Garth Rattray

Not so long ago, a patient came to me with a very painful, blister-like rash extending down his left arm. It was obviously 'Shingles' (Herpes Zoster). Shingles occurs in people previously infected with Chicken Pox (Varicella Zoster). This virus has a nasty habit (sometimes) of hibernating in the spinal cord for many years and then reappearing along the path of nerves that go to the skin.

There was a problem with his medical insurance, so he requested a signed claim form to submit to his company. A few days later, he called to say that his boss accused him of having herpes and fired him. The claim form requires a diagnosis and, upon seeing Herpes Zoster, the human resources manager took it to the boss, who saw it fit to fire his employee for having a communicable disease.

I was tempted to report the bunch of them to the Ministry of Labour, but I feared that, with such a petulant and ignorant boss, my patient would remain fired simply out of spite. I called the boss and calmly explained that Herpes Zoster was in fact Shingles. For the patient's sake, I didn't go into the numerous ethical, procedural and labour law breaches that he and his company committed.

Stigma still strong

Although fairly recent medical advances made in the detection, moni-toring and suppressive treatment of HIV and AIDS (and their attendant medical problems) have caused us to classify them as chronic diseases (of long duration), the stigma, prejudices, ignorance and unreasonable fear surrounding HIV/AIDS remain very strong. So strong, in fact, that HIV/AIDS cannot be thought of as one would 'any other disease'.

Given the fact that HIV/AIDS is not spread by casual contact and knowing that it is a chronic disease that is covered by the National Health Fund and because having it is such an extremely sensitive and private matter, I see absolutely no reason why an employer has the right to know whether an employee is one of those People Living with HIV/AIDS (PLWHA).

Because of the deep respect that I have for my patients and their legal and ethical right to privacy, I cannot disclose such a diagnosis to an employer. In any event, all my HIV-positive patients are gainfully employed and have never had to lose work-time more than my average HIV-negative patients.

Disastrous consequences

If pretesting for HIV/AIDS is allowed, many PLWHA will avoid applying for many well-paying jobs out of fear of discovery. They and their families will lose the opportunities afforded others of their educational and social ilk. Furthermore, no matter how much we educate and warn business management staff, a diagnosis of HIV/AIDS is extremely unlikely to be kept secret. The consequence of exposure can be disastrous.

Workplaces need to educate their employees about the personal responsi-bilities of 'universal precaution'. No one has to fret about becoming infected with the Human Immunosuppressive Virus if they accidentally come into contact with nasal secretions, sputum, sweat, tears, saliva (unless it may be tainted with blood), vomit, urine and even faeces. We certainly don't expect co-workers to come into contact with fluids that require barrier protection like blood, semen and vaginal secretions, synovial, cerebrospinal, peritoneal, pericardial and amniotic fluids. There's no danger of HIV infection at the workplace in the natural course of things.

I doubt very much if any PLWHA would defend the right of employers to pretest for HIV. Until we support protocols with the special needs of everyone in mind, we are not being fair to anyone.

Dr Garth A. Rattray is a medical doctor with a family practice. Feedback may be sent to garthrattray@gmail.com or columns@gleanerjm.com.