We treat the patient in front of us. No matter who they are.

The Arkansas legislature decided to toss this principle tenet of healthcare out the window. 

Doctors and nurses in Arkansas can now refuse to treat patients based on moral or religious objections. Arkansas Governor Asa Hutchinson signed, The Medical Ethics and Diversity Act, SB 289, into law on March 26th.

The law states its purpose is “to protect all medical practitioners, healthcare institutions, and healthcare payers from discrimination, punishment, or retaliation as a result of any instance of conscientious medical objection.”

Health providers’ moral objections are the focus of the new Arkansas law, but the law does not protect patients from discriminatory practices from a healthcare provider. Instead, Governor Asa Hutchinson relies on federal law “that prohibits discrimination on the basis of race, sex, gender, and national origin.”

The Arkansas Medical Ethics and Diversity Act, SB 289, does not include language protecting against discrimination based on sexual orientation or gender identity. 

Most media reports have framed the law as blatantly anti-LGBTQ legislation. The Human Rights Campaign fought against the bill because it allows doctors to refuse care for transgender and LGBTQ patients. Arkansas health providers can now legally refuse services to anyone based on a moral objection as long as it is not an emergency or violate federal EMTALA guidelines.

But the wording of the law goes way beyond issues of sexuality and gender. The law permits any healthcare provider to deny any medical services based on religious or moral objections.

ACLU of Arkansas Executive Director Holly Dickson pointed out the risks stating, “making it easier to deny people health care isn’t just wrong, it’s dangerous.” 

The Arkansas law fails to acknowledge one of the most challenging aspects of medical care. Doctors, nurses, and other healthcare providers work hard to avoid value judgments when providing care. We work to see all patients as worthy and try to avoid bias. 

Medical care is about placing value on each person’s life. Although challenging, health providers try to avoid considering patient culpability when treating people. Our personal feelings must be checked at the door. We treat the person in front of us. 

Pulmonologists do not refuse to treat or blame a chain smoker for getting lung cancer. Trauma surgeons treat drunk driving victims and the perpetrators equally. We do not refuse care to gang members who get shot or deny Covid-19 treatments to those who refuse to wear a mask. 

In Obstetrics and Gynecology, we provide care to pregnant women who use illegal drugs and prescribe PrEP therapy to those with multiple unprotected sexual partners. We don’t insert personal bias or value judgments into patient care. We try very hard to do exactly the opposite.

Our job is to counsel patients on the risks of their life choices. We do not deny care to those who live their lives in ways differently than we do even if we find certain choices morally offensive. 

Patient care is about the patient. Not the provider.

Multiple medical organizations are speaking out. So far, the Arkansas law is opposed by the American Academy of Pediatrics, the American Psychiatric Association, the American Psychological Association, the American Medical Association, the National Association of Social Workers, the University of Arkansas for Medical Sciences, and the American College of Emergency Physicians. Other organizations are likely to oppose the law as well. 

This statement by the Arkansas Chapter of the National Association of Social Workers summarizes the general consensus saying, “no patient should ever be obstructed from receiving legal healthcare based solely on a provider’s personal values.”

Arkansas legislators and Governor Hutchinson must know this law will be challenged in court. Let’s hope the court remembers when it comes to patient care, the patient always comes first. 

The post The Anti-LGBTQ Arkansas Health Law is Dangerous for All of Us appeared first on Medika Life.

What unique challenges do women face in preventing HIV?

According to the Centers for Disease Control and Prevention, some prevention challenges are unique to women:

• Women can pass HIV to their babies during pregnancy and birth and through breastfeeding.
• A woman’s anatomy makes it easier to get HIV through sex compared with a man’s anatomy.
• Having a sexually transmitted infection (STI) raises a woman’s risk for HIV more than a man’s.
• Women are more likely to lack control in relationships and fear violence, stigma, or abandonment when trying to prevent HIV exposure.
• Women are more likely to be victims of sexual abuse. People with a history of sexual abuse are more likely to engage in high-risk sexual behaviors like exchanging sex for drugs, having multiple partners, or having sex with a partner who is physically abusive when asked to use a condom.

How can I prevent HIV?

The best way to prevent HIV is to not have vaginal, oral, or anal sex or share needles at any time. Sharing needles for any reason is very risky.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Male latex condoms are the most effective way to prevent HIV and other STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Female condoms can also help to prevent HIV infection. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
• Get tested. Be sure you and your partner are tested for HIV and other STIs. Talk to each other about the test results before you have sex. Having an STI increases your chances of becoming infected with HIV during sex. If your partner has an STI in addition to HIV, that also increases your risk of HIV infection. If you have an STI, you should also get tested for HIV.
• Be monogamous. Having sex with just one partner can lower your risk for HIV and other STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
• Limit your number of sexual partners. Your risk of getting HIV and other STIs goes up with the number of partners you have.
• Get vaccinated. You can get a vaccine to protect against HPV and hepatitis B, which are STI’s. There is no vaccine to prevent or treat HIV.
• Don’t douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting HIV and other STIs.
• Do not abuse alcohol or drugs. Alcohol or drug abuse may lead to risky behaviors such as sharing needles to inject drugs or not using a condom when you have sex.

The steps work best when used together. No single step can protect you from every single type of STI.

Male latex condoms are a highly effective way to prevent HIV and other STIs, but almost one in every five women who uses only condoms for birth control gets pregnant. The best way to prevent both STIs and pregnancy is to use a latex condom along with another highly effective method of birth control such as an intrauterine device (IUD), an implant, or the shot.

Can I take medicine to prevent getting or passing HIV?

Yes. Several medicines are available to help lower your risk of getting or passing HIV:

Pre-exposure prophylaxis (PrEP)

PrEP is an HIV prevention method for people who do not have HIV infection but who may be at high risk. PrEP is a pill you take by mouth every day.

Talk to your doctor about PrEP if:

• You are HIV-negative but your partner is HIV-positive (known as serodiscordant or mixed-status couples)
• You are not in a monogamous relationship (you or your partner also have sex with other people) and you do not always use condoms
• You inject illegal drugs or share needles
• You have a partner who is HIV-positive, and you want to get pregnant. PrEP may help protect you and your baby.

The Centers for Disease Control and Prevention estimates that PrEP could prevent transmission in as many as 140,000 serodiscordant heterosexual couples. Learn more about PrEP.

Post-exposure prophylaxis (PEP)

PEP is an anti-HIV medicine for people who may have been very recently exposed to HIV. If you think you have been exposed (for example, if a condom breaks), or if you were sexually assaulted, talk to your doctor or nurse about taking PEP.

You must take PEP within three days of exposure to help lower your risk for HIV. You then take two to three antiretroviral medicines for 28 days to prevent the virus from copying itself and spreading through your body.

While taking PEP, you still need to take steps to prevent HIV, including using a condom with sex partners. 

Antiretroviral medicines

If you are HIV-positive, taking antiretroviral (ARV) medicine can reduce your viral load (the amount of HIV in your blood) to keep you healthy. Knowing your viral load measurement and how to control it by reducing it to undetectable levels can protect your unborn baby during pregnancy, labor, and delivery. It can also help prevent spreading HIV to your sexual partner.

What are some behaviors that can raise a woman’s risk for HIV?

Behaviors that raise a woman’s risk for HIV include:

• Having sex with a male partner who has had sex with another man or who has used intravenous (IV) drugs. Sex with a man is the most common way women are infected with HIV.
• Using injection drugs and sharing needles. This is the second most common way that HIV is spread.
• Abusing drugs and alcohol. This can lead to risky behavior, including having sex without a condom, not knowing a partner’s HIV status, or injecting drugs.

Women who drink alcohol or use drugs may also be at higher risk of sexual assault or rape, which may put you at risk for HIV. If you are assaulted or raped, you need to see a doctor right away. Your doctor may decide that you should get post-exposure prophylaxis (PEP). These drugs may lower your chances of getting HIV after you have been exposed to the virus. But these drugs work only if you see a doctor within three days of exposure.

How can I prevent HIV if I inject drugs?

Intravenous (IV) drug users who share needles are at high risk for HIV. Sharing needles can place another person’s blood right into your body, even if the amount is so small that you can’t see it on the needle.

People who inject steroids, insulin, or medicines for other health problems are at risk for HIV if they do not use sterilized needles every time. Whenever you need to use a needle, be sure that it is sterilized. Do not share needles with anyone. You can also get HIV if the equipment used for body piercings and tattoos is not sterilized.

If you inject drugs or medicines, follow these steps to lower your risk of getting HIV:

• Never reuse or “share” needles, syringes, water, or drug preparation equipment.
• Only use needles and syringes that you got from a reliable source (such as drugstores or needle exchange programs).
• Use a new, sterile needle or syringe each time.
• If you must use a needle used by others, clean it with bleach before using it.
• If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).
• Use a new or disinfected container (“cooker”) and a new filter (“cotton”) to prepare drugs.
• Clean the injection site with a new alcohol swab prior to injection.
• Throw away needles and syringes after one use. Do not throw them in the regular trash. You can use an old laundry detergent or milk jug to collect used needles and syringes and then seal the container before disposing of it. Check with your local health department about the correct way to throw away the container.
• Don’t share needles or syringes with friends or family.

How can I prevent HIV if I get tattoos or body piercings?

Follow these steps to lower your risk of getting HIV:

• Ask questions about how the staff sterilizes their equipment. Single-use instruments that cut the skin should be used once and then thrown away. Reusable instruments that cut the skin should be cleaned and sterilized between uses.
• Find out what steps the staff takes to prevent HIV and other infections, like hepatitis B and hepatitis C.
• Make sure your tattoo parlor follows state regulations and health inspections.

I’m pregnant and have HIV. Will my baby get HIV?

If you are getting treatment for HIV, the answer is most likely no. When HIV medicine is used consistently and correctly, a pregnant woman living with HIV who is treated for HIV early in her pregnancy can lower the risk of delivering a baby with HIV to less than 1%. Without treatment, this risk is about 25% in the United States.

All women need to be tested for HIV during their first prenatal care visit, early in the pregnancy. High-risk women who get a negative HIV test result should be tested again later in pregnancy.

Treatment, called antiretroviral therapy, works best when it is:

• Started as early as possible in pregnancy
• Also given during labor and delivery
• Given to the infant after birth

If you are HIV-positive and your viral load is greater than 1,000 copies per milliliter, your doctor may recommend delivering your baby by cesarean (C-section).

I have HIV. Can I breastfeed my baby?

No. If you have HIV, do not breastfeed. In the United states and other countries where clean water is available, using a breastmilk substitute like formula is strongly recommended for women with HIV, because you can pass the virus to your baby through breastmilk.

You can also ask your doctor, midwife, or pediatrician about getting human breastmilk from a milk bank. Find a human milk bank through the Human Milk Banking Association of North America.

Recommendations about breastfeeding with HIV may be different for other countries where clean water is not always available.

How can I help protect my children from HIV?

One way to help protect your children from HIV is to talk to them about HIV, AIDS, and the sexual behaviors that raise their risk for HIV and other sexually transmitted infections (STIs). The earlier you start talking about it, the better. By the third grade, almost all children have heard about HIV.

According to a 2013 national survey of high school students:

• About half of all students have had sex at least once
• One-third are sexually active (have had sex in the past three months)
• Nearly half of the students who are sexually active did not use a condom the last time they had sex

Offsite Resources

For more information about HIV prevention check out the following resources from other organizations:

• Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents — Clinical guidelines from AIDS on antiretroviral therapy (ART).
• HIV Risk and Prevention — Information from the CDC.
• The Basics of HIV Prevention — Fact sheet from AIDS.
• Preexposure Prophylaxis for the Prevention of HIV Infection in the United States — 2014 — Clinical practice guidelines from the Centers for Disease Control and Prevention and the U.S. Public Health Service.

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