Edward White
Edward White is a former editor of The News Lens International.
Fewer than 10 dental clinics across Taipei are willing to treat people with HIV, the head of a local NGO says.
Ivory Lin is the secretary general of Taipei-based Persons with HIV/AIDS Rights Advocacy Association of Taiwan (PRAA).
Lin told The New Lens that some dentists and doctors in Taiwan are reluctant to treat people with HIV as misconceptions surrounding the disease still run deep in Taiwanese society.
People with HIV often experience oral health problems related to the disease. Lin notes a dental clinic in Taipei’s Ximending area, which runs a session for HIV patients, can only find one dentist willing to cover the shift each week.
While it is understood to be illegal for doctors or dentists to refuse to see patients with HIV, Lin says people are not willing to the take the matter through what would likely be a difficult and costly legal process.
Misconceptions
PRAA assesses the HIV treatment systems at hospitals across Taiwan, and helps people with HIV and AIDS through legal issues – among a range of other patient support, prevention and advocacy work.
Lin believes fears in the medical community relating to HIV, in part, stem from the 2011 case at National Taiwan University Hospital, Taipei – organs from an HIV carrier were mistakenly transplanted into five recipients.
And there are some doctors, Lin says, who remain unwilling to treat patients because they are afraid of contracting the disease themselves.
Lin, who has worked with PRAA for more than 15 years, says the issue is more prevalent among surgeons and dentists than other healthcare professionals. She adds that in her experience, younger doctors are more willing to treat HIV patients. Some older doctors, despite holding senior positions at hospitals, have been reluctant to go through professional development in HIV treatment, she says.
Subsequently, many people with HIV don’t want their medical records made openly available to doctors for fear of being turned away or having their care delayed – PRAA is lobbying for changes to the operation of Taiwan’s medical records database.
Lin gives the example of a person the organization has recently been working with. The woman, in her 50s, has been living with HIV for the past 15 years and has been diagnosed with cancer. Lin says the woman, who initially did not tell her doctor she had HIV, was told last year she would need to have a tumor removed. However, the doctor, after finding out the woman was HIV-positive, suggested a non-surgical approach – this is the course of treatment the woman is currently receiving. Lin suggested the doctor did not want carry out the surgery because the woman had HIV.
Discrimination against HIV patients by healthcare workers is not restricted to Taiwan. According to UK charity NAM, a 2008 report showed that a large survey of people with HIV in London found one third of people reported discrimination because of their HIV status. More than half of those said the discrimination had come from a healthcare worker, including 26 per cent from a dentist.
NAM notes the British Dental Association has stated that it is unethical for dentists to refuse care to patients with an infectious disease. People with HIV “who are otherwise well” can be treated routinely in normal settings, the association says.
Taiwan’s statistics may be not telling the whole story
The total number of new cases of HIV reported each year in Taiwan, which started to decrease about a decade ago, has been rising since 2009.
According to the latest numbers from the Centers for Disease Control (CDC), there are more than 32,800 people in Taiwan with HIV and 14,600 with AIDS. That is up from around 30,400 with HIV and 13,200 with AIDS, this time last year. Men account for more than 90 per cent of all cases.
In terms of how the disease is transmitted, male-to-male sexual contact (MSM) accounts for 59% per cent, injecting drug users 21% and heterosexual contact 18%.
Lin says that because the numbers consistently show “MSM” accounting for more than half of HIV/AIDS cases on the island, most of the awareness and testing efforts are targeted at gay men. For example, the CDC approaches LGBT groups at universities to collaborate in setting up examination clinics, but it does not often go to other student clubs, she says.
While PRAA is supportive of continued education and increased check-ups in the LGBT community, it is concerned that given the low testing rates among the general population, an increase in HIV infection rates in other parts of society may have gone unnoticed.
Much of the general public, including heterosexual people of both sexes, are unaware of the risk of HIV infection, Lin says. Further, schools are not always open to PRAA running prevention awareness programmes with students. When the organization does talk to students, teachers often try to water-down their material in an effort to make it less confronting.
Lin says with the continued stigma around HIV and AIDS in Taiwan, some people who contract the disease are afraid to talk about their illness with family or friends.
In Australia, which has a similar population to Taiwan of more than 23 million, 27,150 people are HIV positive. Of that number, an estimated 3,350 (12%) are unaware of their HIV-positive status, according to the Australian Federation of AIDS Organisation. HIV transmission continues to occur primarily through sexual contact between men – of all the HIV diagnoses made in Australia in 2014, 70% of transmissions occurred among men who have sex with men, 19% of transmissions were attributed to heterosexual sex.
*Lin spoke to The News Lens via a translator.
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