Hiv positive patients and the doctor patient relationship perspectives from margins

Examining Privacy Regulatory Frameworks in Canada in the Context of HIV ::

hiv positive patients and the doctor patient relationship perspectives from margins

The patient–doctor relationship is an important concept in health care, As an example, a study of HIV prevention in black men who have sex with men, which . are able,24 from the patient's perspective the emphasis is always on the doctor to positive or negative, about a doctor's behaviour or practice may reinforce or. identify articles reporting on HIV positive patients' perceptions, professional- patient relationship, HIV specialist knowledge, .. doctor-patient relationship, with participants in one study Perspectives from the margins. Participants 52 HIV-positive individuals, 41 men, 11 women, purposively . Care is provided by physician-led multidisciplinary teams where patients have a . ' Becoming an HIV patient': developing a relationship with clinic and clinician .. On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the .

We hypothesize that the sharing of written, spoken or even visual illness narratives can assist dental providers in reframing the often depersonalized and enumerated patient relations into a more personable relationship.

Where the Doctor-Patient Relationship is Heading: Literary Perspectives | Medical Humanities

Using a photo elicitation approach provides an additional complement to this body of literature by lifting out the visual narratives behind stories not yet fully told. Using photos can possibly sharpen participants' memories and reduce the areas of misunderstanding between researchers and participants, while exploring complex social conditions, such as stigmatization [ 3 ]. Photovoice [ 2436 ] can be a critical methodological tool by which to explore language, body and politics.

Photovoice can assist in bridging the gaps between emotionally laden daily stories and culturally distinctive worlds [ 3 ], such as a dental office and people living within various HIV communities. Researchers began visiting the Bethlehem House in to work with their community members to act as simulated patients SP in our objective structured clinical examination OSCE curriculum.

Based on this ongoing partnership, we began to collaboratively develop, with a subset of our SPs, a photovoice project that is intended to assist our students in better understanding the lived experiences of our local HIV patient population. Verbally or visually we take the position that all people act as storytellers and one's shared visual narrative provides access into a person's private and public identity, personality and relational communicative role with others [ 3839 ].

Photography allows any of us regardless of our gender, ethnicity, education or other sociocultural groupings to make observations that can record such narrative abstractions [ 4364042 ]. A photo elicitation process [ 4 ] helps us to make observations that we might not normally make and assist us in connecting core definitions of ourselves with those placed on us by society, cultures and history [ 3 ]. This study, therefore, asks the question: Methods Visual voice protocol The protocol used was informed by photo elicitation, photovoice and photo narrative research and more specifically by the research of de Lange et al.

They were then each given a disposable digital camera because this was the most durable and cost-effective technological option available since two cameras went missing and needed replacing and several were dropped without breaking.

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Also, this project hoped to illuminate that unpracticed photographers, with modest equipment, could perhaps make impactful visual statements about their everyday lives.

Only 12 participants completed the project and 3 dropped out. Prior to the study, participants were oriented to the study and instructed on how to effectively and ethically use a camera, which excluded photographing minors or incriminating activities.

In order to facilitate participation, participants were given bus passes for transportation to and from meetings; they were also given a photo CD of their photographs and hard copies of their images.

Over a period of the next 4 months inparticipants were given two assignments which included: I just can't change the way she feels and thinks about it Discussion According to the international literature, adherence should be recognized as a complex behavioral process influenced by factors including medication regimen 12,27, provider-patient relationship 16,28, and patients' attitudes and beliefs about medication-taking and disease 29, We found that discussions between patients and physicians about the patients' concerns and well-being can encourage or, if absent or misguided, discourage adherence to drug regimens and retention of patients for follow-up, as well as helping to mediate the impact of patient beliefs on adherence.

Guidelines for ART care, including those issued by the Brazilian Ministry of Health 31, recommend that physicians discuss treatment-related issues with their patients. We found that this recommendation was often not appropriately translated into clinical practice by the physicians in our study. Several physicians in the study did not feel that they were communicating effectively with their patients about ARV adherence and the issues surrounding it. Others tried to engage their patients in a discussion about lifestyle and ARV adherence, but did not maintain an open and non-judgmental dialogue.

Insufficient time also played a major role in limiting participants' communication with their patients. Mainly due to understaffed services, the physicians interviewed were generally overwhelmed and had high caseloads.

As a result, many physicians had to limit the amount of time they devoted to discussing treatment-related issues with their HIV-positive patients. These findings agree with those of a qualitative study conducted by Roberts 32, which found that time constraints impaired physician-patient dialogue about adherence, and illustrate the barriers to adherence that can be posed by resource limitations and staff-constrained services.

Although adverse effects of medications may be inevitable, we found that insufficient provider responsiveness to patient concerns about ART side effects may increase the barrier these effects present to adherence. In contrast, effective communication and responsiveness to conflicts between patients' lifestyle and the requirements of medication regimens can act to improve patient adherence.

Corroborating the findings of a previous study by Gao et al. An open and culturally sensitive dialogue between patient and provider about the importance and effectiveness of ART may have the potential to improve adherence among patients who report they are "feeling healthy" and are therefore skipping doses.

On the other hand, conflicts between physician and patients' beliefs can aggravate existing barriers to adherence, and may lead to the loss of patients for follow up. Results of this study indicate that physicians in Rio de Janeiro may benefit from additional training about adherence counseling Given the potential for health care providers to increase or jeopardize HIV treatment adherence, it is imperative that patients have access to additional sources of information and support.

The health care system should develop a referral network of low-threshold services, including mental health facilities, drug treatment centers, and social support facilities such as shelters, and monitor to ensure that individuals are able to access the services to which they are referred.

Our findings reiterate the importance of individualized care for achieving optimal patient adherence. Improved collaboration between NGOs, community-based organizations, and health services could help provide targeted support for adherence, including peer education, adherence groups, and information and educational materials, to specific populations.

Such collaborations could also provide a more culturally sensitive environment to meet the needs of specific vulnerable populations, such as women, drug users, and the homeless.

Our recommendations of improved training, increased collaboration with NGOs, and establishment of a referral network should be feasible within the resource constraints of the Brazilian health care system, as their implementation would not require the creation of new health services or expensive health infrastructure. An increased role for collaborations and referrals could also reduce the caseload of physicians at overstrained health reference centers, allowing them to offer better treatment and care.

Some limitations of the present study should be noted. We assessed a sample of physicians recruited only in reference centers in Rio de Janeiro. Future studies should explore the patterns of adherence communication in settings such as primary health care centers, which serve fewer HIV-infected patients and are staffed by physicians who do not specialize in treating AIDS.

By including patients, future studies should also examine an alternative perspective on the patient-provider relationship. In addition, the study relied solely on interview data.

Further research, including participant observation, is needed to capture actual interactions between physicians and patients. In addition, associations between styles of physician-patient communication and behavioral and clinical outcomes should be assessed using quantitative methods.

In conclusion, adherence to ARV therapy is likely to remain of utmost importance for years to come.

HIV-positive patients and the doctor-patient relationship: perspectives from the margins.

Achieving optimal adherence requires the commitment of both patient and provider. Physicians can best serve their patients by providing thorough information and open discussion about ART adherence beginning prior to the initiation of therapy and extending throughout the patient's lifetime.

hiv positive patients and the doctor patient relationship perspectives from margins

Malta planned and conducted the study under the supervision of F. The empirical data were analyzed jointly by M.

hiv positive patients and the doctor patient relationship perspectives from margins

All the authors participated in drafting the article. AIDS Science [serial online] Improving adherence to antiretroviral therapy. AIDS Read ; Antiretroviral therapy adherence in Brazil.

AIDS ; 18 Suppl 3: J Acquir Immune Defic Syndr ; Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients. AIDS Care ; Physician estimates of adherence and the patient-physician relationship as a setting to improve adherence to antiretroviral therapy.

Physician-patient relationships, patient satisfaction, and antiretroviral medication adherence among HIV-infected adults attending a public health clinic.

hiv positive patients and the doctor patient relationship perspectives from margins

Soc Sci Med ; Barriers to antiretroviral adherence among HIV-infected adults. Roberts KJ, Volberding P. HIV-positive patients' experiences taking antiretroviral therapy in North Carolina. New York Aids Institute. Promoting adherence to HIV antiretroviral therapy.

New York State Department of Health; Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: Scientific Software Development; Strauss A, Corbin J. Basics of qualitative research: Braz J Med Biol Res ; Trust and the acceptance of and adherence to antiretroviral therapy. J Psychosom Res ; Physician beliefs about antiretroviral adherence communication.

The relationship of disease severity, health beliefs and medication adherence among HIV patients. Case-management of HIV-infected injection drug users: Health professional licensing bodies also need to educate their members about legal and ethical obligations regarding privacy and confidentiality.

HIV-positive patients and the doctor-patient relationship: perspectives from the margins.

Regulatory bodies could make the protection of PHI a performance metric for meeting licensing requirements. Enhancing education, training and resources for healthcare providers within regulatory licensing bodies, as well as healthcare corporations, could result in important meso- and macro-level changes. The Legal Network believes that the meso-level "remedies" currently in place for PLWH whose privacy rights have been violated could be improved.

The Legal Network believes that remedies currently available to PLWH whose privacy rights have been violated should also be strengthened; for example, a system of deterrents should be implemented if HICs improperly use and disclose PHI including increased enforcement and compensation to patients.

At the micro level of patient and provider, the Legal Network a reminds us that healthcare providers should only ask questions that are relevant to providing care, for example, there is no need to ask about HIV status if that information is not required to examine or treat someone. PLWH have often remarked about being asked how they acquired HIV during a routine clinical encounter; when telling these stories they are always outraged and annoyed because healthcare providers, who they often have never met before, are driven more by their curiosity than delivering high quality, patient-centred care.

Asking relevant questions during a healthcare encounter is incredibly important for PLWH and highlights one of the nuanced ways that the sensitivity of HIV can be considered in practice because it prioritizes the person's privacy. Healthcare providers should have a confidential, one-on-one conversation with their patients in advance so that a plan to maintain privacy and respect confidentiality is co-created and agreed to.

How will we get there, especially considering that policies in the current political climate are considered within the micro-space of marginal incremental objectives, continually building out from the current situation Lindblom ? At the same time, healthcare decisions are also influenced by economic, social, environmental and political forces; policy makers and governments make decisions based on public opinion, electoral considerations, personal preferences and crisis management Fafard Luckily, PbD has received global acceptance and endorsement by public and private sector privacy regulators around the world Cavoukian As a result, community champions, social workers, researchers, activists and legal experts working in the HIV sector, as well as those concerned with privacy and its protection more broadly, are positioned with sufficient ammunition to enable a paradigm shift.

The time is now to ensure that policy and practice decisions that affect privacy at the micro- meso- and macro-levels are on the government's agenda, and at the very least, are informed by evidence Fafardand grounded in the lived experiences and current realities of service users.

Saara Greene for her mentorship, as well as Dr. Jim Dunn for providing initial review of this manuscript. The author is grateful to have received funding from the Vanier Canada Graduate Scholarships to conduct her doctoral research. National Research Council of Canada. Report published at the Conference on Privacy, Security and Trust. Retrieved April 27, Privacy Protection and the Disclosure of Health Information: Retrieved March 6, Retrieved April 24, Know Your Rights — Disclosure as a Patient.

Retrieved November 20, A Need for Privacy. Retrieved April 21, From Rhetoric to Reality. Retrieved March 30, Retrieved April 22, Retrieved December 28, Evidence and Healthy Public Policy: Insights from Health and Political Sciences. Canadian Policy Research Networks.