Friend is HIV+ applicant -- disclose or not disclose?

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inhiding

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In January 2007, one of my close friends was criminally and negligently infected with HIV. He's also an incredibly smart guy -- MCAT 35 last year, great grades, ECs, etc. He's one of the nicest people you'd ever meet. And he's applying to medical school. I can hardly imagine a better physician, myself -- he has all the right qualities and brains.

Anyway, I'm reasonably sure he's already decided to disclose his HIV status to his schools, and it's really none of my business, but part of me thinks that this just isn't a great decision. He is not REQUIRED to disclose HIV status until after matriculation (as far as I understand) and I guess there are some rules protecting discrimination against HIV+ applicants. But don't you think there are some schools who would just pass him over by not inviting him for an interview due to a 'limited number of seats for many qualified applicants'? Or, in an interview, suppose he got an aggresive/opinionated interviewer who just grilled him about his status? What challenges might my friend face in the application process?

My friend thinks that it's a matter of educating others about HIV but, as a friend, naturally my instinct is to protect him from doing something that might either hurt his application or cause him a lot of emotional distress in the interview process :(.

Thoughts?

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While it may not be his fault, applying to medical school with HIV seems kind of negligent on his own part--he has to be trained for 7+ years in an environment full of diseases and also carries the unique attribute of being a risk to his patients. The potential for his immune system to collapse and die is enormous in this situation and would ultimately mean that he took a seat that somebody else who does not face these challenges could have taken. I know med schools arent supposed to discriminate based on health status and whatnot, but sometimes certain career paths become inaccessible because of our life situations. Why not go for a PhD with medical applications?
 
While it may not be his fault, applying to medical school with HIV seems kind of negligent on his own part--he has to be trained for 7+ years in an environment full of diseases and also carries the unique risk of being a risk to his patients. The potential for his immune system to collapse and die is enormous in this situation and would ultimately mean that he took a seat that somebody else who does not face these challenges could have taken. Why not go for a PhD with medical applications?

OK -- Schools DO take measures to protect both patients and HIV+ med school students. The exact procedure for rotations depends on the school, the student, and the advice of the student's physician. He's DETERMINED to be a physician and he'd be a GREAT one. I have never MET anyone like him before.

Don't suggest other pathways, please. This is a decision he's arrived at with quite a bit of thought.
 
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As far as I know most admissions committees consist of a panel of voting members. Regardless of legality, morality or fairness, the chances that him being HIV+ will have a negative impact on some members' votes is greater than the chance that it will have a positive impact (at best it will make no difference, at worst it will put him at a disadvantage). If he doesn't need to disclose until after matriculation and he's trying to give himself the best chance of being admitted to medical school then maybe he should just not say anything about it right now.
 
imo, I don't think medicine would be the right occupation for him. For one thing, to spend more years in a grueling state of studying and stress wouldn't be the best way to live his remaining years. Although there's a small possibility that his strain will respond well to medication, he should not waste his time hoping/praying.

He should reconsider his entire philosophy on life, and if he wanted to make a difference, he wouldn't have to go into medicine. He could become a public speaker or advocate or something.

http://www.usatoday.com/news/world/2008-08-03-kids-aids_N.htm

"MEXICO CITY (AP) — Keren Dunaway was 5 when her parents used drawings to explain to her that they both had the HIV virus — and so did she. Now the 12-year-old is one of the most prominent AIDS activists in Latin America and a rarity in a region where few children are willing to break the silence and tell their classmates they have HIV for fear of rejection. She edits a children's magazine on the virus."
 
While I agree that it probably isn't the wisest decision (the disclosure- clarification), you really aren't going to be able to put yourself in his shoes. If your friend has accepted his situation and is willing to accept the challenge of applying openly as an HIV+ applicant, then go ahead and support him through it because you clearly understand that it is going to be a difficult road.
 
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As far as I know most admissions committees consist of a panel of voting members. Regardless of legality, morality or fairness, the chances that him being HIV+ will have a negative impact on some members' votes is greater than the chance that it will have a positive impact (at best it will make no difference, at worst it will put him at a disadvantage). If he doesn't need to disclose until after matriculation and he's trying to give himself the best chance of being admitted to medical school then maybe he should just not say anything about it right now.

Thank you for your response -- that's EXACTLY what I'm worried about :(



And for those of you suggesting other pathways -- DON'T.

He's not changing his mind nor do I think he should. He doesn't have to do a surgical specialty for crying out loud.
 
OK -- Schools DO take measures to protect both patients and HIV+ med school students.
That's fantastic, but no matter what they do, he's going to be at a much higher risk of infection than anyone else. What's he going to do during residency? Walk around in a bio suit every day? It's obviously his prerogative to do whatever profession he wants, but deliberately putting yourself in extended daily contact with loads of resistant pathogens when you're immunocompromised sounds pretty unwise to me.

If I were him, I'd avoid mentioning HIV until I absolutely had to. I agree with kdburton that it's more likely to hurt his chances (severely) than help him.
 
If he is not required to disclose, he should not. I agree with you fully.

And for the people giving unasked for advice about what *his* future should entail, shut the hell up.
 
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^MilkmanAl, while I take your point about pathogens...you have to understand: this guy has wanted to be a physician FOREVER. It is what gives his life meaning.

So it's mildly ludicrous to say that, with the available medications we have today, he'd be 'better off not going into medicine.'

He works in a healthcare setting right now for the record.
 
OK -- Schools DO take measures to protect both patients and HIV+ med school students. The exact procedure for rotations depends on the school, the student, and the advice of the student's physician. He's DETERMINED to be a physician and he'd be a GREAT one. I have never MET anyone like him before.

Don't suggest other pathways, please. This is a decision he's arrived at with quite a bit of thought.

Regardless of how determined he is, he is still a risk and is still taking a seat that could be occupied by somebody with a better life expectancy. This is reality. Does this mean he cant do a fulfilling important job for society that involves healing/helping people? Absolutely not. It just means that the MD/DO route is not a very viable option for him anymore. Maybe, as his friend, you should try to get him to weigh things out very carefully and seriously consider a career in research or public healthy policy etc.
 
If he does go the disclosure route, he should expect to be grilled mercilessly at his interviews. This is something that is a major concern and he needs to be able to show that he won't let it affect his performance or the interaction with his classmates.

Things to consider.
As mentioned above, he'll be around a lot of sick people, during residency.

Also, I nicked myself more times than I could count during anatomy lab. Not a huge deal for me. How does he plan to handle this? How does he plan to handle his lab partners when they see him bleeding in anatomy lab?
 
Regardless of how determined he is, he is still a risk and is still taking a seat that could be occupied by somebody with a better life expectancy. This is reality. Does this mean he cant do a fulfilling important job for society that involves healing/helping people? Absolutely not. It just means that the MD/DO route is not a very viable option for him anymore. Maybe, as his friend, you should try to get him to weigh things out very carefully and seriously consider a career in research or public healthy policy etc.

I think people like you are probably what fuel his desire to educate others about HIV. The life expectancy for HIV+ individuals who consistently take medication (as he does) is about the same as other individuals. He's active and you'd never know he has HIV unless he told you.

No way in hell I'd tell him to change careers.

And THANK YOU, Retsage. It's so hard to hear these things about a close friend, you know :( Even if it is just the 'internets'.

I mean, you just have to meet him. He's...really amazing. I feel like I'd be lucky to have him as my doctor. (I think he wants to be a family physician of some kind).
 
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Thank you for your response -- that's EXACTLY what I'm worried about :(



And for those of you suggesting other pathways -- DON'T.

He's not changing his mind nor do I think he should. He doesn't have to do a surgical specialty for crying out loud.

See this speaks ignorance and denial to me. For you to be so steadfast about this but not really be able to back it up (why should a med school admit someone with a known terminal disease that causes immune system fragility?) tells me you two have not really thought this out as fully as you should have.

To answer the question, this needs to be disclosed to be fair to the adcoms as I imagine they will be quite shocked/pissed if they find this out after he has been accepted. Better to let them know up front, even if it does hurt his chances.
 
^MilkmanAl, while I take your point about pathogens...you have to understand: this guy has wanted to be a physician FOREVER. It is what gives his life meaning.

So it's mildly ludicrous to say that, with the available medications we have today, he'd be 'better off not going into medicine.'

He works in a healthcare setting right now for the record.
Actually, I think it's pretty ludicrous to suggest that he wouldn't be better off not going into medicine. Medications are just a stall.
 
Also, I nicked myself more times than I could count during anatomy lab. Not a huge deal for me. How does he plan to handle this? How does he plan to handle his lab partners when they see him bleeding in anatomy lab?

Yeah, it's a consideration. From what I can tell, schools will often either exempt him from certain rotations/classes or have him do other rotations in lieu of the ones he misses. Schools often have specific policies in place for HIV+ individuals, I think. Just as they do for blind, deaf, or physically handicapped individuals. I admit I don't know the details.
 
I think people like you are probably what fuel his desire to educate others about HIV. The life expectancy for HIV+ individuals who consistently take medication (as he does) is about the same as other individuals. He's active and you'd never know he has HIV unless he told you.

No way in hell I'd tell him to change careers.

And THANK YOU, Retsage. It's so hard to hear these things about a close friend, you know :( Even if it is just the 'internets'.

I mean, you just have to meet him. He's...really amazing. I feel like I'd be lucky to have him as my doctor. (I think he wants to be a family physician of some kind).

He is not going to be in a "normal" situation. He is going to be on 30+ hour shifts with little sleep around disease-ridden people. No matter how many antivirals he is on, his immune system is still going to be suppressed like all other med students simply by the extremely exhausting process of residency/clerkships, which, when combined with his condition, is not good.
 
Sorry to hear about your friend's dillemma. I didn't know that medical schools would take HIV+ applicants, I assumed it would be a patient safety concern. Anyhow, if you are looking at it from a purely "highest chances" perspective he probably shouldn't mention it. If he has reasons to do so that outweigh that, then he probably should. It's really his decision.

By the way, what specialty or career path is your friend interested in?
 
Why should a med school admit someone with a known terminal disease that causes immune system fragility?

Other than the fact that he's a perfect candidate apart from the HIV? He has a greater degree of maturity/kindness than almost anyone I've ever met.

Well, I'm going to stop posting for a while. I've given a picture of the situation so I'll just sit back for a while.
 
People with HIV can live very long and productive lives nowadays and I presume it will only get better in the coming years. He doesn't necessarily have to go into fields where he'll be exposed to pathogens regularly. He could go into psych, radiology, pathology, etc.

I don't think he should disclose his status until it is necessary. Just like on this thread he will likely face unfair judgement from adcoms.
 
Other than the fact that he's a perfect candidate apart from the HIV? He has a greater degree of maturity/kindness than almost anyone I've ever met.

Well, I'm going to stop posting for a while. I've given a picture of the situation so I'll just sit back for a while.

I am not arguing against his qualifications, but to suggest he is more qualified than everyone else and thus deserves to have this critical aspect of his health overlooked seems a tad ignorant dont you think?
 
Regardless of how determined he is, he is still a risk and is still taking a seat that could be occupied by somebody with a better life expectancy. This is reality. Does this mean he cant do a fulfilling important job for society that involves healing/helping people? Absolutely not. It just means that the MD/DO route is not a very viable option for him anymore. Maybe, as his friend, you should try to get him to weigh things out very carefully and seriously consider a career in research or public healthy policy etc.

I think life expectancy is not the most concerning factor here. People with HIV are now living for much, much longer with the new antiretrovirals. There's no reason this guy should put his life on hold when he could easily live to the point of normal retirement, especially with new advances being made all the time. Do you tell people who are in their 30s that they shouldn't take up a spot in medical school because they're taking it away from a 23 year old who has a greater life expectancy? I think if you're going to harp on ANYTHING, it should be that HIV is transmissible and there could be an accident.

To the OP - In terms of your friend disclosing his HIV status, I think that it will probably close some doors. Some schools will not want to open themselves up to the liability of having someone with HIV working with patients. However, perhaps that's for the best. If your friend does get in, he will likely get in to a school that is willing to work with him and will be sure that he takes the appropriate precautions, etc, to keep himself and others safe. I think that if he does this he needs to be aware that he's going to probably have some rough interview experiences, as I can imagine that interviewers might focus on his HIV rather than his achievements. Also, I'm curious as to how he's planning on telling schools about his HIV status - is he writing it in his PS?
 
Yeah, it's a consideration. From what I can tell, schools will often either exempt him from certain rotations/classes or have him do other rotations in lieu of the ones he misses. Schools often have specific policies in place for HIV+ individuals, I think. Just as they do for blind, deaf, or physically handicapped individuals. I admit I don't know the details.

I'm pretty sure he'll still have to do anatomy lab and surgery... or at least be responsible for the content.
 
Also, I nicked myself more times than I could count during anatomy lab. Not a huge deal for me. How does he plan to handle this? How does he plan to handle his lab partners when they see him bleeding in anatomy lab?


How will they handle future HIV+ patients?

I've cut myself plenty of times, I've never once bled into someone else's wound, though. Hell, I don't think I've ever once dripped onto someone else at all. When you nicked yourself, did the blood get everywhere? Gush out, hit your lab partner in the eye? Of course not.

He'll need to take precautions, no doubt. As will his lab mates. But these are not major precautions. Wear gloves, avoid direct contact with the blood, and they'll be fine.
 
Also, I'm curious as to how he's planning on telling schools about his HIV status - is he writing it in his PS?

I'm not sure if he wrote it in his PS. My instinct is to say 'yes'. I KNOW for sure that he's writing about it in secondaries.
 
(why should a med school admit someone with a known terminal disease that causes immune system fragility?)

Just to play devil's advocate....at what point would you suggest they draw the line? They won't accept somebody with a compromised immune system, but a terminal illness is ok? Or is a terminal illness not alright, but maybe some other chronic illnesses are? Nobody with a blood-borne pathogenic disease can go? Or only ones that are highly infectious aren't allowed in?

You could argue this multiple ways, really. But I figure so long as they don't take away the licenses of physicians who have HIV or Hep C or whatever, they shouldn't have problems admitted students who have those illnesses.

And OP, for the sake of your friend, I would suggest he not disclose until absolutely necessary. Kind of a don't ask, don't tell policy. I'm afraid that the ADCOMs might see his disease, and not him, and that won't serve him well.
 
He doesn't necessarily have to go into fields where he'll be exposed to pathogens regularly. He could go into psych, radiology, pathology, etc.

How is someone in pathology not exposed to pathogens. That's exactly what they are looking for/working with. You periodically hear about someone in the path lab not closing the lid on something tight enough and the whole lab getting sick...
 
Edit: Posted too late...
 
To answer the question, this needs to be disclosed to be fair to the adcoms as I imagine they will be quite shocked/pissed if they find this out after he has been accepted. Better to let them know up front, even if it does hurt his chances.


And he should care, why?

They cannot remove him from the program once he is in for this - discrimination. They can select against him though, and then cite a myriad of other reasons.



Oncology would also be fine. As would be working in HIV clinics, where they keep everything very sanitary.
 
In January 2007, one of my close friends was criminally and negligently infected with HIV. He's also an incredibly smart guy -- MCAT 35 last year, great grades, ECs, etc. He's one of the nicest people you'd ever meet. And he's applying to medical school. I can hardly imagine a better physician, myself -- he has all the right qualities and brains.

Anyway, I'm reasonably sure he's already decided to disclose his HIV status to his schools, and it's really none of my business, but part of me thinks that this just isn't a great decision. He is not REQUIRED to disclose HIV status until after matriculation (as far as I understand) and I guess there are some rules protecting discrimination against HIV+ applicants. But don't you think there are some schools who would just pass him over by not inviting him for an interview due to a 'limited number of seats for many qualified applicants'? Or, in an interview, suppose he got an aggresive/opinionated interviewer who just grilled him about his status? What challenges might my friend face in the application process?

My friend thinks that it's a matter of educating others about HIV but, as a friend, naturally my instinct is to protect him from doing something that might either hurt his application or cause him a lot of emotional distress in the interview process :(.

Thoughts?

Wow. What a toss up! Normally, I'd say his status is his personal business but he's going into the field of medicine so it's a whole different ballpark. Yes, there is medication but like most posters said, he's at an increased risk but I digress...

So, to answer your question, if he doesn't have to disclose his HIV status, I'd keep it to myself until I had to. They say you won't be discriminated against but we all know that's a load of ish. Kind of like the "ex-con" who applies for a job, although the app says, "...this admittance will not affect your app...", we all know his app is doomed after he admits he's an ex-con, stole something, etc. Fair? No, but life isn't fair so if he really wants to be a physician, I suggest he keep it to himself until he's asked to disclose.
 
But I figure so long as they don't take away the licenses of physicians who have HIV or Hep C or whatever, they shouldn't have problems admitted students who have those illnesses.

According to what I've read on-line (policies at Georgetown and Northwestern), there are similar policies for Hep B and HIV med students. Just thought I'd add that little tidbit.
 
How will they handle future HIV+ patients?

I've cut myself plenty of times, I've never once bled into someone else's wound, though. Hell, I don't think I've ever once dripped onto someone else at all. When you nicked yourself, did the blood get everywhere? Gush out, hit your lab partner in the eye? Of course not.

He'll need to take precautions, no doubt. As will his lab mates. But these are not major precautions. Wear gloves, avoid direct contact with the blood, and they'll be fine.

the problem with anatomy lab is that the tools are the same tools you use all year long...

so, the scissors I nick myself today with might be the exact same scissors you nick yourself with tomorrow... and they don't exactly get autoclaved overnight.

starting to catch my drift?
 
Just like to reiterate that my friend ALREADY works in a healthcare setting. It's part of his 40-hour-a-week job. He also works a second job.

He's a strong guy mentally and physically (in spite of the HIV).
 
the problem with anatomy lab is that the tools are the same tools you use all year long...

so, the scissors I nick myself today with might be the exact same scissors you nick yourself with tomorrow... and they don't exactly get autoclaved overnight.

starting to catch my drift?

Well...so then they'd presumably autoclave HIS scissors, right? Wouldn't that be simple enough? :confused: I dunno. I admit I don't know the details.

As Retsage suggested, they're not going to be asking him to "Please cut open this animal and wave it around next to your partner."
 
I know an HIV+ ID doc who works with HIV+ patients...

Yeah, I think my friend is definitely interested in doing that. Because he has had to face the challenges.
 
He doesn't have to do a surgical specialty for crying out loud.

But at most med schools he will have to do a surgical rotation. And OBGYN and IM, etc. And surgeons are not the only ones sticking themselves BTW. EM, Anesthesia, IM, OBGYN also report their share of needle sticks.

And for most of the non-hands-on specialties like eg rads, rad-onc, etc, you have to do a year of medicine or surgery internship. Not that accomodations couldn't be made if the school/residency knew about it ahead of time and chose to take precautions, but it's not something you really want to keep a secret.

The liability for a hospital if a patient gets HIV from a doctor are potentially limitless. Your friend would be a disaster to try and insure if he were just allowed to work the wards and play with sharps like the typical med student/resident. No insurer would cover the hospital for this. So this is absolutely something they need to know ahead of time, because what they allow this guy to do and still graduate may be a bit involved. So I agree with your friend, he can still pursue his dream, but needs to make sure everybody is on the same page. Not to mention that in a field where everybody hopes to be "helping people" it is going to be pretty lousy if you in fact end up giving somebody a potentially deadly virus.
 
the problem with anatomy lab is that the tools are the same tools you use all year long...

so, the scissors I nick myself today with might be the exact same scissors you nick yourself with tomorrow... and they don't exactly get autoclaved overnight.

starting to catch my drift?


The HIV virus dies in a few seconds when exposed to air. Moreover, he can easily clean the tools with rubbing alcohol. It takes about fifteen seconds, and solves all of your problems. As I said, there may be a few necessary precautions, but they would take very little to implement. We're not talking about prions or Ebola here. We're talking about a disease that involves blood-to-blood transmission. Until you start having sex with your lab partners, or have them bleed inside you, I think you'll be okay. This is paranoia, quite frankly, and it's not quite befitting a profession where you'll be exposed to people with many of these sorts of diseases.

Really, you're making a mountain out of a mole hill. The only worthwhile argument is that the added stress could cripple his immune system further, but, quite frankly, if his mind is set on going, that is his prerogative, and I'll wish him luck for it. He is not a danger to others. I'm not in the business of telling people to give up on their dreams because they could hurt themselves. Where would we get astronauts if that was the case?
 
But at most med schools he will have to do a surgical rotation. And OBGYN and IM, etc. And surgeons are not the only ones sticking themselves BTW. EM, Anesthesia, IM, OBGYN also report their share of needle sticks.

And for most of the non-hands-on specialties like eg rads, rad-onc, etc, you have to do a year of medicine or surgery internship. Not that accomodations couldn't be made if the school/residency knew about it ahead of time and chose to take precautions, but it's not something you really want to keep a secret.

The liability for a hospital if a patient gets HIV from a doctor are potentially limitless. Your friend would be a disaster to try and insure if he were just allowed to work the wards and play with sharps like the typical med student/resident. No insurer would cover the hospital for this. So this is absolutely something they need to know ahead of time, because what they allow this guy to do and still graduate may be a bit involved. So I agree with your friend, he can still pursue his dream, but needs to make sure everybody is on the same page. Not to mention that in a field where everybody hopes to be "helping people" it is going to be pretty lousy if you in fact end up giving somebody a potentially deadly virus.

OK and I will reiterate one LAST time that schools have accomodations to protect the safety of both the med students and the patients. Yes, it would be helpful if I could bring them into the discussion and we could argue day and night as to whether they're successful/effective or not, but that's NOT what I was asking about.

My question was: What challenges might he face in the application/interview process??

Yes, he would be forced to disclose his serostatus AFTER matriculation but NOT before. That is the issue I was trying to bring up.
 
I imagine he'll face the same challenges as he sees in this thread, albeit in a much more political manner. Or perhaps doctors are more acclimated to people with HIV due to exposure with them. I suppose it depends on who his interviewers are.

Want to scare him off from writing about it, though? Just have him peruse this thread and understand that if he is superbly lucky to be interviewed by faculty with a lot of experience and little paranoia, he'll also likely be interviewed by a medical student who thinks much like the ones here.
 
I could see this making for a good personal adversity essay, but I'd just as soon not mention it if it were me. It IS a patient safety concern, after all.

By the way, your argument that he's so kind/mature/compassionate/etc and would make a great doctor sounds completely disconnected from reality. Compassion only goes so far - a good physician requires many other traits. I'm sorry for your friend, and wish him the best. I hope he does realize the tough path he has ahead and is prepared to deal with it. I can't imagine dealing with med school along with HIV treatments.
 
The HIV virus dies in a few seconds when exposed to air. Moreover, he can easily clean the tools with rubbing alcohol. It takes about fifteen seconds, and solves all of your problems. As I said, there may be a few necessary precautions, but they would take very little to implement. We're not talking about prions or Ebola here.

good to know... haven't reached that chapter in I&I yet.
 
Just like to reiterate that my friend ALREADY works in a healthcare setting. It's part of his 40-hour-a-week job. He also works a second job.

He's a strong guy mentally and physically (in spite of the HIV).

Well HIV doesn't mean he'll have mental and physical degeneration right now....just because he's been fine for 2 years doesn't mean he won't have problems down the road. I'm not trying to discourage you/your friend, but some of these arguments for his ability to be a physician are a bit illogical.
 
I imagine he'll face the same challenges as he sees in this thread, albeit in a much more political manner. Or perhaps doctors are more acclimated to people with HIV due to exposure with them. I suppose it depends on who his interviewers are.

Want to scare him off from writing about it, though? Just have him peruse this thread and understand that if he is superbly lucky to be interviewed by faculty with a lot of experience and little paranoia, he'll also likely be interviewed by a medical student who thinks much like the ones here.

Yeah, it's a little late in the game. I think it was mentioned in his PS and I know he's writing about it in secondaries...although he hasn't submitted some of them. I just worry about him, that's all. I'm reasonably sure he's already committed himself to telling the his schools.

But I could totally see some ADCOM grilling him on this issue and not asking him about all of the volunteer work that he's been committed to for so long :( He really is a superb candidate -- he's had to face life challenges I could only ever start to imagine and he's faced them all with enormous integrity (this isn't the place for me to give his bio, I suppose).

Well, we'll see what happens. He's a very smart guy and he's lived with HIV for a while, so perhaps he's ready to be open about his status and live with any problems he's going to face.

My question is: Will he have the chance to face them after ADCOMs find out?
 
I can't imagine dealing with med school along with HIV treatments.

Try being Andy Bell of Erasure! He's been diagnosed HIV+ since 1998, and has toured internationally many times since then. Anyone who's ever seen an Erasure show knows the energy that Andy is capable of, and he does that night after night while on tour.
 
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