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

[Law2Doc]

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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 think you are assuming that such accommodations are already in place and won't present issues if he waits to reveal. I don't think this is true everywhere, (or even at most places) and it definitely will take time for places to figure out how they want to handle things (in meetings, with insurers, etc) to make the necessary adjustments. A lot of schools outright ask if you have any condition that would necessitate accommodations. I seem to recall, when applying to med schools, filling out forms indicating that I had no preexisting physical disabilities or conditions and foresaw no issues with completing my medical school education as currently in place. And again when completing applications for residencies they ask a similar question. So the goal of schools is not to have this sprung on them upon matriculation, nor does that seem particularly reasonable.

So I gotta believe your friend is playing it safe/smart by making sure that any school that accepts him isn't going to give him any issues down the road. Will that result in fewer acceptances? Probably. But honestly, the folks who were going to reject him rather than make accommodations are those same folks who are going to give him a hard time once he's there, so you are better off learning this now.

 

[StIGMA]

I have not read the rest of the posts. This is the Medical College of Georgia's statement on HIV/AIDS:

STATEMENT ON HIV (AIDS)
The Medical College of Georgia School of Medicine encourages medical
school applicants who believe they are at risk for HIV infection to seek
HIV testing and counseling prior to admission. Depending on the stage
of one's HIV infection, persons who test HIV positive may wish to
reconsider their career goals because of:
1. the prolonged period of medical education and the significant
possibility that they may become disabled during training or early in
their career:
2. the infectious hazards of certain portions of medical education and
practice;
3. barriers to certain invasive clinical activities and fields of
specialization because of possible hazards to patients; and,
4. the financial cost of medical education.
Any School of Medicine student who knows or has reason to believe that he/she has HIV infection is required to report this information immediately to the Dean of the School of Medicine and Hospital Epidemiology. Failure on the part of a student to report a known HIV infection may result in disciplinary action, up to and including dismissal.


Hope that helps. Policy may differ at other schools.

 

[203712]

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).

Take a look at the response you have from this thread, since many here will be future doctors, it is the response you can expect from Adcoms.

seems like more then half think its wrong for your friend to get into this, and a select few think its cool. With that in mind, seems obvious to me that disclosing this information will hurt him.

BTW, all we are going by is your assertions that your friend is the awesome, but I wonder how he writes his own story. I think hearing it second hand gives it less power you know? and maybe he can depict his dream of becoming a physician and only a physician better then you can. IDK, why doesn't he come on this form and discuss it? Or is he incognito, inhiding?

 

[MaseratiGT]

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?

I agree with all of your posts.

We are working with infectious diseases everyday. The point of universal precautions isn't just for the safety of the physicians.

I don't know about you guys, but when I'm in anatomy lab, I'm assuming that ALL of the lab partners I'm working with have something I don't want. So, I take precautions to protect myself from all of you anyway.

 

[inhiding]

^L2D, yeah, we've had to check of checkboxes under 'technical standards' and/or sign that we've read them, but to the best of my knowledge he'd pass them...(I don't really remember, I have to admit I haven't read them very closely).

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102179677.html

Pretty informative. I'm not sure how on earth I'm going to bring this up to him without sounding insensitive. On the other hand, I'm sure by now he's aware of public opinion re: HIV status.

The related question is, of course: Do you tell your patients if you're an HIV+ physician?

 

[Sunfire]

Take a look at the response you have from this thread, since many here will be future doctors, it is the response you can expect from Adcoms.

To think that pre-meds or students are anywhere near being an Adcom is pretty laughable. Most in this thread are plainly uneducated about the HIV virus. Trust me that if you had HIV, you wouldn't want those posters as your Doctors.

 

[inhiding]

BTW, all we are going by is your assertions that your friend is the awesome, but I wonder how he writes his own story. I think hearing it second hand gives it less power you know? and maybe he can depict his dream of becoming a physician and only a physician better then you can. IDK, why doesn't he come on this form and discuss it? Or is he incognito, inhiding?

Yeah these are all really good questions.

(1) I have no idea how he's writing about it. I think he's having some trouble with secondaries. I totally agree that the writing/story can make or break the application.

(2) A lot of what I know about his desire to be a physician he's told me personally. But it's not even just what I hear him say. It's the way that I see him interact with patients, with irate healthcare personnel, insensitive doctors, abusive family. He's borne it all with the greatest integrity and consideration for others. He PREFERS to think about other people's problems and help them. He's not the type of guy to sit around feeling sorry for himself.

(3) I didn't want to bring him into this discussion because I feel that a significant portion of SDN pre-allo consists of semi-insensitive snobs that may or may not have good advice. NOT ALL, of course. There's a reason I'm posting here -- for the ones who AREN'T insensitive and ARE willing to give good advice. But enough SDN pre-allo posters are insensitive to the point where I would have a difficult time recommending this source to him directly. For example, I don't think my friend would benefit in the slightest from the "try another profession" crap. He's thought this through. He's not going to change his mind. Certainly, the last thing in the world I want to do is give identifying information about my friend.

 

[Depakote]

I did a quick google search and only found the Northwester policy that you already mentioned. I would suggest your friend look at the specific sites or contact the individual schools he's applying to (possibly anonymously) and request information regarding HIV+ applicants. Either way, as L2D mentions, this would be something the school would appreciate knowing about ASAP prior to matriculation so if they need to arrange accommodations, they can... but my gut says mentioning it during the application process is probably going to bring forward more "thanks but no thanks" responses than someone with his stats should get.

 

[Sunfire]

Maybe find out where this Dr. went to school?

http://www.thebody.com/content/art45995.html

 

[inhiding]

Maybe find out where this Dr. went to school?

http://www.thebody.com/content/art45995.html

Yeah, I'll give my friend his e-mail address (posted at the bottom of the page). That's a great idea. Thank you for your posts, Sunfire. They've been nothing but helpful.

 

[beachblonde]

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.

What you said here is definitely not common knowledge; I don't think people realize that HIV is only BSL-2 (along with, say, the flu).

I agree with the advice that people gave about contacting schools regarding this policy; your friend can do it rather anonymously over the phone ("Hi, I'm applying, can you tell me what the policy is on HIV+ applicants and disclosing their status?"). It would behoove him to follow each school's individual policy.

It might be a little naive of me to say this, but I would hope that if your friend has a strong application, he would get in somewhere. Not that any school would ever own up to rejecting him because of his HIV status (talk about getting in trouble with that).

 

[Depakote]

Realistically, your friend should brace himself for rejection.

Plenty of applicants get rejected for small flaws in their application. In an application environment this competitive, it could be possible that your friend gets passed over simply due to his HIV status, whether it's stated or not. I'm not saying it's right or fair, but he should be ready for that possibility.

 

[smq123]

The potential for his immune system to collapse and die is enormous in this situation

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.

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.

(why should a med school admit someone with a known terminal disease that causes immune system fragility?)

😕😕😕 What are you people talking about?!

The friend in question has HIV, NOT AIDS. There's a crucial difference.

AIDS means that your immune system is not working, and that you have fewer immune cells than you need to have normal function. HIV just means that you have the virus that eventually, if left untreated, will cause AIDS. By talking about his "immune system fragility," etc, you make it sound like this guy is dying on his feet. But, as long as he hasn't progressed to AIDS, he'll be just fine.

If the OP's friend takes his HAART therapy faithfully, keeps in frequent contact with his ID specialist, and has an undetectable viral load, he is in perfectly good health. He's as healthy as you are.

And there is a VERY GOOD chance that his strain will respond well to medication. There is a wide variety of anti-virals that are currently in use, and it is likely that the OP's friend is already on a regimen that works.

While I understand that many of the people posting in this thread are pre-meds, or have just started MS-1, I find it appalling that any of you would presume to comment on the state of this guy's health when you clearly don't understand very much about HIV, AIDS, and HAART. 😡 I think that the decision to pursue a career in medicine is up to the OP's friend and his ID specialist. It's NOT up to us to comment whether or not he's "too frail" to pursue this path.

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...

On my recent pathology block, all that work was done almost exclusively by PAs and lab techs. The pathologists just read the slides that had been prepared by someone else. Similarly, all the truly pathogenic stuff was handled by technicians and technologists.

Aside from the surgical pathology block (in which you deal with specimans that have already been removed from the patient), I don't think I ever saw a pathologist get his hands dirty.

It probably varies from program to program, but I don't think that you're necessarily exposed to pathogens, just because you're in a pathology lab.

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.

👍 Best advice in this thread.

 

[deleted74029]

Here is the CDC's factsheet on HIV and its transmission. I'd suggest you guys read it. Here is also an excerpt that I found interesting.

http://www.cdc.gov/hiv/resources/factsheets/transmission.htm

"There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States."

 

[diosa428]

(3) I didn't want to bring him into this discussion because I feel that a significant portion of SDN pre-allo consists of semi-insensitive snobs that may or may not have good advice. NOT ALL, of course. There's a reason I'm posting here -- for the ones who AREN'T insensitive and ARE willing to give good advice. But enough SDN pre-allo posters are insensitive to the point where I would have a difficult time recommending this source to him directly. For example, I don't think my friend would benefit in the slightest from the "try another profession" crap. He's thought this through. He's not going to change his mind. Certainly, the last thing in the world I want to do is give identifying information about my friend.

When you post on an anonymous internet forum, you can't expect everyone to agree with your personal opinion. Furthermore, it's obnoxious to ask for people's opinions and then tell them that they suck because they're not telling you what you want to hear. Topics on this forum often stray off topic and you can't post a controversial issue like this without expecting people to make their own thoughts and judgements known. You may not like their opinions, but they may not like yours. The mature response would be to ignore them, rather than wasting space on this thread repeatedly commenting about how people aren't giving you the responses you want. They're going to do it anyway.

 

[inhiding]

Realistically, your friend should brace himself for rejection.

Plenty of applicants get rejected for small flaws in their application. In an application environment this competitive, it could be possible that your friend gets passed over simply due to his HIV status, whether it's stated or not. I'm not saying it's right or fair, but he should be ready for that possibility.

I'm pretty sure he is ready for rejection 🙁.

He's also applying to other types of non-traditional alternative medical programs at which I'd imagine he has a better shot of acceptance (don't care to specify further).

Still...he's a phenomenal guy. I'd like to be in med school with him. I'd like to see him happy and treating patients; not cast out to the sidelines. But maybe that's just me being selfish and protective of him.

 

[Depakote]

Here is the CDC's factsheet on HIV and its transmission. I'd suggest you guys read it. Here is also an excerpt that I found interesting.

http://www.cdc.gov/hiv/resources/factsheets/transmission.htm

"There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States."

That is pretty interesting. I don't know what I would have expected the stats to be, but I'm glad to see that they're that low.

 

[VneZonyDostupa]

😕😕😕 What are you people talking about?!

The friend in question has HIV, NOT AIDS. There's a crucial difference.

AIDS means that your immune system is not working, and that you have fewer immune cells than you need to have normal function. HIV just means that you have the virus that eventually, if left untreated, will cause AIDS. By talking about his "immune system fragility," etc, you make it sound like this guy is dying on his feet. But, as long as he hasn't progressed to AIDS, he'll be just fine.

This paragraph is actually false. When you have HIV (not AIDS), your immune system IS compromised to an extent. AIDS is defined as HIV which has suppressed your T-cell count below a critical value. You don't go from healthy to AIDS overnight. Your T-cell count will drop/fluxuate, even with medication. Couple this suppression with the lack of sleep and stress of medical school...

And there is a VERY GOOD chance that his strain will respond well to medication. There is a wide variety of anti-virals that are currently in use, and it is likely that the OP's friend is already on a regimen that works.

That's good his regimen is working...right now. You should do some research on antiviral resistance and HIV mutation. Those two factors are the reason new HIV drugs are a huge market.

On my recent pathology block, all that work was done almost exclusively by PAs and lab techs. The pathologists just read the slides that had been prepared by someone else. Similarly, all the truly pathogenic stuff was handled by technicians and technologists.

This varies program to program. You can't use an exception to disprove the rule.

Aside from the surgical pathology block (in which you deal with specimans that have already been removed from the patient), I don't think I ever saw a pathologist get his hands dirty.

See comment above.

 

[chessknt]

That is pretty interesting. I don't know what I would have expected the stats to be, but I'm glad to see that they're that low.

Yes I found that interesting as well, but that still doesnt change my opinion that it is irresponsible to head into the field knowing that you have HIV ahead of time. How many of those infected medical professionals had HIV before they were in medical school? We dont know.

Inhiding, you may want to just take a step back and look over things. You automatically assume those of us who dont support this are "insensitive snobs," but the reality of his situation is that there are equally qualified healthy applicants that dont pose a huge risk to patients, so why should he be given preference over these people? Why is another career path so absolutely unacceptable given his circumstances? Most of us know what it feels like to see medicine as the only possible choice, but if something life-changing (like HIV) were to come up, then there are other aspects of life that could take its place.

 

[doomknight]

your "friend" has it tough, but I mean if he doesn't mind potentially wasting so much tuition and end up not being able to practice medicine in the end, let "him" do it. If he really wanted to be a doctor, trying to do it will at least put his chance at greater than 0%, although it might come off ironic that his reason for being a doctor was how so considerate he was of others and how mature and how much he wanted to help people.

 

[MilkmanAl]

This paragraph is actually false. When you have HIV (not AIDS), your immune system IS compromised to an extent. AIDS is defined as HIV which has suppressed your T-cell count below a critical value. You don't go from healthy to AIDS overnight. Your T-cell count will drop/fluxuate, even with medication. Couple this suppression with the lack of sleep and stress of medical school...

Took the words right out of my...fingers?

 

[Vihsadas]

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.

I agree. Frankly, I'm pretty appalled at a lot of the posts in this thread. We live in the western world where combination therapy and options for HIV control are extremely broad. HIV is more or less a controllable chronic illness in North America. Sure, there are still a number of unlucky HIV patients who do not respond well to the medications for whatever reason, but if he's one of them, he'll eventually find out. If his viral load is low, and he has HIV, not AIDS, he is in no way functionally different than your or I. In the hospital (at least where I work) you treat every patient as if they could have a potential communicable illness and protect yourself accordingly. Short of open wounds, those protections are completely sufficient for HIV.

Should it be a factor in his decision to practice medicine, and more importantly, will it be a factor in the admissions process? Absolutely it will, and he should be prepared to have a damn good answer to the responses that have been posted in this thread because he's going to hear them at interviews. But "immune system fragility" or the fact that he is somehow disabled compared to other medical students is a mis-informed opinion IMHO.

The real issue is the possibility of transmission to patients, but as that study was posted earlier showed, there have been statistically zero cases of doctor -> patient HIV transmission. Personally, I do not think that his HIV status should hinder him throughout the admissions process, even though it probably will.

People fail to realize that the HIV landscape is vastly, dramatically different than it was in 1989. In fact, that NIH study posted earlier about whether or not patients would switch if they had an HIV infected doctor is, in my opinion, basically worthless because it was published in 1989. I would guess that if the study was re-performed today the number would be different. There would probably still be a negative bias in terms of patient opinion, but I don't think we can draw any conclusions about the current landscape based on a relatively archaic study in terms of the history of HIV.

your "friend" has it tough, but I mean if he doesn't mind potentially wasting so much tuition and end up not being able to practice medicine in the end, let "him" do it. If he really wanted to be a doctor, trying to do it will at least put his chance at greater than 0%, although it might come off ironic that his reason for being a doctor was how so considerate he was of others and how mature and how much he wanted to help people.

If he was going to disclose it anyway, I don't think that there would be anything wrong with writing in his PS that a large part of his motivation comes from his illness. I think it might be a good central theme.

 

[smq123]

Your T-cell count will drop/fluxuate, even with medication. Couple this suppression with the lack of sleep and stress of medical school...

Well, yeah, everyone's T-cell count fluctuates. That's normal.

But, if you're on a good HAART regimen and otherwise healthy, there's no reason why you couldn't handle the stress of med school.

A lot of HIV+ patients who are on HAART have normal CD4 counts (>500). They're as immunocompromised as you are, in that case.

That's good his regimen is working...right now. You should do some research on antiviral resistance and HIV mutation. Those two factors are the reason new HIV drugs are a huge market.

What?! 😕😕

No, no. Look, HIV mutations occur when the virus replicates. The ENTIRE PURPOSE of HAART is to prevent viral replication. By preventing viral replication, you decrease the chance that mutations will occur. In fact, if you take your HAART regimen as prescribed, you should not have any mutations. That's how viral loads can become "undetectable."

Just to spell it out: HAART DECREASES THE RISK OF VIRAL MUTATIONS, BECAUSE IT SUPPRESSES REPLICATION. Got it?

Are you even in med school??? 😕

This varies program to program. You can't use an exception to disprove the rule.

To be honest, I think that having pathology residents do the daily work of techs and technologists would actually be the EXCEPTION. Using techs and technologists to do the daily dirty work is the rule.

Again - are you even in med school?

 

[inhiding]

If he was going to disclose it anyway, I don't think that there would be anything wrong with writing in his PS that a large part of his motivation comes from his illness. I think it might be a good central theme.

That's what his PS was about I believe.

 

[chessknt]

I agree. Frankly, I'm pretty appalled at a lot of the posts in this thread. We live in the western world where combination therapy and options for HIV control are extremely broad. HIV is more or less a controllable chronic illness in North America. Sure, there are still a number of unlucky HIV patients who do not respond well to the medications for whatever reason, but if he's one of them, he'll eventually find out. If his viral load is low, and he has HIV, not AIDS, he is in no way functionally different than your or I.

As I and other pointed out earlier, residents do not live very healthy lives and their immune systems are strained at considerable lengths. Couple that with some other random infection you pick up with a patient and now the HIV infection can and will matter quite a bit, hence my usage of immune system fragility.

Regardless, the OP is very intent on allowing this friend to pursue this goal, but has yet to really provide a response on why this is a good choice over the multitude of other, less hazardous, options open to him.

 

[shiftingmirage]

I believe to have AIDS your t-cell count has to be below 200.

People who are HIV+ can have undetectable viral loads. Yes, HIV comprimises the immune system, but as previously said, if treated properly, people can live a normal life span. If we are going to prevent individuals that may face a premature death for known health reasons from applying to medical school we would also need to ban: individuals with strong family histories of cancer, CHF/circulation problems, smokers, those that are overweight (there goes me), others that I am forgetting, will all be prevented from applying to med school. I would also bet there are doctors currently practicing that are HIV+ and have no idea, should we make HIV testing mandatory for current/future doctos?

Although I would not condone disclosing his status, I wouldn't be surprised if he has included it in his PS/reasoning why he wants to go into medicine, even if he was pre-med before being positive.

 

[inhiding]

A lot of HIV+ patients who are on HAART have normal CD4 counts (>500). They're as immunocompromised as you are, in that case.

His CD4 count is normal and his viral load is 'undetectable'. I appreciate the people in the thread who seem to have some idea of what HIV is; there's a LOT of misinformation out there. Apparently one school my friend was looking at discouraged HIV+ people from applying because they "wouldn't have a chance to practice long." Maybe they last updated their website in the 1970s 😕.

 

[inhiding]

Regardless, the OP is very intent on allowing this friend to pursue this goal, but has yet to really provide a response on why this is a good choice over the multitude of other, less hazardous, options open to him.

OK, I'm not his mother. Just his friend. It's his life and I respect his decision. I support his decision as a close friend and someone who knows his capabilities. I don't terribly feel the need to defend that to anyone on this board (and don't intend to either).

 

[inhiding]

Should we make HIV testing mandatory for current/future doctors?

I'm going to avoid answering the question but I will say that the med school policies I've read seem to indicate that HIV testing is NOT mandatory for med school students. However, if you DO know that you're seropositive, you are required to disclose that to the school after matriculation (kind of like that MCG policy posted above).

 

[HIVdoc2b]

This paragraph is actually false. When you have HIV (not AIDS), your immune system IS compromised to an extent. AIDS is defined as HIV which has suppressed your T-cell count below a critical value. You don't go from healthy to AIDS overnight. Your T-cell count will drop/fluxuate, even with medication. Couple this suppression with the lack of sleep and stress of medical school...

The amount of misperception and wrong info out there about HIV never fails to astound me.

Your first point is just plain wrong. I know folks who have been infected for many, many years, and have essentially normal immune systems. HIV- people can have CD4 cell counts between 700-2000. I know HIV+ patients who have CD4 counts >1000. Furthermore, talk to any HIV provider and they will tell you that a patient with a CD4 count over ~400 has no greater risk of getting sick than any HIV- person. AIDS is defined as having had (AT ANY TIME) a CD4 count below 200 cells/mL AND/OR having had one of a set list of OIs (CDC classification - look it up, you might learn something). In the HAART era, it is possible to carry an AIDS diagnosis and be perfectly healthy.

You also might be interested to know that smoking increases your CD4 count. I doubt very many of you will argue that smoking makes you healthier.

Now, on to your points about being debilitated before the OP's friend ever gets through with his training. The average length of time between HIV infection and AIDS, given the natural history of the disease (that is, assuming no HAART) is 9 years. It takes NINE YEARS to lose enough CD4 cells to acquire an AIDS diagnosis. The OP's friend may not even need ARVs yet. Now factor in HAART, and the fact that a single regimen can be easily effective for 5 years (often more).

To the OP, I do think that your friend should hold off disclosing his status until he has to (depending on the institution). As this thread should have illustrated, there are still a vast number of people even within the healthcare professions that are woefully undereducated about HIV/AIDS, and the diagnosis still carries a stigma. But I fully support his/her decision to go to medical school, and can only hope that he/she manages to educate a few of these chuckleheads as to the facts.

/rant

 

[Vihsadas]

As I and other pointed out earlier, residents do not live very healthy lives and their immune systems are strained at considerable lengths. Couple that with some other random infection you pick up with a patient and now the HIV infection can and will matter quite a bit, hence my usage of immune system fragility.

Regardless, the OP is very intent on allowing this friend to pursue this goal, but has yet to really provide a response on why this is a good choice over the multitude of other, less hazardous, options open to him.

But that's the thing, if his HIV stays HIV and does not progress to AIDS, then some random infection will have the same effect on him, as it would on you or me. With a very low or undetectable viral load and relatively normal CD4 count, his immune system in that case is not any more fragile than your own, and should handle the infection fine. The stressful lifestyle of the resident will not be a factor if his HIV is controlled properly (refer to smq's post). If he progresses to AIDS, then I'd absolutely agree with you, and in that case he should worry about his personal health. As it stands, however, controlled HIV is not a condition that would hinder his performance. Again, IMHO, the only real concern is transmission to patients, which as was shown earlier can be almost completely avoided with the proper practices and safeguards in place.

 

[smq123]

As I and other pointed out earlier, residents do not live very healthy lives and their immune systems are strained at considerable lengths. Couple that with some other random infection you pick up with a patient and now the HIV infection can and will matter quite a bit, hence my usage of immune system fragility.

Just having HIV does NOT make your immune system "fragile." The real question is: How many immune system cells do you have left?

When taking care of HIV+ patients, one of the first things we look at is a CD4 count. Even if you have HIV, if you have enough CD4 cells, your immune system is not more "strained" than it would be if you were HIV-. You'll still be able to fight off infections.

Look, I've had HIV+ patients with CD4 counts of 1000, and they looked healthier than I did. There's no reason why an HIV+ patient with a good CD4 count should be worried about surviving residency. (Well, not unduly worried, anyhow - EVERYONE'S afraid of not surviving residency. 😉)

As this thread should have illustrated, there are still a vast number of people even within the healthcare professions that are woefully undereducated about HIV/AIDS, and the diagnosis still carries a stigma.

Well, to be fair, most of the people on this thread who have seemed the most undereducated about HIV/AIDS are either pre-meds, or have just started medical school. So....they're not quite in the healthcare profession yet. I'd like to think that any physician that was on an adcom would know better....

 

[Aidan]

The posts by some of the people on this thread are pretty appalling. In the recent past, HIV has gone from being almost an immediate death sentence, to having a life expectency of ~10 years, to having a nearly average life expectancy. Someone with HIV can nearly have an average life now-a-days, and all the advances in HIV treatment have all been recent. Think about the next 20-30 years, surely it will be even better than it is now, with more research.

That said, it's pretty ridiculous for someone to not follow their dream because of being HIV+. The extra precautions he will have to take, like making sure he doesn't cut/stab himself will just make him a more precautious physician. The things he goes through on a daily basis with his virus/syndrome will only make it easier for him to connect with patients on their level - a more understanding physician.

To the person that keeps saying 'someone else with a better life expectency deserves his seat', um.. yeah, no.. so sorry.

However, I don't think he should disclose it right away. It's one thing to be accepting of having an illness, and that's good and fine, but he should take into consideration that his pride is not worth losing an acceptance at a school he wants to go to. I would sit and explain to him that it's honorable to disclose his illness because he's accepted it, but it's shooting himself in the foot. I can't really think of a situation where an application disclosing HIV+ status would be a good thing at an interview. Interviewers won't see it in the same light that he, you, and I see it in. Just try to get him to understand, but reinforce that you'll be behind him if he truly decides to disclose it before matriculation.

 

[stiz]

This thread is reminding me of the movie GATACCA ...

I guess in this case it would be GAUACCA ...

 

[bozz]

In January 2007, one of my close friends was criminally and negligently infected with HIV.

Was it through drugs or rape? Not that it matters, but he might have to mention the reason to the interviewers.

 

[inhiding]

Was it through drugs or rape? Not that it matters, but he might have to mention the reason to the interviewers.

Not drugs. It's a criminal offense to have sexual/intimate relations without disclosing a KNOWN HIV+ status; (i.e. if you KNOW you have HIV and you don't disclose this to a sexual partner, you can be reprimanded/fined/put in jail depending on the severity of the crime). I don't know the details of the situation, but I believe he was in a relationship with another guy who, as I said "criminally and negligently infected him with HIV."

I'm sure my friend will have to disclose the events surrounding it 🙁 Just one more reason I think he should avoid talking about it. He insists that he's fine with talking about it but...I find that a little difficult to believe sometimes. I imagine interviewers could ask some pretty hard and/or mean questions 🙁

 

[bozz]

Not drugs. It's a criminal offense to have sexual/intimate relations without disclosing a KNOWN HIV+ status; (i.e. if you KNOW you have HIV and you don't disclose this to a sexual partner, you can be reprimanded/fined/put in jail depending on the severity of the crime). I don't know the details of the situation, but I believe he was in a relationship with another guy who, as I said "criminally and negligently infected him with HIV."

I'm sure my friend will have to disclose the events surrounding it 🙁 Just one more reason I think he should avoid talking about it. He insists that he's fine with talking about it but...I find that a little difficult to believe sometimes. I imagine interviewers could ask some pretty hard and/or mean questions 🙁

oh man.. I thought you meant that he had been negligent 🙁

 

[inhiding]

oh man.. I thought you meant that he had been negligent 🙁

Well someone was negligent...but I meant his partner of 6 months 🙁 Maybe I'll clarify the original post at some point.

 

[Mayday]

Well, to be fair, most of the people on this thread who have seemed the most undereducated about HIV/AIDS are either pre-meds, or have just started medical school. So....they're not quite in the healthcare profession yet. I'd like to think that any physician that was on an adcom would know better....

Know better, yes. However, even though people know better, they don't necessarily follow that knowledge. There is a social stigma attached to being HIV+, and regardless of what they may intellectually know about the disease, the people on the adcoms my still color their opinions with the social stigma they attach to HIV+.

I saw a study once (and I really wish I could find it again so that I could give a link) where people were shown three pictures and asked which of the three would make a better president, neighbor, doctor, teacher, etc. In the majority of the cases, even though the people in the study knew intellectually that people are people, and that sex and race have nothing to do with their abilities, the older white male was chosen as a better president and doctor over a minority, or even a younger white male. The frumpy older white woman was invariably chosen as the better choice for a teacher. The same "gut reaction" applies here as well probably.

I think if the person is HIV+, they should go ahead and follow their dreams. I would say do not disclose until required to, but it sounds like the disclosure in the PS has already been done. At this point, there really is nothing to be done other than damage control. Let the adcoms know how you (I'm going to assume it is you - generally when people are asking for help for "their friend" they are generally asking for themselves - if I'm wrong, just read as though I was talking to your friend.) contracted the disease, what your current viral load and CD4 count are, and how you plan on coping with the disease through med school and residency.

 

[smq123]

I'm sure my friend will have to disclose the events surrounding it 🙁 Just one more reason I think he should avoid talking about it. He insists that he's fine with talking about it but...I find that a little difficult to believe sometimes. I imagine interviewers could ask some pretty hard and/or mean questions 🙁

Actually, I find it hard to imagine any interviewer asking him how he contracted it. They might ask if he's sure that he isn't infected with any diseases like Hepatitis B (which also often affects people who engage in unprotected promiscuous sex) or Hepatitis C (which often affects people who use IV drugs and share needles). But otherwise, they probably would not ask for the exact details as to how he contracted it.

🙂 inhiding - I think it's really sweet of you to worry about him like this. I've done it for some of my friends on similar issues. But....he's an adult. He will make his own choices, and fight for acceptance to med school on his own terms. All you can do is stand back and support him.

 

[deleted74029]

Yes I found that interesting as well, but that still doesnt change my opinion that it is irresponsible to head into the field knowing that you have HIV ahead of time. How many of those infected medical professionals had HIV before they were in medical school? We dont know.

Inhiding, you may want to just take a step back and look over things. You automatically assume those of us who dont support this are "insensitive snobs," but the reality of his situation is that there are equally qualified healthy applicants that dont pose a huge risk to patients, so why should he be given preference over these people? Why is another career path so absolutely unacceptable given his circumstances? Most of us know what it feels like to see medicine as the only possible choice, but if something life-changing (like HIV) were to come up, then there are other aspects of life that could take its place.

I honestly don't understand this argument, should we reject the non-traditional applicants as well because they aren't as "healthy" as college age juniors?

If its been proven that doctors with HIV pose a miniscule threat, if any, to patients then there should be no other deliberation on the matter. If the doctor himself wants to take the chance of being around a significant amount of pathogens for the rest of his life then so be it. Thats his decision and I'm sure he'd rather live his life doing what he wanted to rather than prolong it by doing something he hates.

We always throw around the "its not about holding off death, but improving the quality of life" quote but heres a situation where its totally applicable and we ignore it.

 

[inhiding]

^ to clarify, this actually IS my friend. I'd probably be making the same assumptions as you, but FWIW the I've only altered the info slightly (dates, etc.). I give you my anonymous-internet word of honor 😳.

I hope I am a good friend to him. I try 🙁. But he's had to educate me out of a lot ignorance about HIV. Not gonna lie, there are plenty of things I didn't know about HIV before I met him.

 

[diosa428]

Not drugs. It's a criminal offense to have sexual/intimate relations without disclosing a KNOWN HIV+ status; (i.e. if you KNOW you have HIV and you don't disclose this to a sexual partner, you can be reprimanded/fined/put in jail depending on the severity of the crime). I don't know the details of the situation, but I believe he was in a relationship with another guy who, as I said "criminally and negligently infected him with HIV."

I'm sure my friend will have to disclose the events surrounding it 🙁 Just one more reason I think he should avoid talking about it. He insists that he's fine with talking about it but...I find that a little difficult to believe sometimes. I imagine interviewers could ask some pretty hard and/or mean questions 🙁

I hate to say this, because I wish it weren't true, but medicine is still a conservative field, and I honestly think that the only thing worse than telling an adcom that you have HIV is that you got it through gay sex. I mean, it's better than getting it through drug use (obviously) but there are going to be people on adcoms (older, conservative white men who seem to be on every adcom in the country) who are not going to take that well. Again, the advantage is that if your friend is accepted, it will likely be at a school that will be a better fit for him anyway, but it just seems that he may be closing doors by revealing all this information right now.

 

[smq123]

Know better, yes. However, even though people know better, they don't necessarily follow that knowledge. There is a social stigma attached to being HIV+, and regardless of what they may intellectually know about the disease, the people on the adcoms my still color their opinions with the social stigma they attach to HIV+....The same "gut reaction" applies here as well probably.

That's fair enough, I guess.

I don't know - I don't know how many adcoms are made up of predominantly physicians. And, honestly, once you take care of a lot of HIV+ patients, and see them in your outpatient clinic, a lot of that "social stigma" gets lost. At least, for me it did. The ones who you see in the outpatient clinic are often extremely healthy, and live full and active lives. These are including the ones who have been on HAART for a long time.

Let the adcoms know how you (I'm going to assume it is you - generally when people are asking for help for "their friend" they are generally asking for themselves - if I'm wrong, just read as though I was talking to your friend.) contracted the disease, what your current viral load and CD4 count are, and how you plan on coping with the disease through med school and residency.

I don't think there's any real need to explain how he contracted the disease. And he certainly doesn't need to go into his current viral load and CD4 count. I mean, if a type 1 diabetic applies to med school, I'm sure that there's no real need for that person to explain how old he/she was when they developed diabetes, what their HbA1C levels are, how much insulin they use a day, etc.

 

[inhiding]

I hate to say this, because I wish it weren't true, but medicine is still a conservative field, and I honestly think that the only thing worse than telling an adcom that you have HIV is that you got it through gay sex. I mean, it's better than getting it through drug use (obviously) but there are going to be people on adcoms (older, conservative white men who seem to be on every adcom in the country) who are not going to take that well. Again, the advantage is that if your friend is accepted, it will likely be at a school that will be a better fit for him anyway, but it just seems that he may be closing doors by revealing all this information right now.

Yeah, and believe it or not, we live in a Bible-belt conservative-voting state. He's an eternal optimist, I guess...🙁

EDIT: We live in a tiny liberal pocket within the state.

 

[inhiding]

I don't think there's any real need to explain how he contracted the disease. And he certainly doesn't need to go into his current viral load and CD4 count. I mean, if a type 1 diabetic applies to med school, I'm sure that there's no real need for that person to explain how old he/she was when they developed diabetes, what their HbA1C levels are, how much insulin they use a day, etc.

I think I might remind him that he DOES NOT have to answer any questions he feel are unfair or unreasonably personal. I know there are certainly parts of my personal life that, if directly and PERSISTENTlY asked about, I would tell an ADCOM straightforwardly that I do not care to answer the question.

 

[Mayday]

I don't think there's any real need to explain how he contracted the disease. And he certainly doesn't need to go into his current viral load and CD4 count.

the main reason I suggested this is that if his health stats are really good, that info could be used to negate the possible issue of "Well, how many years is he really going to be able to practice" and also to assure the adcoms that they are not making a bad "investment" in him as a med student. And as for explaining how it was contracted, that would be to forestall any questions of drug use.

 

[VneZonyDostupa]

A lot of HIV+ patients who are on HAART have normal CD4 counts (>500). They're as immunocompromised as you are, in that case.

No, "a lot" of HIV+ individuals do not have normal CD4 counts. They may have high counts, but not normal.

What?! 😕😕

No, no. Look, HIV mutations occur when the virus replicates. The ENTIRE PURPOSE of HAART is to prevent viral replication. By preventing viral replication, you decrease the chance that mutations will occur. In fact, if you take your HAART regimen as prescribed, you should not have any mutations. That's how viral loads can become "undetectable."

Just to spell it out: HAART DECREASES THE RISK OF VIRAL MUTATIONS, BECAUSE IT SUPPRESSES REPLICATION. Got it?

HAART is only as effective as the patient is at taking it. If you miss a few doses, you can build a drug resistance and will have to switch to another therapy, which may or may not work for you. I've seen plenty of patients have horrible reactions to certain drugs, and I've seen patients who switch to anew regimen only to find out that their specific infection is already resistant to it.

Are you even in med school??? 😕

Again - are you even in med school?

I think you clicked on the wrong forum. This is called the "Pre-Allopathic" forum, meaning most people on here are "pre-med". No worries, I'm sure your ego just got in the way when you were trying to click on the Allopathic forum.

 

[8744]

Hey. My school tested us for HIV. I don't think they would have kicked you out if you were HIV positive however.

 

[Sunfire]

I hate to say this, because I wish it weren't true, but medicine is still a conservative field, and I honestly think that the only thing worse than telling an adcom that you have HIV is that you got it through gay sex. I mean, it's better than getting it through drug use (obviously) but there are going to be people on adcoms (older, conservative white men who seem to be on every adcom in the country) who are not going to take that well.

Hmm, not sure I agree. Doctors are the ones who fought against "conversion therapy". The AMA staunchly spoke out against it.

http://209.85.141.104/search?q=cach...a+conversion+therapy&hl=en&ct=clnk&cd=3&gl=us

Anyhow, I think you'd be surprised how many Doctors are well educated and have actually dealt with people from all walks of life.