The essay with this title’ has asked several pertinent and important questions. I would like to add a few comments.

The essay indicates that instead of expected relief, the patient encounters hostility, fear and rejection and asks why doctors and others behave thus.

AIDS is really a twin epidemic. The first is that of the disease itself. The second, which compounds the issue, is the epidemic of fear, Fear is bred in ignorance and enhanced by the inevitability of the termical outcome. Adding to this and further clouding the issue is the brand of social stigma.

Fear-has its roots in ignorance. We are at the ‘alarm’ stage of what is no doubt a severely stressful situation. To those working to promote awareness of the facts on AIDS this can be frustrating but there is a danger in being condemnatory of the ignorance. The only remedy is to intensify the educative programs at all levels and in every forum.

In terms of transmission, the hepatitis B virus is indeed many times more dangerous but we have a vaccine against it whilst as of today the patient with AIDS has no way out except the grave. Remaining aware of this fact we must emphasise that at present we have to concentrate on prevention.

As regards stigma, it is both unwise and uncharitable on the part of doctors and others to make snap judgements of implied immorality especially when these are made without factual knowledge. Even if behavioural culpability is established, it is not worthy of a health professional to have a condemnatory attitude in treating any one in anguish. The injunction that the ‘physician is called to be an instrument of God’s mercy and not his justice’ is very relevant.

Any form of involuntary testing must be resisted. Tests or1 patients occasioned by fear in the rninds of hospital staff and adtninistrators should be preceded by education of all those seeking treatrnent at the clinic.

The flaws and fallacies in the tests for detecting infection by Hurnan Immune-deficiency Virus (HIV) make it imperative that we spare no effort at establishing a correct diagnosis. We must also bear these in mind when counselling. Once diagnosis is certain one must soften the blow and help in every way without raising false hope.

It is unethical of surgeons to refuse to treat infected patients. As regards blood collected fortransfusion which, on tests, shows that the donor was infected by HIV, the mandatory obligation seems to be restricted to the destruction of that unit. I believe that social obligation goes further. The donor must be made aware of his role in the infectivity chain. What if the shock is too much for him and he commits suicide? To avoid such tragedies it may be best to evolve a system for-informing all potential donors of blood (and other components of the body) that they are required to undergo pre-donation tests for infection by HIV. Where such tests are positive, the donation cannot be accepted. Post-test counselling should follow in such instances.

Serious and concerted efforts the part of the medical profession are urgently called fat if we are to move meaningfully out of the alarm stage and progress to a truly caring system for promoting health.