tear, fingers get stuck with suture needles or scalpels. It's unfortunate, but it happens and doctors can transmit diseases to patients. Medical school requires that students perform some of the procedures where this is a risk. If there is a forseeable risk that the doctor or student could transmit were an accident to occur, that person ought not partake in the procedure. As is appropriate, this is why medical schools require students and doctors to be regularly tested for hepatitis and HIV. And very sadly yes, as I said before, I don't think medical students could ethically complete all of the requirements of medical school. HIV+ doctors could practice in most areas of most specialties, but there are certain procedures and certain specialties in which the risk of transmission to patients is prohibitively high. I wish it weren't the case, but it's the nature of our chosen profession.

(Yes, I meant "protected sex" because it's unsure enough to warrant extensive precautions.)
 
dopaminophile said:
Surgeons don't operate for several months after a needlestick from an HIV+ patient because it would be unethical to put the next patients at that risk.

That's not really true. If they take the prophylaxis there is almost a 0% chance they will contract HIV. I know a surgeon who had a needlestick from a positive patient and was back at work the next day. Probably the next hour, actually. He took the prophylaxis and was fine. The chances of getting HIV from a needle that is infected is something like 3% I think, and the prophylaxis can cut the risk by 50-80% if taken correctly, I believe. Which leaves us with a 1% risk of being infected, and if the surgeon cuts himself and then re-enters the open field, a 3% risk of his patient being infected. In all, about .03% of a chance that any exposure would result in transmission to the physician AND transmission to another patient.
 
I think my sentiments are fairly restricted to any communicable disease. The good thing about Hepatitis B though, is at least there is a vaccine. As I know of, there are no vaccines for Hepatitis C, and only a limited number of treatments for it (interferon therapy).

As for PEP, I think it is really only restricted to workplace infections, and generally the chance of a physician being exposed more than once in his or her lifetime is probably not too high. This girl's (the OP's friend) case though is completely different, since she would be repeatedly exposed to the virus through sexual activity, and also if infected, have a possibility of transmitting to someone else in the hospital. The point is, a physician who is infected is putting other people at risk; it's not an isolated case anymore, and accidents do happen.
 
I worked with an AIDS clinic and shadowed the surgeon. Now, that doesn't give me a whole lot of authority on the issue, but the surgeon I shadowed told me that his hospital's policy was that, after a needlestick or other high-probability exposure, the surgeon wasn't to operate until the patient was tested. If the patient was negative, the surgeon could operate but surgeon and patient had to be tested again at 1,3 and 6 months. If the patient tested positive, the surgeon could practice but couldn't operate for 6 months. Imagine the liability of the hospital if a physician were to transmit HIV to a patient.

The clinic I worked with told me the chances of transmittence from a needle stick were roughly 1/300. I'm sure that different studies have said different things.
 
indo said:
Let her do what she wants. She knows the risks and she knows what parts of a married relationship she has to give up in order to stay safe. I don't think I could handle knowing my wife was dying but perhaps she knows a better way to deal with it than I do.
Would I put it on my PS? hmm, perhaps. It is pretty ballsy to enter a relationship knowing ahead of time that you will have your heart crushed by witnessing the withering death of your spouse. If you want your PS to be original this might be the way to go since pretty much everyone has cured at least one disease and volunteered somewhere and did something that "changed their lives". Anyway, whatever.





Side note: Should a family practitioner be required to disclose his or her HIV+ status to patients?

I agree but when you're already in love it's very hard to abandon her also.

i sorta asked that about even med students
 
i am also shocked by people's responses. first of all, the question was not "do you agree with my friend's relationship," but rather "should she write about it" and so many of the replies are people making judgments about her relationship.

LVDoc said:
I don't know how anyone, any friend, could let a person knowingly go out with someone who is HIV+. It would be in my natural instincts to prevent my friend from harm, whether direct or indirect; I know I definitely would try to provide her any information I had about any possible worst case scenarios that could happen (partner-to-partner transmission, mother-to-infant transmission, etc.), as well as the likelihood of those occurances happening.

well that's very noble of you. however, i fail to see how you can treat someone with HIV as less than human. one of my closest friends is HIV+, and i would like nothing more than to see her find someone she can spend the rest of her life with. we don't know her fiance's history... whether it's his fault that he contracted the virus. what if he got it from a blood transfusion in 1983? (i had another friend when i was growing up who contracted HIV that way - she died before her 13th birthday.) why should he be subjected to a life alone when they could potentially be happy together, just because you think that people have no idea how to protect themselves. have some compassion for HIM too. (on a side note, i don't know this guy, or anything about their relationship either... just giving an alternate point of view here)

now back to the topic. should she write about it? if HIV is one of her primary reasons for going into medicine, she should absolutely write about it. i would think that it's definitely awkward to put it in the context of her relationship with the guy, but if the subject of HIV (esp. research, or relating to HIV patients) is important to her, and she's comfortable backing it up in interviews, then definitely go for it.
 
dopaminophile said:
Cmon Pscho, don't go nuts. Accidents happen, gloves tear, fingers get stuck with suture needles or scalpels. It's unfortunate, but it happens and doctors can transmit diseases to patients. Medical school requires that students perform some of the procedures where this is a risk. If there is a forseeable risk that the doctor or student could transmit were an accident to occur, that person ought not partake in the procedure. As is appropriate, this is why medical schools require students and doctors to be regularly tested for hepatitis and HIV. And very sadly yes, as I said before, I don't think medical students could ethically complete all of the requirements of medical school. HIV+ doctors could practice in most areas of most specialties, but there are certain procedures and certain specialties in which the risk of transmission to patients is prohibitively high. I wish it weren't the case, but it's the nature of our chosen profession.

(Yes, I meant "protected sex" because it's unsure enough to warrant extensive precautions.)

really? all schools? isn't that an invasion of privacy?
 
Believe me, her interviewers will definitely have a word or two with her. Whatever is written on a personal statement is fair game for interviews. Obviously, if it is a really personal experience (tragedy, death, etc.), they probably won't be inclined to talk so much about it, but this...

It is illegal to ask certain questions at an interview. I don't know if this has ever stopped an interviewer before, but certainly in my experience, things that I have mentioned on my personal statement were definitely brought up. She will be asked to explain her motivation to enter medicine at her interviews. How else will she put this in context unless she mentions her relationship? Red-flag.
 
LVDoc said:
I think my sentiments are fairly restricted to any communicable disease. The good thing about Hepatitis B though, is at least there is a vaccine. As I know of, there are no vaccines for Hepatitis C, and only a limited number of treatments for it (interferon therapy).

As for PEP, I think it is really only restricted to workplace infections, and generally the chance of a physician being exposed more than once in his or her lifetime is probably not too high. This girl's (the OP's friend) case though is completely different, since she would be repeatedly exposed to the virus through sexual activity, and also if infected, have a possibility of transmitting to someone else in the hospital. The point is, a physician who is infected is putting other people at risk; it's not an isolated case anymore, and accidents do happen.

there is no vaccine for Hep C but there are treatments: liver transplant but also pegalated interferon and ribavirin which for some genotypes is very effective.
 
LVDoc said:
Believe me, her interviewers will definitely have a word or two with her. Whatever is written on a personal statement is fair game for interviews.
that's true; i learned the hard way
 
myodana said:
i am also shocked by people's responses. first of all, the question was not "do you agree with my friend's relationship," but rather "should she write about it" and so many of the replies are people making judgments about her relationship.



well that's very noble of you. however, i fail to see how you can treat someone with HIV as less than human. one of my closest friends is HIV+, and i would like nothing more than to see her find someone she can spend the rest of her life with. we don't know her fiance's history... whether it's his fault that he contracted the virus. what if he got it from a blood transfusion in 1983? (i had another friend when i was growing up who contracted HIV that way - she died before her 13th birthday.) why should he be subjected to a life alone when they could potentially be happy together, just because you think that people have no idea how to protect themselves. have some compassion for HIM too. (on a side note, i don't know this guy, or anything about their relationship either... just giving an alternate point of view here)

now back to the topic. should she write about it? if HIV is one of her primary reasons for going into medicine, she should absolutely write about it. i would think that it's definitely awkward to put it in the context of her relationship with the guy, but if the subject of HIV (esp. research, or relating to HIV patients) is important to her, and she's comfortable backing it up in interviews, then definitely go for it.
i sorta said the same thing without mentioning specific examples. The whole thing really pisses me off as this hits very close to home.
 
myodana said:
well that's very noble of you. however, i fail to see how you can treat someone with HIV as less than human. one of my closest friends is HIV+, and i would like nothing more than to see her find someone she can spend the rest of her life with. we don't know her fiance's history... whether it's his fault that he contracted the virus. what if he got it from a blood transfusion in 1983? (i had another friend when i was growing up who contracted HIV that way - she died before her 13th birthday.) why should he be subjected to a life alone when they could potentially be happy together, just because you think that people have no idea how to protect themselves. have some compassion for HIM too. (on a side note, i don't know this guy, or anything about their relationship either... just giving an alternate point of view here)

I did not imply that this person should be considered as sub-human. You're on the verge of mentioning discrimination of some sorts, as I can see from your response, but you are dealing with a sexually transmitted disease here. There was one guy out on the east coast recently that had a super-resistant, super-virulent strain of HIV and infected >100 people. I suppose he should be free to have fun too, right? Especially when 94% of the people who contract AIDS die within five years on average.

I have seen cases of two HIV+ people in relationships, but never an HIV+/HIV- partner. In the former case, since they are both infected, there is no real defined risk in terms of transmission (unless one partner is infected with a mutant strain, and that could pose problems). In the latter case, as I said, risk of transmission is key.

"Just because you think they have no idea how to protect themselves." What? Read the abstract I posted a page prior to this. It very well shows that even with protection (excluding abstinence), there is a degree of risk involved.
 
This is a general reply to multiple posters comments- so no one take one particular comment as ment for "you"...
I think this friend is perfectly capable of loving an HIV+ person and entering a mature relationship with that individual--- IF she is properly educated and prepared to take extra precautions, should the relationship become sexual, and prepared for the consequences if those precautions fail. I don't think she is either a good or bad person for chosing to enter or decline such a relationship. Many people (not saying anyone on this forum) see HIV+ people as individuals that routinely make bad decisions and routinely enter into questionable sexual relationships. But, sometimes people (both guys and girls) make a questionable decision to sleep with someone and ended up HIV+ from that, and its even possible that both parties didn't even know the HIV+ person had HIV at the time.

Anyway, and off my soapbox now, I don't think anyone should judge her for wanting to enter a longterm relationship with this HIV+ person, as long as she is aware of the proper precautions, ect. to take.

Now, about bringing it up in a personal statement or interview... I'm not sure I would directly volunteer the info just because you don't know any weird bias of that adcom, but if asked about a challenging situation and this seemed to fit the answer, then yes, volunteer the information. If you are worried that this knowledge might affect your admissions, mention it as a friend, but not a significant other. The other thing about whether to include it in a personal statement--- I don't know, I wouldn't, because the personal statement should be about me and my abilities. Not about my relationship with someone... I mean if this guy were your average joe, would you include him? I might mention close interactions, relationships, something along those lines, but still make sure the statement is about her... you aren't trying to get him admitted.

Again, if I missed something, I apologize, I read the first page and had so much to say, and I didn't mean to offend anyone, so I hope that was the case!!
 
criminallyinane said:
Oh no you din't! This post is 37 kinds of wrong. How dare you talk about people with HIV as if they are animals, sub-humans not deserving of being considered regular people who want to be in relationships? Who made these rules that it is "okay" to be friends with someone with HIV but UNFORGIVABLE to think about marrying one? Are you really as closed-minded and prejudiced as you come across in your post? I am scared for your patients and colleagues if you ever get into medical school.

I understand this is SDN and everyone is trying to be idealistic, but there needs to be a line drawn. Having sex with an HIV victim is F*****' CRAZY! I feel bad for the man because he doesn't deserve it and the OP's friend is a sweetheart for showing love. I just can't believe I'm the only one here who thinks it's attempted murder even if it is protected sex. I hope they do get happily married, but I pray she just doesn't do anything dangerous.

Sorry if I didn't make it clear, but I'm assuming "marriage" is equivalent to a "long term sexual relationship." If not, why can't they just continue being "good friends" without exchanging vows? I didn't mean to come across as a close-minded pig. Given my definition of marriage, "I am scared for your patients and colleagues if you ever" support intercourse between a positive and negative.
 
LVDoc said:
... but you are dealing with a sexually transmitted disease here. There was one guy out on the east coast recently that had a super-resistant, super-virulent strain of HIV and infected >100 people. I suppose he should be free to have fun too, right?

please try not to put words in my mouth - i never said that anybody with HIV should freely spread it around and do whatever they want... i said that they can have a relationship.

LVDoc said:
I have seen cases of two HIV+ people in relationships, but never an HIV+/HIV- partner.

well, i have. and as much as you might not believe it, there are people out there who have relationships with HIV+ people and do not contract the virus. you have to be careful, as i'm sure you already know.

LVDoc said:
Read the abstract I posted a page prior to this. It very well shows that even with protection (excluding abstinence), there is a degree of risk involved.

i could go into a whole list of alternatives... but i'll leave you to search goofyfootpress.com and those other fun websites for fun safer sex info.
 
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