HIV positive dentists/ students?

[armorshell]

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Yes, but disclosing to any patient would almost definitely be the end of your career anyway.

Now, practitioners have the right to ask a patient's status, so patients should have the same right. That's the only reason I would argue that a dentist should disclose. I'm just not totally sure that I would (unless an incident happened.) But I'm also strange and would not take prophylactic antiretrovirals if I had a needle stick with an HIV+ patient, so I may be of a different perspective. 🙂 (I started a thread with just that thought.)

But like I said before, disclosing an HIV+ status and therefore likely ruining one's career defies the entire purpose of deciding to pursue a dental career as a positive person. So if I were to do that, I wouldn't disclose.

You of course have the right to ask, what health practitioners don't have is the right to compel an HIV test, so it's a moot point. HIV+ status is protected by the ADA (and the ADA 😛) and this thread proves why HIV+ status needs protecting, even from the highly educated.

 

[zoothslooth]

Nice topic, thought provoking and educational...

Quick dialogue between my wife and me:

Me: "Would you choose to see a dentist that you knew was HIV+ ?
Wife: "How likely is it that a dentist injures himself/herself in my mouth?"
Me: "Not very, would that make a difference to you?"
Wife: "I guess it wouldn't because I would still choose to see someone else."
Me: "Why?"
Wife: "Because even though the risk is very small, it is a risk that I can control, it's my choice."
Me: "OK"

My point, if people know that it is maybe more likely to win the lottery than get infected with HIV from you, most will still chose to see someone else. Is it against the law to not tell patients? No. Is it ethically wrong to not tell patients? In my opinion, I'm not sure but I lean towards thinking that it is ethically wrong.

If you want to be a dentist and help out those in need, practice on those who need the most caring, understanding dentists- those in similar situations to yourself. I don't mean that in a harsh way, but in a sincere way. Help those out that may get lost in the shadows because of their medical conditions.

 

[fusedtometal]

Nice topic, thought provoking and educational...

Quick dialogue between my wife and me:

Me: "Would you choose to see a dentist that you knew was HIV+ ?
Wife: "How likely is it that a dentist injures himself/herself in my mouth?"
Me: "Not very, would that make a difference to you?"
Wife: "I guess it wouldn't because I would still choose to see someone else."
Me: "Why?"
Wife: "Because even though the risk is very small, it is a risk that I can control, it's my choice."
Me: "OK"

My point, if people know that it is maybe more likely to win the lottery than get infected with HIV from you, most will still chose to see someone else. Is it against the law to not tell patients? No. Is it ethically wrong to not tell patients? In my opinion, I'm not sure but I lean towards thinking that it is ethically wrong.

If you want to be a dentist and help out those in need, practice on those who need the most caring, understanding dentists- those in similar situations to yourself. I don't mean that in a harsh way, but in a sincere way. Help those out that may get lost in the shadows because of their medical conditions.

Thanks for sharing. I do agree with you. I am not about to let HIV stop my life, and I can take care of myself and others. I am happy to help marginalized people, but it isn't realistic to limit one's practice, or is it? I honestly don't know. Anyways, I'm a long way off from practicing, and I hope to find out more and more as the years go on. I was shadowing one dentist last week who had another doctor who comes to his office to do complicated root canals and extractions. That seems like it would help me stay safer. Safe is good. Disclosing to everyone= going out of business= not being a dentist= unrealistic. Unrealistic= people automatically not questioning their dentist's HIV status.

 

[moxn]

I guess not in gay California

you're going to be a healthcare provider and you're unwilling to even make the proper semantic distinction between HIV and AIDS?
HIV+ and AIDS are different... it's a subtle but profound distinction... learn it.

it's funny how one can immediately gauge who the ignorant/insensitive ones are by the fact that they refer to people with HIV as "having AIDS."
i don't even need to read the rest of your post to know nonsense will follow.

and, fusedtometal, this whole thread is frankly a non-issue.
we practice universal precaution for good reason: to protect the practitioner, the patients, and the community.
as a doc you will have patients come into your clinic who will not disclose std's or hepatitis status... and it won't matter from a cross-contamination perspective because you will be practicing universal precautions.
and patients who do disclose an infectious disease... really, what are you going to do?
when you read their medical history, it raises an eyebrow at most... but are you going to glove up differently or sterilize/disinfect differently? no.

this is the entire point of universal precaution procedures.

you're going to be cautious (as everyone should be) when you practice, and the rest of these other hypothetical scenarios are possible but unlikely (and an acceptable risk). i'm also liable to get mugged when i walk home from the bars every friday night... but that's one of the acceptable risks of the whole enterprise...

go to dental school, and be a great dentist. this is a non-issue.


and to the other posters who would not treat HIV+ patients:
you do have the right to refuse treatment to anyone... but it is highly unethical to refuse treatment to a HIV+ individual. the bottom line is, you are a healthcare provider.
ethically you are entitled to refuse treatment to someone who is uncooperative, etc, or in the case of the practice i worked in, people who come in wanting to pay for veneers obviously with drug/criminal enterprise money. you are entitled to refuse treatment to patients of such a nature...

but refusing treatment to someone with an infectious disease rather defeats the purpose of being a healthcare provider...

 

[KOM]

and, fusedtometal, this whole thread is frankly a non-issue.
the rest of these other hypothetical scenarios are possible but unlikely (and an acceptable risk). i'm also liable to get mugged when i walk home from the bars every friday night... but that's one of the acceptable risks of the whole enterprise...

and to the other posters who would not treat HIV+ patients:
you do have the right to refuse treatment to anyone... but it is highly unethical to refuse treatment to a HIV+ individual. the bottom line is, you are a healthcare provider.

Actually, it IS an issue because quite frankly different people have different ideas on what exactly an "acceptable risk" is.

Some people choose not to go to the bars every Friday night and walk home because that's not an acceptable risk to them.

Because biases towards this disease are so pervasive in our society, I imagine many people when offered the choice to know if their dentist was HIV+ would say OF COURSE and subsequently choose to see another dentist. Even if they knew that the risk was exceptionally low. But they don't ask...why is that?

I suppose it's because there's a certain level of trust that this profession has obtained from society. This is a good thing.

But, what harm would this do to the profession if that highly unlikely accident were to happen and people found out that the profession didn't require disclosure. That trust would dissolve. On the flip side, would the trust remain even if a dentist was required to disclose to a health board and the accident still happened? In this case it's almost like we allowed it to happen...so would the trust still dissolve?

I guess I'm not sure anymore about what's the best policy for the profession and for all parties involved. I know I'll want my patients to trust my capacities as a dentist and if I can't trust another dentist knowing how small the risks are then what does that have to say about my trust in the profession?

I am sympathetic to fusedtometal's situation and it is true that disclosing such info. to patients would make it very difficult to make a living. As such, I think that at the very least, disclosing to a state licensing board is sufficient in that it affords the most potential in protecting all parties involved. If symptoms of the disease become more pronounced 5,10,15 years down the road then other health professionals will be available to you to re-evaluate those risk factors and potential for transmission.

What are your opinions on this type of disclosure? I suppose even this conveys a certain lack of trust, but do you feel that would still be violating your right to privacy? Just curious.

 

[KOM]

and to the other posters who would not treat HIV+ patients:

but refusing treatment to someone with an infectious disease rather defeats the purpose of being a healthcare provider...

Completely agree!! 👍

 

[fusedtometal]

Actually, it IS an issue because quite frankly different people have different ideas on what exactly an "acceptable risk" is.

Some people choose not to go to the bars every Friday night and walk home because that's not an acceptable risk to them.

Because biases towards this disease are so pervasive in our society, I imagine many people when offered the choice to know if their dentist was HIV+ would say OF COURSE and subsequently choose to see another dentist. Even if they knew that the risk was exceptionally low. But they don't ask...why is that?

I suppose it's because there's a certain level of trust that this profession has obtained from society. This is a good thing.

But, what harm would this do to the profession if that highly unlikely accident were to happen and people found out that the profession didn't require disclosure. That trust would dissolve. On the flip side, would the trust remain even if a dentist was required to disclose to a health board and the accident still happened? In this case it's almost like we allowed it to happen...so would the trust still dissolve?

I guess I'm not sure anymore about what's the best policy for the profession and for all parties involved. I know I'll want my patients to trust my capacities as a dentist and if I can't trust another dentist knowing how small the risks are then what does that have to say about my trust in the profession?

I am sympathetic to fusedtometal's situation and it is true that disclosing such info. to patients would make it very difficult to make a living. As such, I think that at the very least, disclosing to a state licensing board is sufficient in that it affords the most potential in protecting all parties involved. If symptoms of the disease become more pronounced 5,10,15 years down the road then other health professionals will be available to you to re-evaluate those risk factors and potential for transmission.

What are your opinions on this type of disclosure? I suppose even this conveys a certain lack of trust, but do you feel that would still be violating your right to privacy? Just curious.

I would do that if it were the law in my state. In California, that is not the law. The nature of HIV makes monitoring by a health professional a necessity for a good outcome. I have a good doctor, and I don't see why he wouldn't handle the issues of working to help manage my illness, its progression, and changes in the potential for transmission. It is within the scope of his practice, and he is very capable.

People might ask, they might not ask. If they don't ask, it could be a variety of reasons; for example, they might not care, they might not think of it, they might not want to think of it, they might be shy, they might respect another's privacy. I would practice in a way to ensure my future patients' positive oral health and; therefore, promote their general health and well-being. I would ensure they are comfortable and happy with the services provided. I would practice with an extra level of care with sharp instruments, and keep a keen awareness of my skills and comfort. I feel like assumptions that others make belong to them. If they assume that the dentist is negative, that the laws require disclosure, that the profession of dentistry somehow gives them full protection from any risks associated with treatment, its not realistic. Using universal precautions works.

Patients are responsible to finding out what the disclosure laws are if that concerns them. Their trust in the profession should be based on facts.

 

[notanormalgent]

If I went to a dentist who performed on me, then somehow injured himself and I became contaminated...Then he informed me he had HIV, I would give that dentist the BEATING of his life. Then I'd sue the **** out of him.

That's my honest take on the whole situation, and I don't think many people would react too differently. No one would take it "lightly" if they were just informed that they were contaminated with a disease that prevents them from ever making bare-back love with his/her partner...That's Hell on Earth.

 

[armorshell]

If I went to a dentist who performed on me, then somehow injured himself and I became contaminated...Then he informed me he had HIV, I would give that dentist the BEATING of his life. Then I'd sue the **** out of him.

That's my honest take on the whole situation, and I don't think many people would react too differently. No one would take it "lightly" if they were just informed that they were contaminated with a disease that prevents them from ever making bare-back love with his/her partner...That's Hell on Earth.

I'm sure beating the life out of someone would really help your court case 🙄

 

[KOM]

Using universal precautions works.

You know, with the ever-so increasing prevalence of the disease you'd think more people would demonstrate "universal precautions" when engaging in sexual activities.

 

[I'mFillingFine]

But, what harm would this do to the profession if that highly unlikely accident were to happen and people found out that the profession didn't require disclosure. That trust would dissolve. On the flip side, would the trust remain even if a dentist was required to disclose to a health board and the accident still happened? In this case it's almost like we allowed it to happen...so would the trust still dissolve?

Interesting question. That's why I don't think disclosure is a good idea. I cannot see how disclosing would NOT ruin an HIV+ dentist's career.

How can someone therefore help patients with no patients? It defies the purpose of the whole thing.

And I agree that it doesn't do that much good to just disclose to a board because what are they to do about it? I suppose if there were laws that required more frequent universal precaution auditing and that sort of thing.

If I went to a dentist who performed on me, then somehow injured himself and I became contaminated...Then he informed me he had HIV, I would give that dentist the BEATING of his life. Then I'd sue the **** out of him.

That's my honest take on the whole situation, and I don't think many people would react too differently. No one would take it "lightly" if they were just informed that they were contaminated with a disease that prevents them from ever making bare-back love with his/her partner...That's Hell on Earth.

So you'd want to murder a dentist but you're still willing to have lots of sex? Which do you think is more risky overall?

What about a dentist with a severe respiratory illness that eventually kills you after you get it from a sharps accident? Would you be as mad as if it was HIV? I doubt it. HIV has such an intense reputation for being the worst disease in the world.

Also, answer me this: If your dentist disclosed to you before treatment, would you still accept treatment?

 

[KOM]

I would do that if it were the law in my state. In California, that is not the law.

You don't choose do something simply because it's law. You do something because you feel it's the right thing to do.

You stated in another thread that you would choose to get meds if you were stuck by a needle even though the rate of seroconversion is less than 1%. With all your talk about "acceptable risks," and "universal precautions" I believe you're being hypocritical.

Question...you contracted the virus through sexual contact. You failed to use proper precautions then. Hell, I bet your partner didn't disclose to you their status. Do you see all the irony here?

 

[fusedtometal]

You don't choose do something simply because it's law. You do something because you feel it's the right thing to do.

You stated in another thread that you would choose to get meds if you were stuck by a needle even though the rate of seroconversion is less than 1%. With all your talk about "acceptable risks," and "universal precautions" I believe you're being hypocritical.

Question...you contracted the virus through sexual contact. You failed to use proper precautions then. Hell, I bet your partner didn't disclose to you their status. Do you see all the irony here?

I was with an unscrupulous person who I strongly suspect infected me on purpose. I did always use protection, also. The risks for sex are a completely different magnitude than risks from dental care.

I don't need you to point out irony to me, Mary!

 

[ObliqueRidge]

two words: san francisco

 

[KOM]

Very interesting...

Yeah, it seems intentional infection might actually be more commonplace than I would have liked to imagine. I guess I would hate to think that the protection the ADA affords people with HIV is exactly the protection that may have contributed to you becoming infected with HIV in the first place.

In this case, one might surmise that the law was to blame for your exposure. In at least a few states that I've heard about, transmitting the virus knowingly to another individual will give you a life sentence but how does that law protect you, the innocent, before the fact?

Your words from another thread..."I would take the meds, and ask for triple therapy." I don't want to play psychiatrist, but this sounds like you reminiscing on all the things you could have done differently as far as prevention goes...and you would have taken every precaution necessary...no matter how small the risk...and you would have done it 3X over.

Now, carry that a little further and think about your patients. Do they deserve to know?

 

[fusedtometal]

Very interesting...

Yeah, it seems intentional infection might actually be more commonplace than I would have liked to imagine. I guess I would hate to think that the protection the ADA affords people with HIV is exactly the protection that may have contributed to you becoming infected with HIV in the first place.

In this case, one might surmise that the law was to blame for your exposure. In at least a few states that I've heard about, transmitting the virus knowingly to another individual will give you a life sentence but how does that law protect you, the innocent, before the fact?

Your words from another thread..."I would take the meds, and ask for triple therapy." I don't want to play psychiatrist, but this sounds like you reminiscing on all the things you could have done differently as far as prevention goes...and you would have taken every precaution necessary...no matter how small the risk...and you would have done it 3X over.

Now, carry that a little further and think about your patients. Do they deserve to know?

If you knew what the actual law said, you wouldn't surmise that because a positive person is required by law to disclose to all sex partners before the fact.

Triple therapy refers to the combination of drugs, triple and double therapy are used almost interchangeably in PEP, one is for a more significant exposure, though both have been shown to be effective. Triple therapy is not 3X the standard therapy.

Again, you are talking about my comparison becoming infected sexually through a sex act with a very high risk for transmitting HIV to a dentist working on a patient, which is virtually no risk. The laws, the precautions, and risks are completely different.

You should read up on risk of transmission and the laws. This thread is not about me, its about those things, I am just another person trying to navigate through those things, and I would do what is acceptable for current standards in the medical and legal fields. Your comments show that you do not know the risks or the laws at all.

 

[KOM]

If you knew what the actual law said, you wouldn't surmise that because a positive person is required by law to disclose to all sex partners before the fact.

Triple therapy refers to the combination of drugs, triple and double therapy are used almost interchangeably in PEP, one is for a more significant exposure, though both have been shown to be effective. Triple therapy is not 3X the standard therapy.

Again, you are talking about my comparison becoming infected sexually through a sex act with a very high risk for transmitting HIV to a dentist working on a patient, which is virtually no risk. The laws, the precautions, and risks are completely different.

You should read up on risk of transmission and the laws. This thread is not about me, its about those things, I am just another person trying to navigate through those things, and I would do what is acceptable for current standards in the medical and legal fields. Your comments show that you do not know the risks or the laws at all.

You're right. My point was that the law isn't going to protect you even if they made it obligatory for people to disclose their status. People will still become infected, as in your case. The law shouldn't dictate what a person feels to be morally correct.

We obviously have different perspectives, but I very much appreciate hearing your opinion. In my mind, the patient's right to choose what type of health care they receive is as personal a choice as your right to privacy. You put all the statistics aside, people if given the decision, will choose another provider. That's the cold hard truth. Biases, statistics, etc won't change that anytime soon.

You're also right, I know much less about HIV than you. I was taught that a patient with a specific disease will usually know way more about it than you will when you confront it.

Why, for example, a person would opt for a treatment plan that is for a "less significant exposure" is beyond me. In fact, there was another thread about how Imfillingfine asked if he was crazy for passing on these medications.

You talk about being infected through a sex act with a very high risk of transmitting the virus...but it didn't have to be high risk. You were given a choice. Much like your patients might want the choice.

And again, you're right...I truly don't know the risks or the laws. I only know what I feel to be morally correct which is unfortunately not set in stone.

 

[KOM]

Needle sticks happen. Are you going to sacrifice your practice in the name of being "morally correct" and disclose then, or would you keep it a secret based on the law's and literature that state how unlikely it was that anything may have happened?

My opinion...you have a disease that is potentially infectious- you must be held to a higher standard of care than the rest of us. That standard, at the very least, is disclosure to the governing body that grants you the right to practice.

 

[K90]

You can refuse to treat any patient you want; I guess not in gay California where the liberals are all about universal health care. Since we don't have universal health you dont HAVE to treat anybody. here's why... It is a private institution where people come for a service that you can either give or choose not to. If I owned an airline company and someone was drunk I wouldn't let them on my aircraft due to safety. If someone has AIDS and I don't want to treat them I have every right to not treat them (in my eyes). Obviously due to the screwed up disability act there are ways you have to get around this violation of our constitution. As long as you don't give a reason on why you aren't treating the patient then they can't claim you violated the disibility act. It's as easy as that!

Does that apply to muslims and airplanes?

 

[fusedtometal]

HIV-Positive Dentist Absolved

American Medical News (09/15/97) Vol. 40, No. 35, P. 22

Abstract: HIV-positive dentists are not obligated to inform patients of their seropositive status as part of informed consent for dental procedures, the Supreme Court of Delaware ruled. The court denied the patients' claims of "mental anguish" and said the dentist was not liable for "battery" for touching the patients while HIV-positive. An investigation conducted by the state Division of Public Health found that the dentist's sterilization methods and safety precautions were above average, so patients were not likely to have contracted HIV from him. None of the 630 patients who were screened for HIV after being informed of their dentist's HIV-infected status tested positive for the virus.

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[fusedtometal]

Kaiser Daily HIV/AIDS Report

In The Courts | Eleven Organizations Challenge Firing of HIV-Positive Dental Hygienist
[Dec 12, 2000]
The American Public Health Association, the American Dental Association, and the Infectious Diseases Society of America are among 11 national organizations challenging the 1997 firing of an HIV-positive dental hygienist, Reuters Health/JAMA reports. The lawsuit originated after Spencer Waddell's employer, Dr. Eugene Witkin of Valley Forge Dental Associates in Atlanta, Ga., was informed by Waddell's physician of his HIV-positive status. Waddell was then fired, although Witkin admitted that he had never received any training related to HIV and was confused about how HIV was transmitted. A lower court dismissed Waddell's initial lawsuit, saying that he posed a "significant risk" of transmitting HIV to patients. The new suit is the "first" to be brought after the 1998 U.S. Supreme Court ruling in Abbott v. Bragdon (Gale, Reuters Health/JAMA, 12/8). In that case, the court found that HIV-positive people are covered under the Americans with Disabilities Act, which "prohibits discrimination in employment, housing, medical care and other public services" (Kaiser Daily HIV/AIDS Report, 6/26/98). Waddell's attorney, Stephen Scarborough of the Lambda Legal Defense Fund, said, "The fact that very reputable professional organizations are concerned about science and the integrity of their positions takes away the notion that this is just a self-interested party arguing his case" (Reuters Health/JAMA, 12/8).

 

[fusedtometal]

Needle sticks happen. Are you going to sacrifice your practice in the name of being "morally correct" and disclose then, or would you keep it a secret based on the law's and literature that state how unlikely it was that anything may have happened?

My opinion...you have a disease that is potentially infectious- you must be held to a higher standard of care than the rest of us. That standard, at the very least, is disclosure to the governing body that grants you the right to practice.

I don't even understand this. Needle sticks are a risk to the dentist from an infectious disease the patient has. How would I put a patient at risk? Would I do this by sticking myself and then sticking the patient after that with the same needle accidentally?!?!

 

[ScubaDr2B]

Aside from any law or study in a journal article that says its "OK" to not tell your patients you are HIV positive, you MUST think about the well being of your patients. No matter how great or small the risk is, the risk is always going to be there. If your desire to be a dentist overrides your ethical responsibility to tell patients your status I seriously think you should reconsider, as dentistry is a profession in which ethics come into play every single day, multiple times a day.

 

[KOM]

If somebody comes to me and says they want to screen me for HIV because my dentist tested positive and its in the court system I think I would undergo a short period of "mental anguish." Right up until I see those test results.

 

[armorshell]

Aside from any law or study in a journal article that says its "OK" to not tell your patients you are HIV positive, you MUST think about the well being of your patients. No matter how great or small the risk is, the risk is always going to be there. If your desire to be a dentist overrides your ethical responsibility to tell patients your status I seriously think you should reconsider, as dentistry is a profession in which ethics come into play every single day, multiple times a day.

In the face of law and research, you still continue to believe he's in the wrong. At this point all we're talking about is discrimination, which is why the laws are in place.

 

[I'mFillingFine]

Aside from any law or study in a journal article that says its "OK" to not tell your patients you are HIV positive, you MUST think about the well being of your patients. No matter how great or small the risk is, the risk is always going to be there. If your desire to be a dentist overrides your ethical responsibility to tell patients your status I seriously think you should reconsider, as dentistry is a profession in which ethics come into play every single day, multiple times a day.

This is not an ethical violation. Your personal values are such that you think an HIV+ dentist should disclose that particular condition (though I doubt it applies to other dieases. Do you feel the same for hep? TB? The flu?) That would be a decision you have the right to make.

It can also be argued that it is not ethically fair to the patients to disclose and therefore lose your practice. You could have done 30 years of good to your community, and the moment the word is out, that's pretty much it for you. How is that fair to them?

 

[Lopyswine]

I don't even understand this. Needle sticks are a risk to the dentist from an infectious disease the patient has. How would I put a patient at risk? Would I do this by sticking myself and then sticking the patient after that with the same needle accidentally?!?!

maybe you get your blood from a stick on the NEXT patient.

 

[armorshell]

maybe you get your blood from a stick on the NEXT patient.

If you're not sterilizing instruments between procedures, you've got a lot of problems already...

 

[partyflavor]

Please see the content at the following link: http://www.ada.org/prof/resources/topics/hiv/legal.asp

It is the ADA's take on what your duties would be and addresses all the important issues.

 

[KOM]

I don't even understand this. Needle sticks are a risk to the dentist from an infectious disease the patient has. How would I put a patient at risk? Would I do this by sticking myself and then sticking the patient after that with the same needle accidentally?!?!

You stick yourself, abrade yourself, have open sores, etc that transfer the virus. What's so complicated? Stick yourself, bleed into patients mouth during an invasive procedure...very unlikely yes, sticking a patient and then sticking yourself less unlikely, but still unlikely. We've been through this before.

Discrimination towards those with HIV is unfortunately way too common. I imagine people developed a lot of this "hate" because now people had an additional concern to think about before having that guilt-free unprotected sex. They want to blame someone for this inconvenient truth (thanks Gore).

This form of "hate" doesn't seem to be validated because we can't blame each other just because viruses are opportunistic. Or can we? There have been cases of people with HIV intentionally infecting other individuals. There have been accidents in health care. There have been those who, by their own choice, choose to have unsafe sex and perpetuate the disease that essentially increase risk factors for everyone else. How so? Well, one way to look at it is that the longer the virus is perpetuated, the higher the potential for mutations that may subsequently put people at greater risk. Or is that a stretch?

On the other hand, can we blame those who were born with HIV, those who pass the virus unknowingly, etc? Hell no, and it's difficult to protect some without protecting others.

I think for many people, another question is where paranoia for the disease becomes considered a form of discrimination. Generally speaking, laws on this matter have cast enough doubt for me that current policies either A) aren't protecting the right people or B) aren't protecting enough people period. Why else would 50,000 people or so get infected each year?

I still maintain that if you or I know that we're HIV positive, and we're in a position where trust is so highly valued (as in the dental profession) then not telling them amounts to deceit. AIDS is a current health-care crisis and keeping it in the shadows doesn't protect anyone.

 

[fusedtometal]

You stick yourself, abrade yourself, have open sores, etc that transfer the virus. What's so complicated? Stick yourself, bleed into patients mouth during an invasive procedure...very unlikely yes, sticking a patient and then sticking yourself less unlikely, but still unlikely. We've been through this before.

Wow, that's some pretty rough dentistry, sounds like one might have to inject themselves with lidocaine to rough themselves up pretty bad and stab themselves that hard without being aware, not to mention not using gloves .

I imagine people developed a lot of this "hate" because now people had an additional concern to think about before having that guilt-free unprotected sex. They want to blame someone for this inconvenient truth (thanks Gore).

What???

I still maintain that if you or I know that we're HIV positive, and we're in a position where trust is so highly valued (as in the dental profession) then not telling them amounts to deceit. AIDS is a current health-care crisis and keeping it in the shadows doesn't protect anyone.

I completely disagree with you, and I am glad the law is on my side. We've been through this before. Your energy, passion, and vehemence would best be channeled to writing your representatives in government and getting the support of others who share the same concerns as yourself to do so. Alternately, you might want to file a lawsuit should the occasion arise.

 

[KOM]

Absolutely if I exposed my patient I would tell them. I would follow the law.

You say that now...but when you have 300K+ in debt, an established practice with clientèle that you've acquired over years of practice, and a family that relies on you, such an obvious decision may become more convoluted.

Fusedtometal - you said you'd protect your right to privacy over the ignorance of others. How much more ignorant of the disease were you before you contracted the virus? Also - if you're protecting your right to privacy based partly on the fact that this ignorance is based on the population not knowing these small risk factors involved...well, then educate them. The problem you have is that many of us KNOW the risk factors and still would like the opportunity to choose. Does that amount to discrimination? I don't believe it does when it involves a person's health-care.

As ImfillingFine stated, patients have the right to ask about a dentist's status. I think it would be fair to say that if they were truly concerned about it, more patients would ask their dentists. If the dentist says that information is private, I think that may be a fair enough indication for the patient to then re-evaluate their priorities. So to hell with it. If the day comes that an accident occurs you will have to come to grips with it and the rest of the profession will suffer as a result of your inaction.

 

[KOM]

In other news, Joe Biden got the call from Obama for VP pick while undergoing a root canal. Relevance? None, whatsoever.

 

[ScubaDr2B]

Wow, that's some pretty rough dentistry, sounds like one might have to inject themselves with lidocaine to rough themselves up pretty bad and stab themselves that hard without being aware, not to mention not using gloves .

Have you ever had a scaler slip when you are scaling someones half inch of calculus from the lingual of their lower incisors with a towner? I realize its a small chance but you don't have to be doing "rough dentistry" for an accident to happen, and in this case and many others you will just cut right through gloves. I've yet to bleed into a patients mouth, but I can see very easily how it can happen.

 

[KOM]

I completely disagree with you, and I am glad the law is on my side. We've been through this before. Your energy, passion, and vehemence would best be channeled to writing your representatives in government and getting the support of others who share the same concerns as yourself to do so. Alternately, you might want to file a lawsuit should the occasion arise.

The laws state you "don't have to" disclose your status...they don't state "you can't" disclose your status. What I'm trying to explain to you is that laws don't dictate ethics. Laws differ from state to state and usually what I get from you is responses like "I would do what the law asks for" or "I'm glad the law is on my side." You need to start thinking outside the law and stop thinking the law is some sort of universal truth that will protect everyone in every circumstance.

Do you think other groups won't be challenged with discrimination in this profession? If you were homosexual would you live a lie in your community just so you could practice free from that specific form of discrimination? HIV is a part of you...it's in your blood...and just because it's something you can hide from casual observation doesn't mean you *should* hide it.

But, if you think laws dictate what is right or wrong I'd be interested in hearing where you feel you fall under the ADA (dis. act).

Under your protected status from the ADA "An individual is considered to have a "disability" if s/he has a physical or mental impairment that substantially limits one or more major life activities.

You seem a very bright and informed individual to me...so are you mentally impaired?

If no, is it a physical disability?

Or is it the third clause "being regarded as having such a disability?"

I bet you bite on the last one...for which I can hardly wait to reply.

 

[fusedtometal]

The laws state you "don't have to" disclose your status...they don't state "you can't" disclose your status. What I'm trying to explain to you is that laws don't dictate ethics. Laws differ from state to state and usually what I get from you is responses like "I would do what the law asks for" or "I'm glad the law is on my side." You need to start thinking outside the law and stop thinking the law is some sort of universal truth that will protect everyone in every circumstance.

Do you think other groups won't be challenged with discrimination in this profession? If you were homosexual would you live a lie in your community just so you could practice free from that specific form of discrimination? HIV is a part of you...it's in your blood...and just because it's something you can hide from casual observation doesn't mean you *should* hide it.

But, if you think laws dictate what is right or wrong I'd be interested in hearing where you feel you fall under the ADA (dis. act).

Under your protected status from the ADA "An individual is considered to have a "disability" if s/he has a physical or mental impairment that substantially limits one or more major life activities.

You seem a very bright and informed individual to me...so are you mentally impaired?

If no, is it a physical disability?

Or is it the third clause "being regarded as having such a disability?"

I bet you bite on the last one...for which I can hardly wait to reply.

I feel like the law takes into account the risk, and even some of the ethics beyond that. I also feel like even exposing someone with 300K in debt to pay, I would still tell that person and go through the necessary steps with them, should that happen, which I honestly don't think so. I will also add that with sex I didn't feel that way. I knew I was taking high risk into my hands, and I lost.

I am actually mentally disabled by having bipolar disorder. This does not make me less bright or well-informed, but it has been and can be a formidable challenge. HIV makes me disabled in that I have to fight depression more carefully and constantly monitor my progress through therapy and medication management. HIV physically causes a great deal of impairment by making my energy level unpredictable and that is frustrating. I do the best I can through diet and exercise, and it helps a lot.

I don't feel like if some patients found out I was positive, it would make much of a difference. This is a big city and not a small town, and there is a lot of support for positive people here. I am very lucky in many ways. Hell, I even ran across a few dentists working here who have obvious physical signs of HIV disease, like facial wasting, and they are successful, practicing dentists who seem very excited and rewarded by what they do.

I don't know, why, but I feel like you are assuming that I want to "hide" my status. I do not, but what I do want to focus on is on being a professional and the patient's healthcare. With the statistics on universal precautions, I feel like my status isn't an issue, and with all the issues in taking care of a patient, like thinking about how to best implement a plan of treatment for them, anxiety, financial issues, I am not going to throw fear of HIV into the mix if its not an issue statistically or legally. It's just not necessary or prudent, and I have a right to privacy as well. If a patient wants to ask, there is nothing at all to stop them, and if that's a big fear for them, believe me, they will.

I consider myself a compassionate and ethical person, and I don't consider myself financially motivated enough to disregard other people. I feel like my decision is ethical because it is based on statistics, facts, and laws. I am not trying to squeeze through a loophole in the law. The law is a good law, it is based on what has been scientifically proven, and the rights we have in American Society. Dentistry involves a great deal of compassion and caring for people when they are vulnerable, if I did not feel like I could do that safely, I would not try to.

 

[KOM]

How 'bout this one...

Disabled because you are substantially limited in the "major life activity" of reproduction because of your disease.

Getting more complex now...

 

[KOM]

Btw, I truly appreciate your honest responses. I think we are all learning a lot about the disease and its impacts. For that I thank you.

 

[fusedtometal]

Here is another piece of knowledge for you. Sperm washing enables people with HIV to safely reproduce with their negative partners. Adoption of a child is also an option, and not a bad one, I think, in an over-populated world with innocent, poor, orphans; and, there are many, many African orphans who have lost both parents to HIV.

I'd rather not focus on my more personal issues like this one, if you don't mind, but rather more pragmatic ones which address the concerns of an HIV positive practitioner.

I, too have learned a lot, so thank you as well. I know this an emotional subject for many people. HIV and dentistry have had quite a rocky, controversial relationship. Here in 2008, it seems, in comparison to 1991, rather straightforward as to the extent of the issues and risks.

 

[KOM]

HIV makes me disabled in that I have to fight depression more carefully and constantly monitor my progress through therapy and medication management. HIV physically causes a great deal of impairment by making my energy level unpredictable and that is frustrating. I do the best I can through diet and exercise, and it helps a lot.

I'm very sorry for the conditions you describe and I have nothing but respect for you in rising above and pursuing your dreams. That's incredible in my mind and I know laws exist specifically so you can get to where you want to be free from specific forms of discrimination.

In an original question you posed that I don't think has been answered you asked if you should disclose to the dental school itself if you were HIV+ when applying and I know from personal experience that this is an extremely difficult question to ask.

My wife is Muslim and from Africa and an American and she is white. In applying for med school does she say she's African-American? Does this affect whether she will get in based on race? Does she refrain from joining specific clubs in med-school because she's heard that Islamic-clubs put her at a disadvantage in applying for residencies? When I was applying for dental school, and was asked specifically by an interviewer at Kentucky named Carol Leslie if I was Christian do I reply "yes" because I know Kentucky is within "the Bible belt?" I know very well about discrimination issues and I have a great deal of respect for laws that protect those discriminated against.

So...I have a strange perspective of where laws begin to protect and discriminate against applicants at the same time.

I'm not sure I know the answer to the question based on being honest to who you are vs. achieving your goals and that Fusedtometal, is why I persist in debating the issue with you. Because I don't feel I 100% know the answers myself.

My primary concern in your situation is that the disease will create larger risk factors for patients that should necessitate a higher standard of treatment. I've heard anti-retro viral drugs pose side effects such as nausea and fatigue which have the potential to increase those risk factors.

The fact that you seem to have placed so much careful consideration in your responses, your goals, etc makes me less concerned for people like you, but for people in similar situations who don't share those values.

 

[KOM]

I'd rather not focus on my more personal issues like this one, if you don't mind, but rather more pragmatic ones which address the concerns of an HIV positive practitioner.

I completely understand, but often times it's the personal issues which allows an individual to open their eyes/broaden their perspective to a conflict at hand and become truly understanding of them.

 

[notanormalgent]

So you'd want to murder a dentist but you're still willing to have lots of sex? Which do you think is more risky overall?

What about a dentist with a severe respiratory illness that eventually kills you after you get it from a sharps accident? Would you be as mad as if it was HIV? I doubt it. HIV has such an intense reputation for being the worst disease in the world.

Also, answer me this: If your dentist disclosed to you before treatment, would you still accept treatment?

I wouldn't murder him, but believe me, I'm not exactly sure how I'd react, but in any life threatening situation I don't react nicely.

If a doctor potentially contaminated you how would you react? Say "oh, gosh, whoopsie daisy, it's ok...I guess..." I doubt it.

Would I still accept treatment? Possibly. When I'm a dentist I'm sure I'm going to come across patients with HIV, but I at least want to be aware of the risk and know EXACTLY what I'm getting into. My reaction as stated above would be due to the fact that it was an unpleasant surprise. But if I had absolute trust in my dentist...And this is a matter that requires a lot of TRUST on top of the trust you have in your dentist for his abilities, I am not opposed to having a dentist with HIV.

 

[fusedtometal]

I just got onto the dentaltown message boards, and the actual practicing dentists have a very different take on this issue than a lot of the responses from this thread. There's even a dentist saying he wouldn't mind an HIV positive oral surgeon doing extractions on his 18 y.o. son.
I like hearing what those people actually practicing in the field are saying.

 

[KOM]

I just got onto the dentaltown message boards,

How do you get onto those? I tried setting up an account and they started asking for all my personal information, where I practice, etc. It didn't seem they provided categories for dental students. Thanks.

 

[fusedtometal]

Wow. Those message boards are so chock full of info, I can't believe it....from what I remember, just put in dentistry and then under the next heading there is a pull-down where student is an option. I just put down my school for organization, and I left some things blank, no biggie.

 

[bipolardoc]

I haven't found any information on dentists or students who are HIV positive. Is it possible to practice anywhere in the US? Are HIV positive people going into dentistry? I would like to know what people think. If you were positive would you tell that as part of your story when applying to dental school?
Thanks

Just curious since you posted the topic and asked the question for others to answer, how did you get HIV and if anyone read thru this entire thread they will notice you do have HIV, and not to be an *****, but if I noticed all the stats you put of how hard it is to get HIV of being 1:2Million or whatever, if it is so hard than how did you contract it?

I have anxiety and been suffering for it for years, when I enter into a healthcare field I do not think it is anyones business to know neither would I disclose it to anyone, but again, its hard to give someone Anxiety, its not contagious as HIV is.

There is a huge stigma for those with HIV, I would say it will probably kill your prospects of a business if you tell every single patient your HIV, yet again if I was your patient and you didnt tell me I would be pissed as heck and probably try to sue your ***** off and go to planned parenthood and test myself 100000000000 times, but yet again, I do have anxiety so makes stuff worse for me.

This is a hard one to discuss. I mean you have the right to do anything you want for your future, and I am sure there are a few dentists and docs out there that are HIV positive and doing fine in practice.

If you're looking for reassurance it be hard to find here, i mean its hard as heck for anyone to make it seem like ooo HIV is all accepted and so on, if there was a cure to it, if it wasnt so deadly, etc... I think it would be different. Even if its hard to contract with protection, I think a lot would be anxious. I remember dating a fine as heck girl before who confided in me before we had sex that she had herpes. Now if she took her meds, we had protected sex, etc... it be hard to get, but to be honest, screw that called me narrow minded if you want, I dumped her eventhough i cared alot for her, now were friends and I dont have to have the anxiety of having sex while worrying if I am going to get a sore on my penis the next day...

 

[ObliqueRidge]

"This is a big city and not a small town, and there is a lot of support for positive people here."

THis was fused to metals quote about his city san francisco. I believe that there should not be this much support for people who are spreading a deadly virus. I am all for people with aids having an equal shot at things, but to go beyond that is a little whacked out. I really can't grasp this. Seems like a feel good notion to me....you know, the stuff that makes you feel good but is doing jack squat to society and potentially is making it worse. But, as long as your inner peace is fine then the world will be a better place? I think you are creating an escape for HIV positive people to say that their disease is OK when it is far from it. They made a mistake and should not be told it is fine or they might spread it further.
I am sorry that you had to contract this deadly disease, but not in the respect that your city feels sorry for you. I feel that the person you gave this to should be put on trial for attempted murder. it is no different;you have a disease that will eventually kill you. But I will not go so far as to protect you from telling a dentist you have HIV and saying it is none of the dentists business to know if their patient has HIV. Say what you will but it is not logical.

 

[losdientes]

I'm not going to argue with the law, but this is my personal view on the matter.

I believe you said it's required by law to alert your partners, but let's just put that aside for one moment.

I would not want my sexual partner to put a condom on and think that he doesn't have to mention his HIV status unless the condom breaks. I'd want the same from my dentist. I would not want my dentist to withhold his HIV status because he's wearing latex gloves and then admit to it when he cuts his finger and drips blood into my mouth.

I feel I deserve to know the risks. Like I said, I wont argue with the law, but that is my personal belief.

I realize an HIV diagnosis will alter one's life and perceptions, so I don't think any of us can truthfully relate to where you're coming from. These are the opinions of uninfected individuals who would personally want full disclosure. Had you never been infected with the virus, you may very well be reiterating the thoughts of many of us.