AIDS infections

It would be a pity if your article Most HIV/AIDS cases identified too late (April 24, 1997) left readers, particularly those in the medical profession, with the impression that special precautions are required when treating patients infected by HIV. Clearly medical staff are at some risk when treating any patient with an infectious disease, and for this reason, a set of procedures called "universal precautions" should be followed in every case. Among listed procedures, there are details for the handling and disposal of used syringes and needles.

As the article makes clear, many infections, including HIV, cannot be easily identified through a clinical examination of the patient. It must be assumed that any patient could be infected by such diseases. Universal precautions protect against this. In fact, many equally dangerous infections such as hepatitis are transmitted much more easily during medical treatment. The risk of contracting these is much higher if correct procedures are not followed.

These points are still not clearly understood by many in the medical profession, resulting in frequent proposals that all patients should be tested for HIV before treatment. Such testing would not only be discriminative but would also be inconclusive, since tests for HIV are not effective during the first several months of infection. Thus risks might be taken following a potentially false negative result. In addition, it just is not feasible to test for all possible latent infections.

But of course accidents do occur. As the article noted, medical personnel have become infected with HIV as well as hepatitis and other diseases from contact with patients. If immediate action is taken following such accidents, the risk of infection can be greatly reduced. By providing a clear set of procedures to be followed after every accident, such as a needlestick injury, much of the fear felt by medical staff in handling patients with infectious diseases can be reduced. This can help reduce discrimination against such patients.

CHRIS W. GREEN

Grup Koordinasi Nasional

Mobilisasi AIDS Nusantara

Jakarta