After reading the "Don't Tell" essay (pp. 116-9) in your textbook, and watching the videos on HIV/AIDS, discuss any of the following (you don't all have to discuss the same issues):
- the ethics of needle-exchange
- what is your obligation as a health-care professional to the dignity & protection/confidentiality of all, but especially vulnerable, patients like IV-drug users, homosexuals, prisoners, etc.?
- public health, especially protecting the blood supply
- http://www.npr.org/sections/codeswitch/2014/12/24/370937993/new-blood-donation-rules-would-still-exclude-many-gay-men
- http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/QuestionsaboutBlood/ucm108186.htm
This subject has generated so much controversy. Some feel the actions being taken, such as Narcan kits and needle exchanges, are enabling. I feel if I had a child with an illness such as heroin addiction, I would want the tools necessary to help. An HIV and Hep C epidemic are on the horizon along with numerous other diseases. What we can do to help lower the number is start educating our children much earlier. They need to see the true graphic nature of this affliction. I am not sure what age would be appropriate according to stages of development, but 6 or 7 would not be out of the question in my mind.
ReplyDeleteI am with you it is all about EDUCATION! I also support the needle exchange and Narcan kits. I do think at times about how it could be me dealing with an issues as I have two children at the ages of 23 and 16. It is the world we live in and we must take action. You can never think it won't happen to my family. Bad things can happen to anyone no matter who we are.
DeleteWith the increase of drug abuse on the rise I think it is important to start education children at a young age. Parents also need to be educated about the signs and possibility that your child can be exposed to such a terrible thing.
DeleteAfter watching the Frontline Report video I am more abroad with the needle exchange program and Narcan kits being passed out or just readily available. I hear about it the news and see it at work how bad the heroin use is in our area but when you think about how fast disease can spread it becomes a bigger problem. By having the needle exchange program it will also promote education to bring awareness to the disease process and how it spreads among the population. This education needs to start at a young age so; awareness can spread instead of illness.
ReplyDeleteBad things certainly happen to good people. Happens all the time, however I don't feel like Narcan kits are the answer. It is only extending the illness instead of turning the addict to recovery. I think they send the wrong message, that it's a safety net to overdose, rather than a chance to get help. The answer definitely lies within getting those willing to accept help, the best rehabilitation possible.
DeleteI have seen how the effects of heroin abuse can ruin a family. Kelly you are right having the Narcan kits available are not the answer. A lot of time when you bring someone out of their "high" they are not grateful that you saved them they get angry that you ruined their high . I have a friend that lost her 26 year old daughter to a heroin overdose and her life has never been the same. She struggles with this loss every day. In her story her daughter had struggled with her addiction for 10 years, she had exhausted her life savings sending her to different rehabs, bailing her out of jail and receiving the phone calls that she was found unresponsive and brought back. In this case she didn't want the help, don't think she wanted to die, but was not ready to get clean. There needs to be more done to stop this epidemic of drug abuse and the spread of HIV. This disease needs more that needle exchange.
DeleteEducation in key ! Early and often. I don't think as parents we can talk to our children enough about the potential dangers of drugs, but where does our responsibility as parents end and the responsibility of our children to make good choices begin? I feel for your friend Kelly, because we feel that overwhelming desire to protect our kids at all costs, but being a good parent sometimes just isn't enough. We have to teach our children to make those informed choices , monitor their friends , their mental health etc.. parenting is a daunting task in this age.
DeleteThe Frontline videos were very informative about the evolution and epidemiology of HIV. It was interesting to see how HIV showed its face, the development of the symptoms and deaths, yet the scientists were off track in the early stages of recognition. It puts a new perspective on a disease when you know now what they didn't know then. It is clear that with time and education, people become more understanding of a disease and with that comes a reduction in stigmas attached to the disease. Of course prejudices will always exist, however great leaps can be made with advances in technology and education.
ReplyDeleteI agree with you about the Frontline videos it was so imformative about the age of AIDS. I grow up during that time and I have to say I don't remember anything like I seen on the frontline video. I feel my parents really shelter be from the world when I was young.
DeleteEducation is key and we certainly need to start earlier with children. Many parents are very hesitant to allow their children to hear about illicit drugs and sex. Somehow, many feel it may "give them ideas." I feel like people still have their heads in the sand
DeleteIt is kind of shocking in this day that the transmission of HIV/AIDS is so rapid with all the education that has been going on for years. I feel that I have probably been naïve to the fact that even with all the education out there it is still such a problem. I know that it has never went away but I thought the spread of the disease had decreased. I think I believed this because the focus was protecting yourself from the transmission of the disease sexually. Now with the increase on IV drug abuse on the rise the spread of the disease has changed. I am not if the answer is to do a needle exchange program but it is a start to further educate people about the dangers and spread of the disease. I think this also give another opportunity for possible intervention for drug abuse. If there are programs out there that get people to come n for the exchange maybe the abusers will reach out for help. Another opportunity for education and help.
ReplyDeleteAfter reading the article in the New York Times I am shocked! I guess I live in my own little world, oblivious to what is going on. I know that drug abuse is out there, but thankfully I have not had close friends or family members affected by drugs. As far as the needle exchange, it seems like a good alternative. But at the same time what happens when a person is desperate for a hit and doesn't have a clean needle, do you think that will stop them from shooting up? I think education starting at a young age is a way to educate against drug abuse for some, but for others it does nothing. Law enforcement and government should have stricter punishments for drug trafficking and abusers. I don't know what the answers are but until someone wants help and is willing to go to rehab, they are not going to stop. Needle exchange is only enabling as well as the distribution of narcan.
ReplyDeleteI too received so much education from this topic. I just don't think that making Narcan or needles available is the solution to this problem. I just don't know what the solution is. Stricter punishment might be an option but I'm not sure I can make that educated decision either.
DeleteAfter reading the New York Times article, I was not surprised that one of the interviewees stated it was a "homosexual disease". I feel like much of the education about HIV emphasized on the sexual behavior of others or being infused by infected blood. I believe the growing epidemic of heroin abuse within the community directly reflects the booming population of people being dx with HIV and Hepatitis C. It is unfortunate that so many citizens became addicted to prescribed narcotics because the MD abused their authority to prescribe them. I believe the drug companies and MD that often prescribed narcotics with no diagnostic test that justifies the need for pain management should be responsible to pay a specific amount for community education, prevention, and treatment. This epidemic in Indian should be a wakeup call of what our future will hold. Almost daily in the ED, I come in contact with an addict that uses dirty needles. Just think HIV can lay dormant for 10 years. Wow! I don’t necessarily agree with needle clinics, narcan kits to be provided to the abuser but, I feel like this is an action to protect the community! It is our responsibility as health care professionals to start the education early, protect the dignity of others, promote healthy living styles, provide resources, and support!
ReplyDeleteI agree jodi. We have to start somewhere and if providing clean needles to keep members of our community safe I think it needs to happen. We need to stop judging and try to start helping, provide education, promote healthy lifestyles and most of all support.
Deletelooking at the needle exchange form our prospective as ER nurses gives me some pause. You see the addicts as they come in from the street and definitely have much higher risk to needle exposure that I would as an inpatient nurse . From a protection perspective I see our point in providing clean needles, but this is certainly not an answer- its the equivalent of placing a band -aid on an artery.
DeleteI think that needle exchange is necessary in preventing other diseases. Recently their was an article that the indiana gov had approved needle exchange programs to try and cut down the rising cases of Hiv and hepatitis. Needle excahnge programs are not reimbursed by the government which i think is a big mistake. Needle exchange programs due not cause dependency they promote safety in an awful situation. If we continue they way it is the cases of HIV and HEP will continue to grow.
ReplyDeleteI am on the fence in regards to the needle exchange/ narcan kits- I feel they give permission for addicts to continue to use. I have always had the attitude that "if our dumb enough to do heroin, then why should we save you by giving you narcan?" I recently watched a program where drug dealers in Memphis were "testing" product by giving addicts heroin they had cut , and if they didn't die but got a good buzz without overdosing it was considered " good sh**" if we give unlimited access to narcan, I think this simply reinforces this sort of behavior .
ReplyDeleteThis is such a double edged sword- we save addicts lives with narcan only to pay for the long term complications associated with their addictions ; rotten teeth, heart valves, drug treatment. But on the other hand if we don't support needle exchange programs we ALSO pay for the complications ; hepatitis, HIV, AIDS. There is n clea answer here. I think interventions must be done early to prevent drug use from ever happening. I have talked to my kids about drugs from the time they were old enough to understand the concept that drugs are "bad." We need to develop more drug awareness/prevention programs aimed at our children. Only then will we make any headway on the war.
I agree with you!! I too am on the fence with this topic. I see heroin addicts frequently in the ICU and once they recover they sign themselves out AMA. So let me give you a clean needle so when you come back you might not have HIV or Hepatitis. And if we don't give clean needles then that is exactly what we will be doing, combating HIV or some other contagious disease. Early education is so important.
DeleteI was on the fence about the Narcan kits but after watching this video and trying to put myself in the situation if this were to ever happen to my boys, I can't lie and say I wouldn't want a medication to help reverse the overdose he would be experiencing. Heroin is such a large issue right now and I think education is where everything needs to start. I feel like we learn some about heroin here and there but all kids in school need to start seeing the precautions of what a heroin addict goes through and the kind of life one would live while being addicted to heroin. This education needs to start young and continue every year while in school. Schools also need to offer assemblies where volunteer recovering addicts come and talk about their journey while addicted and teach the kids the ways to stay clear of the drug and the reasons why never to even try it. Kids so well with personalizing things and seeing another person who experienced it and teaching about heroin will be remembered more than a teacher everyday in class. Preventing the use of Heroin will lower the chances of Hepatitis and HIV.
ReplyDeleteOur obligation to all patients is to provide confidentiality. When it comes to HIV/AIDS or HCV we generally don’t take any increased contact precautions. Carlos, from the reading, doesn’t want to tell his sister about him being infected with HIV despite that she will be caring for his wounds. As his nurse you would have to explain the risks to him because of this but ultimately you have to support his decision. Teaching his sister universal precautions and providing her with gloves and equipment to protect herself.
ReplyDeleteWith regards to vulnerable patients dignity topic. I have taken care of a patient who had AIDS and almost died. After being on the ventilator for a month he got better and when he was able to talk he told us not to tell anyone he had AIDS. Not even his male significant other.Talk about an ethical dilemma. He admitted that he had multiple partners in the recent past. So with the HIPPA law no one was made aware of his diagnosis. His dignity was preserved. I do believe he told his significant other though.
ReplyDeleteSo the vulnerable population has rights just like everyone else. We are obligated to uphold these rights, even if it generates moral conflict within ourselves.
After giving this more thought I remember the Doctor giving the patient the ultimatum of him(the patient) telling his partner he has AIDS or the doctor would do it for him. The doctor did not require the patient to tell his family of his diagnosis though. I was glad that the doctor did that so the patient's partner could get tested and get medical help if it was necessary.
DeleteI think with HIV, the doctor has to report to the public health department, which will follow up with partners. But that might depend on state law, and wouldn't necessarily be the same everywhere.
DeleteI am not all that shocked about the outbreak of HIV. It's not in the forefront of our minds, in our news or in our fears. As a society I feel Americans developed somewhat of what I call an "attention deficit disorder" attitude. As soon as one crisis comes to our attention, the previous falls to the wayside. I know that's an exaggeration, and I do think it is a defense mechanism. We cannot always be on high alert. That being said, in the late 90's and early 2000's I felt there was more education on HIV and AIDS. My kids had education in school, I felt like there was a public awareness and concern. With the development of more effective antivirals, I think people are less fearful than when there was no treatment. I believe the idea of giving people clean needles is a good one. I know there are thoughts that it makes it easier to do drugs. I don't think it does. I think it gives healthcare providers (or whomever is distributing needles) a chance to interact with those at risk. The desired outcome of the program is not a decrease in drug use. The desired outcome is a decrease in HIV or Hep C.
ReplyDeleteI'm so glad I read your blog. Your last few sentences made so much sense. I agree and I have changed my mind about this idea of free needles. Thank you.
DeleteAs healthcare workers, we are required to respect privacy/confidentiality and treat each patient with dignity regardless of diagnosis. As we talked about in our nursing class, clearly these patients have a lack of coping skills to overcome their addiction. I feel we all give these patients the same care as the others, and probably more because they are more demanding. I feel sometimes my other patients are neglected because I am so consumed with the care of the one addict patient. I am also in favor of the needle exchange and narcan kit programs. After reading the article above, it makes sense to give free needles and exchange for dirty. I have looked at charts of patients who have arm abscesses from a needle being broke off in their arm. I didn't know they were using the same needle up to 300 times until it becomes so loosy goosy it just falls right off in their arm! As far as the narcan goes, I'm not sure I agree that it should be passed out freely to addicts. I think it should be available, but more regulated, like the availability of AED's in public places, or a designated sober person who has it that may be family or friend of the patient.
ReplyDelete