AIDS Facts AND Fears

December 11, 1990|By Habib Aounand Patricia Aoun

An article by Drs. Hacib and Patricia Aoun that appeared on the Opinion * Commentary page Tuesday suggested that Johns Hopkins Hospital was the source of The Sun's first articles about Dr. Rudolph Almaraz, the surgeon who died last month of AIDS. In fact, The Sun learned of the story from patients who called the newspaper. In addition, Hacib Aoun -- whose name was spelled incorrectly with the article -- should have been identified as a former Hopkins physician who contracted AIDS while treating a patient. He sued the hospital for slander, alleging that Hopkins breached an agreement to keep information about his illness confidential. The suit was later settled out of court.

0 The Sun regrets the errors and the omission.

A WELL KNOWN surgeon died of AIDS and a well known hospital stirred up a storm. Johns Hopkins Hospital called the press to announce that it was sending letters to offer free testing to all the patients of the surgeon. The news was immediately bannered on Page One of The Sun and picked up by the national media. Panic followed.

This train of events was unnecessary and counterproductive. There was no reason to believe the surgeon had transmitted HIV to any his patients. In 10 years of the AIDS epidemic and after millions of surgical and dental procedures every year (some of them performed by HIV-positive persons), there has only been a single report of possible transmission from a dentist to a patient. There have been no reports of surgeon-to-patient transmission, despite several studies in the medical literature where hundreds of patients of HIV-infected surgeons were tested.


All this suggests that the risk to patients is close to zero, that there was no rationale behind the action of the hospital and no justification for the sensational display in the paper.

These actions have greatly frightened the general public and the patients of that surgeon. Maybe the surgeon's patients needed to know, but loud publicity was not the most considerate or compassionate way to inform them. If the hospital was truly concerned for the patients, and not just concerned about issuing a pre-emptive strike to prevent litigation, a telephone call, a telegram or letter would have been more discreet and professional.

Instead, Johns Hopkins Hospital and The Sun have greatly contributed to worsening the misunderstandings surrounding AIDS and how one gets it. Inevitably, they have also contributed to worsening discrimination against HIV-infected health-care workers.

Some persons, even within the medical community, are already proposing that those infected with HIV not be allowed to care for patients. There have been cases of discrimination against HIV-infected health-care workers that illustrate the importance of, and need for, clear recommendations based on facts -- nurses, technicians, doctors and even pharmacists, who were removed from their duties or denied employment when their employers found out they were infected with HIV.

More recently, some employers have demanded to know the HIV status of employees, alleging that such information would be necessary to determine whether the employee could work. In one such case the demand was upheld by a federal court. Because of these exaggerated concerns and public displays, some persons, both in and out of medicine, will propose testing all health-care workers for HIV, or at the very least singling out certain groups perceived as being ''high-risk.''

Such screening could be justified only if the risk of transmission from health-care worker to patient were found to be meaningful. And, since the risk of acquiring HIV at hospitals appears to be higher for medical staff than for patients, then it would also seem logical to demand HIV screening of patients before performing surgery or invasive procedures on them. But screening of patients invades privacy, and, as recently reported by researchers at the San Francisco General Hospital, does not appear to have any effect on decreasing the number of meaningful exposures in hospitals.

The hospital has never been a totally risk-free environment for patients, but AIDS is not one of the important risks that patients face from doctors or hospitals. Adverse reactions to medications, problems with blood transfusions, bacterial infections and medical negligence are more common occurrences.

Nobody advocates taking an useful medication from the shelves because of one associated death; nobody advocates closing an operating room because a patient died from a surgical infection, and we do not revoke the license of a doctor accused of malpractice. Yet compared to these risks, acquiring an infection with HIV from an infected health-care worker is the least likely of all.

Current scientific information does not support removing qualified health-care workers from most clinical practices if they use the barrier precautions recommended by the Center for Disease Control. These infection-control practices should suffice for the protection of both patients and health-care workers. To do otherwise would be to promote a double standard which discriminates against the health-care worker.

AIDS is an illness plagued by misconceptions on the part of the public, and it takes very little to make the problem worse. The press and medical institutions have a responsibility to educate the public with information based on facts, not on fears.

The writers are physicians in the Baltimore area.

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