Case Conversation – Script

Physician (00:01):

Michael. I’m I’m really glad we had you come back in for today’s appointment. If you remember last week we decided to, to send an HIV test.

Patient (00:09):

No, I do remember doctor,

Physician (00:12):

The test came back positive, and I think it’s the really important that we discuss what that means and that we give some time to ask all the questions that you have about this information.

Patient (00:35):

I’m sorry. … I thought it would be, are, are you sure

Physician (00:41):

The test is accurate, and the reason we sent the test is I thought maybe some of the things you complained about might be related to HIV. So, uh, I think we’re gonna have to assume it’s, it’s a real result. We’ll do some additional tests today to confirm, but, but I know, I know this is very hard news to hear. Um,

Patient (01:10):

I’m I what’s gonna happen. Am I gonna die?

Physician (01:17):

Well, you know, one of the most important things I can convey to you right now, and I, I really mean this is that we’ve made enormous progress in HIV treatment. It is not a death sentence. In fact, today, uh, on HIV treatment, people with HIV can lead long and normal lives. Just like people who are HIV negative. Um, we’re gonna talk about starting treat <affirmative>. In fact, we’re gonna talk about starting treatment today, but I really wanted to give you time to ask as many questions as you want, and we’ve got plenty of time. So, so feel free.

Patient (01:55):

What does long and normal mean? Like for long, you’re saying long and normal. I mean like, like what does that mean long,

Physician (02:04):

You know, amazingly, we have studies now that show that people who start out taking HIV treatment right away before they’re too sick. Like you, you’re not too sick can lead lives that are as long as people who don’t have HIV. Uh, and you know, you’re starting out at this point of really strong health, which you have in your favor. So I’m, I would be very optimistic if I were you. I know this is still hard news to hear, but I wanna put, put the, you know, I wouldn’t say this if I didn’t mean it, there is no reason why you will ever get sick from HIV or die from aids, as long as you take your medicines.

Patient (02:42):

So do I have, do I have AIDS too? Does that mean the same thing as HIV?

Physician (02:49):

It is confusing, but there’s a virus called HIV and the virus in people when it’s not treated, they can get sick from the virus and eventually develop aids and aids are the complications from HIV, but we can prevent that from happening. Uh, and by taking your medicines, you’ll be able to keep that from happening and you’ll be able to stay healthy for a very long time. Now I know this information is very hard to hear about being positive, but I also want really to, to give you some hope right at the outset like this, because I, I I’m. So I’m just so excited about the treatments that we have to offer you now,

Patient (03:31):

But you’re saying that, so how likely is it that I, that I like I get aids or so in general, like how, oh,

Physician (03:43):

I don’t think there’s any chance that you’re ever gonna get sick from aids, given where you’re starting from given your state of health. Now, um, you take the medicines, you will be fine. Uh, it’s really gonna be more a matter of adjusting to this because, um, <affirmative> now you’re gonna have to take some medicines to stay healthy and that’s something you’re not doing

Patient (04:05):

Anything now it’s with, I, I don’t mean to interrupt. It’s just with it’s like, I don’t know how I got, how did I get H HIV? Like I, I, I’m not sure.

Physician (04:14):

Yeah. So we know pretty much everybody gets HIV from, from having sex with someone who’s HIV positive. Uh, and some people who, if they use injection drugs, they get it from sharing needles.

Patient (04:29):

I’ve never used. Okay.

Physician (04:31):

So, so you know, the, you probably got it from someone you had sex with. It’s predominantly vaginal sex and anal sex that lead to HIV transmission, much less oral sex. But we don’t know in each person who, I mean, unless you know, someone or you suspect someone, there’s no way we can know who you got it from.

Patient (05:05):

So, I mean, I don’t know, cause I’ve had partners in the past. I I’m just sorry. I, I, I just like how, how long have I had it? I, I, I’m just trying to think back to when I lost my virginity and everything. I, I, I, I it’s been a while.

Physician (05:26):

Right. Um, we can’t really say, uh, how long people have had it unless they’ve had an HIV test before. And when I asked you last week, I don’t think you have, have you ever had an HIV test? No. Yeah. So sometimes when people acquire the virus, they have short afterwards a period that feels like the flu or like they have a case of mono where they feel feverish have sore throat, maybe lose some weight, um, have some diarrhea, get a rash. Did you recall almost like that at

Patient (05:58):

All? I, I did have like, uh, the flu a few months ago. Yeah. I thought it was the flu,

Physician (06:03):

You know, it’s hard to say, uh, without a previous test, we can’t say for sure. Um, but I just want to tell you that, that it doesn’t really change our approach to your treatment, how long you’ve had it. It just, it really, probably more important for, for potentially notifying your, your partners.

Patient (06:23):

My God do, does that, like, I might have gotten other people sick then. Yeah.

Physician (06:28):

Well, it is important that we try to notify your partners. First. I want to reassure you about something. This is not your fault. You know, this is something that happened,

Patient (06:41):

But I feel like if I infected other people, it is my fault. Well,

Physician (06:43):

It’s, it’s not your fault. Uh, I, I just, this is we, we are not here to like, try to assign blame to what is part of life, which is sexual activity. Um, I do want to, uh, tell you that state

Patient (06:57):

Knew how long I added cuz I do feel like it affected a lot of people. If I did, I don’t know, mother, I had like 16 partners in the past.

Physician (07:10):

There are a few ways we can go about doing this. Uh, one is you could contact them yourself, but some people are very uncomfortable doing that.

Patient (07:17):

No, I, I that’s so embarrassing. Yeah.

Physician (07:24):

The other, the other thing we can do is, um, department of public health has a partner notification service and they will interview you and find out who your partners have been and then contact the owe people without telling them it’s you. And just tell them that they might have been exposed to HIV and that they should get tested. Uh, I know that people who’ve used that service find it a, a way of, of notifying partners without going through the embarrassment of having to call people themselves. So both both think are, are available to you. I mean, you’re calling yourself. The other thing is, is that if you are like looking for the right language to use, to call someone, uh, we have some, some really good counselors here who can help you work on this. Who’ve talked to other people in the past and help you kind of work through that process.

Patient (08:18):

I don’t want to tell, I mean, if someone else can tell, I don’t, I don’t mean you to be a coward, but I, I don’t want to tell them if they can’t. So, so it’s like, like, like with COVID they track who, who I’ve had sex with,

Physician (08:29):

They don’t track. No, no, but they will interview you and then you tell them that people you’ve you’ve potentially, uh, exposed and then they will call.

Patient (08:41):

But I have, I’ve met some, one night stands. I don’t know who they are.

Physician (08:44):

Some people you won’t be able to, to reach.

Patient (08:46):

Oh my God. Yeah.

Physician (08:49):

Um, I do wanna mention this just because it’s, it’s, it’s part of health regulations is that, that we do report your name, uh, to the state department of health. They then take that information and remove all the identifying and information and then, and then send it to the CDC. It’s

Patient (09:08):

So it’s confidential.

Physician (09:09):

It’s totally confidential. Uh, and fortunately they take seriously how important privacy is. Uh, so therefore they guard the information very, very carefully. And I’m only telling you that to be as transparent as possible – the things we’ve discussed here is confidential. And of course your electronic medical record and the people you talk to here in this clinic will keep all your information confidential.

Patient (09:39):

Yeah. You had told me that before, but for something like this, I wanna make sure that it’s completely, especially if you’re telling other people. Yeah, I don’t. Yeah.

Physician (09:48):

Yeah. This is very private information. We, we take it extremely seriously. A as, as of course, we, we, we, we, we’re doing exactly what we do for, for our patients as we do for our friends or family and ourselves.

Patient (10:02):

I don’t know that a lot of people talk about false positives. Are you sure it’s not a false positive?

Physician (10:07):

Well, you know, once again, I’m really, uh, I’m really pretty sure these tests are very, be very accurate. And, um, you know, I trust you darling ne never, never say never. Uh, but, and we’re gonna do some additional tests today to confirm, but I think we should assume it’s positive.

Patient (10:28):

I, I, I don’t mean to question like, I, I, it just that, you know, I, I don’t want, I don’t want other people to, but it’s just that, I don’t know. It’s it’s really overwhelming. I wasn’t, I was expecting a no, I was expecting you to tell me no, and I, I don’t, uh, just,

Speaker 3 (10:46):

I’m just, I’m sorry, doc. I just, I don’t know what to say.