"My dentist told me I may have HIV. Now what?"

Objectives:

1. Identify and discuss key issues surrounding HIV diagnosis, disclosure, care and treatment using the core values of medical ethics: autonomy, beneficence, non-maleficence, and justice.
2. Provide a platform for students to work in interprofessional teams to develop a comprehensive plan of care for a person newly diagnosed with HIV that emphasizes long-term physical and psychosocial wellness.
3. Generate discussion related to common ethical challenges in HIV diagnosis, care and treatment.
4. Consider a person newly diagnosed with HIV in the context of their personal and professional life and the role of the interprofessional team in assisting that person to live well.

Activity Description:

Mr. N is a 40 year old gay male who is a software trainer that travels frequently for work; grew up in a religious family, with a father who is a minister. In August 2013, Mr. N. was at a dental appointment while he was also experiencing an acute onset of chills, night sweats, and rash. Dental team noticed oral thrush upon exam; offered and performed a rapid HIV test, which was positive. After a brief presentation of the case, the group will split up into interprofessional teams to discuss the case and create a plan of care for the patient. Examples of some issues to discuss in interprofessional teams include:

Dental/Clinical/Medical: Mr. N. was experiences signs and symptoms of acute HIV infection.

• Discuss symptoms, diagnosis and implications of acute HIV infection
• Discussion around logistics and ethical considerations in managing positive results in a busy dental clinic

Psycho-Social: Mr. N. is insured but has high co-pays for medications. The patient is emotional about his diagnosis and its implications on his personal life and his health.

• Discuss involvement of case management for assistance with insurance and financial concerns
• Discussions around ethics and reality of sexuality, disclosure to friends/partners and long-term health implications of HIV: What does this mean for his future relationships and intentions to have a family?
• How can and should the team assist with disclosure to friends, family and partner(s)?

Legal:

• Patient’s emotional distress over his diagnosis is affecting his performance at work and he is facing termination. Does he need to/should he tell his employer why?
• Partner Notification – what if the patient has unknowingly transmitted HIV to a partner(s)? How can the patient be supported in notifying partner(s) of possible exposure?

Pharmacy:

• What can Mr. N. do to maximize his well-being and medication adherence? When will he start treatment?
• What are the implications of treatment of acute HIV infection?

Dental implications:

• Evaluate dental status as infection can impact any immunocompromised concerns. Be sure diet status is reviewed, discuss HIV and dental concerns (pts meds may impact oral status).
• What are the implications of smoking on oral health? Advise on maximizing oral health status.

Physical Therapy:

• Is there a need to focus on exercise/physical activity when one is not sick/disabled or overweight? What are the implications of smoking on physical health?
• How can physical activity impact feelings of anxiety and depression?