The age-old difficulty with communicable disease is that question of culpability: how much should we blame ourselves for our infection?
We’ve all been infected with –at the very least– a common cold (+/- a healthy cleanse of profuse traveller’s diarrhea.)
Whenever I get sick, I tend to self-blame: “it was probably because I didn’t wash that fruit properly, because I ate delicious roadside food at sketchy venue ‘x’, because I wasn’t diligent about my hand hygiene.
The modern physician is inundated with recurrent messages about how doctors = vectors of disease. Our white coats, our stethoscopes, our notepads, our iPhones. There are now even individuals whose full-time job it is to police hospital handwashing. I tend to agree we could collectively do better as doctors.
But, if you live in a poorly ventilated slum on the outskirts of Lima, we generally agree that your level of culpability in entrapment of TB is zero. How can one be blamed for contracting something just because they breathed?
Innumerable epidemiologic studies have proven that environmental and socioeconomic factors pose the strongest risks for contracting the worst types of infectious disease.
This week is HIV/TB week. We discovered yesterday that pre-marital HIV testing in Peru is mandatory. Popping the question commits you and your potential betrothed on a trip to the (in)voluntary counseling and testing centre.
Announcement of this fact in class was, unsurprisingly, met with an uproar. We collectively imagined the ensuing pre-marital strife. Weddings called-off at the last minute due to unexpected discoveries of partner infidelity.
However, Peru is not the first or only country to employ strategies along these lines. In Canada, HIV testing is done as routine screening on all pregnant women. Perhaps pre-marital testing is not a far stretch from pre-natal variety.
None of us agree on what is the best strategy for “control” of diseases that are inextricably intertwined with human behavior. Ironically, “control” is sometimes best achieved by letting go. By relinquishing our collective professional grip on treatment/diagnostics and bringing it closer to those who could benefit.
Maybe one day testing for HIV will also be just like an over-the-counter pregnancy test. True: there will be some degree of false positives and false negatives; falsely alerted and falsely reassured. But I haven’t met a pregnant women yet who didn’t go to the doctor afterward to confirm the life-changing event of a blue-strip on a pee test.
So next time it’s Friday night, and you’re picking up the fixings for a romantic date with your loved one, imagine this: a bottle of wine, candles, and, hell, why not throw in a rapid test for HIV? (And while you’re at it, one for gonorrhea, herpes, and syphilis too.) Happy Valentine’s Day.