Tuesday, March 10, 2009

"I cannot tell this to my wife doctor".

" I cannot tell this to my wife doctor.She will explode and may even take her own life".
A 43 year old man was telling this to me in my clinic.
He is HIV positive.He know about this for last 3 years.
I was asking him if he had tested his wife for HIV.
No he had not tested his wife.He had not told his wife yet. He is working in a far away place and visits his family only occasionally.

Are you using condom when you are with your wife? I asked.
'No' was his answer.

I did not know what to say.I had seen him 3 years ago when he was first found 'positive'.I had given a detailed lecture to him about what to do and what not to do.I had asked him to tell his wife about his 'positive' state.I had stressed on use of Condoms.
He had neither told his wife nor used condoms while having sex with her.

I was angry. "I can't treat you if you do not follow my advise". I threw his papers on the table. He and his friend who accompanied him started pleading.

" I cannot tell this to my wife doctor.She will explode and may even take her own life".

"What are you doing? You are now giving her infection and killing her.And you still say you are afraid she will commit suicide?"
I cannot ethically decline treating him. So what should I do?

I was confused. His CD4 cell counts are low and he should be started on ART. He is so afraid of stigma and discrimination that he is not willing to go to Government ART centre.

There is a law that says the doctor have to reveal the result to the spouse if she/he asks. I told him about it. From his face I could make out that he is mentally resolving never to bring his wife to me.

I had an idea.I should make him realise that telling his wife and testing her is also important for his health.

"I have to start you on anti viral medicines now.With in few months the number of viruses in your body will become very small.But if your wife is positive and you are having sex with her without condom the viral load will not decrease as your wife will transmit the virus to you."

He was confused first, I explained again to make him understand. Slowly he realised that it is important for his health that his wife is tested and given treatment if needed.Also the fact that having unsafe sex is unsafe not only for his wife but also for him.

He agreed to take his wife for testing. I gave prescription for 2 weeks and asked him to come back with the result of his wife's test. Will he do as I advised? I do not know.
But what a selfish man?


Indian Home Maker said...

No children? Not worried about who will look after his parents?

This is really shocking, I thought ... I didn't think he could be so selfish... but then it is common - for men to infect their wives, we hear of it.

Now he might bring his wife. Please do tell us what happened. Isn't he a murderer if she is infected?

deepz said...

Really,he is too selfish..even after konwing that he is HIV positive,how could he countiue his physical relationship with his wife? he should never be forgiven...

how people can be so selfish?

Charakan said...

IHM, they have healthy children in mid teens.
Men always infect their wives and I have so many positive widows including few grand mothers under my care.Good thing is they are doing well with ART which is now available free of cost in Govt centres. Some of those widows are also active in 'positive network' helping others like them.The Husbands died because they were diagnosed either late or the medicines then were very expensive.
I wanted to wash hands off him but.... it is un ethical.

Charakan said...

deepz... yes I was really angry with him.Wanted to refuse treating him,but that is un ethical. I am hoping due to his selfish interest of maintaining his health,for which testing and treatment of the wife is also important he may bring her.

Bindhu Unny said...

So many wives getting infected like this. Hope this man will do as he was told.

Charakan said...

Bindu, I do not think he will tell his wife.He may start using Condom,for his own benefit.

Seema said...

I would not think he is selfish, Guess he is too scared of consequences on such a disclosure to his wife. Maybe he needs professional help like an NGO worker or someone who can workout a better way to overcome his fears, stigma etc and ultimately convince him to tell his wife. After all he is suffering too..

IHM raised very good point on criminalisation but sadly India is yet to come up with a law to try individuals who spread the disease knowingly and intentionally. Many western countries have adopted such laws and makes it as a mandatory disclosure to partners. India has a HIV bill pending for about 5-6 years now but the core issue adressed in that bill is discrimination and access to medication. I lost track of Indian laws now so don't really know what stage the bill is right now.

Charakan said...

Seema,Yes he is scared of the consequences.I think his wife is a strong lady and questions will be asked.Still when I said telling her and using condoms is also in his interest he seemed to be more interested in telling the truth.
I think it is mandatory to disclose your positive status to your spouse even in India.The doctor is also supposed to inform the spouse if asked.Should the doctor try to find out the wife and tell her? I do not know

Seema said...

Here is the answer to your Question if you can get to read this case (Mr. X v Hospital Z (1998) 8 SCC 296. It is a Supreme Court of India decision which is not very clear but lays down that even though there is no mandatory requirement for a physician to disclose HIV status to the spouse, there is no liability issues on breach of doctor patient confidentiality in case the doctor chooses to disclose. I guess the medical ethics journal can throw some more light on this issue. Hope this info is useful.

Charakan said...

Thank you Seema for the information.What I learned in my training and imparted to my trainee docs is it is against the law not to inform the spouse if he/she asks about the diagnosis.May be the same ruling.
Now can you ask you Seema something. How ethical is it to post about patients like the way I do?

Khalil Sawant said...

I think he probably got it from somewhere else, and fears that his wife will come to know that, if he tells her that he is positive

Charakan said...

Khalil welcome to this blog.Sure he got it from outside marriage as it happens most of the time.Still most of my 'positive'husbands slowly become ready to tell their wives.Also they take precaution so as not to spread it to their spouse.This man it seems is adamant that wife should not know.

Anonymous said...

Opulently I assent to but I about the post should prepare more info then it has.

Anonymous said...

Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!

Anonymous said...

its only men who are selfish to that extent. Had they been really humane they would not have cheated in the first place,would not have bought sex (indirectly promoting prostitution) and would not have transferred it their partners.Then HIV wouldn't have spread to female folk..