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HIV/AIDS and the Paediatric Surgeon 153

antiviral therapy be delayed for several weeks after initiation of Ethical Issues
tuberculosis treatment in order to minimise the risk of IRIS particularly The considerable stigma associated with HIV may stem from its original
40
for those at greatest risk. recognition in male homosexuals, as well as in the personal nature of
43
Surgical Prophylaxis human sexuality. The stoning to death of Gugu Dlamini by members
of her own community in South Africa after she had announced that she
Evidence suggests that male circumcision offers some protection against
41
infection with HIV-1, although this evidence is far from being incon- was HIV-infected was an extreme example of the stigmatisation of this
43
42
trovertible. All agree, however, that circumcision alone is insufficient disease. Certainly at some point HIV became treated differently from
other sexually transmitted diseases, presumably, amongst other reasons,
to prevent transmission of the disease, and circumcised men must still be
due to the inability of governments to offer treatment and the dated
advised to engage only in safe sexual practices, including condom use.
perception that the condition was inevitably lethal. Clearly, patient
The acceptability of this form of potential partial preventative measure by
confidentiality is paramount, but the singling out of HIV as a disease
individuals as well as to populations has yet to be determined.
apart from all others adds to the stigmatisation that patients experience.
Every patient has a right to know his or her HIV status, and testing
44
should be offered to all who are unaware.
Key Summary Points
+
1. HIV is a retrovirus that infects and destroys the CD4 6. There is no difference in the surgical risk for asymptomatic HIV-
lymphocyte and monocyte, exposing the patient to risks of infected patients and noninfected patients.
immune deficiency.
7. In symptomatic patients, the clinical status—and not the HIV
2. Incidence of HIV/AIDS is high in Africa. status—dictates the management of the patient.
3. Most children become infected during gestation or delivery, and 8. The toxic effects of antiviral treatment dictate its use within a
this risk may be reduced by perinatal antiviral therapy. structured programme.
4. In asymptomatic neonates, PCR testing is more accurate than 9. Circumcision alone is not an adequate prophylaxis for HIV.
routine antibody testing.
5. The occupational HIV risk to health care workers is low, and is
further reduced with universal precautions and postexposure
prophylaxis with antiviral therapy.

References

1. de Cock KM, Mbori-Ngacha D, Marum E. Shadow on the 11. Gandhi NR, Moll A, Sturm AW, Pawinski R, Govender T, Lalloo U,
continent: public health and HIV/AIDS in Africa in the 21st century. et al. Extensively drug-resistant tuberculosis as a cause of death
Lancet 2002; 360(9326):67–72. in patients co-infected with tuberculosis and HIV in a rural area of
2. Fauci AS. HIV and AIDS; 20 years of science. Nature Med 2003; South Africa. Lancet 2006; 368(9547):1575–1580.
9(7):839–843. 12. Lazzi S, Ferrari F, Nyongo A, Palummo N, de Milito A, Zazzi M,
et al. HIV-associated malignant lymphoma in Kenya (Equatorial
3. Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail Africa). Human Path 1999; 30(10):1269–1270.
C, Hlongwa-Madikizela L, et al. Young people’s sexual health
in South Africa: HIV prevalence and sexual behaviours from 13. Sitas H, Pacella-Norman R, Carra RA, Patel M, Ruff P, Sur R, et
a nationally representative household survey. AIDS 2005; al. The spectrum of HIV-1 related cancers in South Africa. Int J
19(14):1525–1534. Cancer 2000; 88(3):489–492.
4. Montagnier L. Historical essay: a history of HIV discovery. Science 14. Ansell N, Young L. Enabling households to support successful
2002; 298:1727–1728. migration of AIDS orphans in southern Africa. AIDS Care 2004;
16(1):3–10.
5. Clavel F, Guétard D, Brun-Vézinet F, Chamaret S, Rey MA,
Santos-Ferreira MO, et al. Isolation of a new human retrovirus 15. Dabis F, Msellati P, Meda N, Welffens-Ekra C, You B, Manigart
from West African patients with AIDS. Science 1986; 233:343– O, et al. 6-month efficacy, tolerance, and acceptability of a short
346. regimen of oral zidovudine to reduce vertical transmission of HIV
6. Gao F, Bailes E, Robertson DL, Chen Y, Rodenburg CM, Michael in breastfed children in Côte d’Ivoire and Burkina Faso: a double
SF, et al. Origin of HIV-1 in the chimpanzee Pan troglodytes blind placebo controlled multicentre trial. Lancet 1999; 353:786–
troglodytes. Nature 1999; 397:436–441. 791.
16. Embree J, Njenga S, Datta P, Nagelkerke N, Ndinya-Achola
7. www.avert.org/aafrica.htm. JO, Mohammed Z, et al. Risk factors for post-natal mother-child
8. Harries AD, Nyangulu DS, Hargreaves NJ, Kaluna O, Salaiponi transmission of HIV-1. AIDS 2000; 14(16):2535–2541.
FM. Preventing antiretroviral anarchy in sub-Saharan Africa.
Lancet 2001; 358(9279):410–414. 17. Campbell C. Migrancy, masculine identities and AIDS; the
psychosocial context of HIV transmission on the South African
9. Fassin F, Schneider H. The politics of AIDs in South Africa: beyond gold mines. Soc Sci and Med 1997; 45(2):273–281.
the controversies. Brit Med J 2003; 326(7387):495–497. 18. Leclerc-Madlala S. Infect one, infect all: Zulu youth response to the
10. Wohlgemut JP. AIDS, Africa and indifference: a confession. Can AIDS epidemic in South Africa. Med Anthrop 1997; 17(4):363–380.
Med Assoc J 2002; 167(5):485–487.