HIV Treatment Contingent On Proof Of Patient Compliance

02-03-2007 | Categories:

Ethics

Pictured above are “Little Traveller Dolls.” (See below)

Finding hope in South Africa is a posting about Ian Schwartz, a medical student in Winnipeg, who returns each summer to South Africa, the country of his birth, to to work as a volunteer at an AIDS clinic located 30 minutes from Durban in KwaZulu-Natal, South Africa, one of the hardest hit areas on the continent.

The entire post is worth reading, but two sections that deal with patient compliance, both disturbing in different ways, are excerpted here:

if they are below 200 CD4 cells/Ml, necessitating anti-retroviral therapy, instead of getting the ARVs they are sent off with three months worth of antibiotics, to prove their adherence to the medication regiment. Only once they have completed this placebo-esque treatment can they begin their ARV therapy. By this time, many people will have died, or their AIDS will have progressed beyond hope.

Still others get their ARV treatments, Schwartz observes, suffer some side-effects, visit the sangoma (traditional healer), who gives them something to make them vomit, picks up the ejected tablet, and explains authoritatively that it is this poison that is making the patient sick.

Commentary

While I was aware that some patients discontinue needed medication on the advice of practitioners opposed to traditional Western medicine, the notion of withholding ARV treatment until seriously ill patients successfully undergo a three month antibiotic trial to prove their willingness and capacity to comply was new to me and has motivated me to re-assess some of the processes we routinely use to determine whether, for example, a liver transplant candidate meets an ambiguously defined capacity to adhere to treatment before performing the life-saving procedure.

Little Traveller Dolls

According to the post, Ian Schwartz, in addition to volunteering his time at the clinic, also raises money for its support by selling “Little Travellers”—South African-made dolls of pins. The dolls are made by women who are caregivers at the clinic and whose families and friends have been affected by AIDS. Thus far, Schwartz, with the help of colleagues and friends, has raised more than $50,000 through the sale of the $5 dolls. The money, Schwartz says, helps Hillcrest maintain its programs and provides economic empowerment to the women who make the dolls.

Anyone interested in supporting this effort can purchase the “Little Traveller Dolls at Dolls For Sale.¹

Footnotes

AlignMap has no affiliation with, fiscal interest in, or information about the “Little Traveller Dolls” project beyond that provided by the referenced post [back]

« One Problem — One Hero
My Adherence Sucks »

Related Posts: