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 As part of my work at Positively Women this year I have been running some HIV awareness trainings for dentists and GPs in the London Boroughs of Hammersmith and Fulham.

 The trainings had been designed following a small research we did among people living with HIV in those boroughs. We distributed questionnaires, ran focus groups, and the findings were quite shocking

 Even if 96% of people living with HIV are registered with a GP,  60% would not tell their GP of their HIV status, and 33% perceive their HIV status prevents them accessing effective care from a GP.

Looking at PLHIV accessing dental care, the picture is even gloomier. Only 65% of people living with HIV, who participated in our research, are registered with a dentist

Moreover 55% would not tell their dentist about their HIV status.   Overall 53% of our respondent told us that they felt that their HIV status was preventing them accessing dental care.

 The positive people involved in responding to the questionnaire and the focus groups suggested that to improve the situation GPs and Dentists should receive more trainings around HIV and stigma.

 So I designed a module that could be delivered in about an hour which would go through the basics of HIV awareness and address stigma. GPs and Dentists have very busy schedules and I needed to have something that could be delivered during their lunch breaks.

 We offered the free training to most GPs surgeries and Dentists in Hammersmith and Fulham. Only 4 surgeries replied they were interested in attending even if we were offering  it for free and  to be delivered at their premises.

 I went on to deliver those few trainings, and it was one of the most difficult experiences in all those years that I have been an HIV and Sexual Health trainer.  

For the first time I found myself addressing a definitely unsympathetic crowd.   In spite of my quizzes, DVD with people talking about living with HIV, case studies, I constantly had the feeling that they were thinking that I couldn’t possibly know more of them, who were medically trained.

Some dentists felt it was totally justifiable to always book  HIV positive patients last, because a special cleaning was needed, and they also suggested that it would be better to have a ‘special room’ to reserve to treat HIV positive people. They seemed unmoved by my questions: What about the fact that a third of those who live with HIV still haven’ t been tested? What about other blood born viruses such as Hepatitis C which are much more endemic and contagious? Shouldn’t everybody be treated as if they were potentially contagious? What are Universal Precautions recommended by the World Health Organization for?

 Another shock came with a group of GP’s. I had a question in my quiz which asked what the probabilities were for HIV positive women who have access to ARVs and all the interventions to reduce transmission to have a healthy baby. Most of them ticked the box 50%, while it is 99%!

 Afterwards they didn’t even let me play the DVD where people talked about stigma, and when I asked them if they understood the role that stigma played in stopping people accessing health services they corrected me saying: ‘Imagined stigma…’. I felt like shouting: “Well I  have lived with HIV for 13 years and I can be pretty certain that there is nothing imaginary about the stigma and discrimination many of us experience.”

 I left the GP training fuming. I kept thinking, if these are the attitudes of well educated health professionals, how much worst can it be among the general population? How much more do we need to speak up, be visible and educate our communities for ignorance and prejudice to be over come?

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6 thoughts on “GPs and Dentists’ attitudes to HIV

  1. Hi Sylvia, what an awful experience, to be faced with all those ‘professionals’ stigmatising attitudes, I wish you had had another woman with you for support. I have had similar experiences with dentists, in particular a consultant, when I told him about my meds the silence in the room was overwhelming and the atmosphere changed, he and his two nurses each silently made known their feelings about my status, but I kept telling myself that I was being oversensitive. Weeks later I had to cancel an appt with him due to ill health and when I later phoned to make another I was left in no doubt that they didn’t want me to come back and of course I knew it was about my status. I should have reported them but I just felt shattered by their attitudes, and also felt that I certainly did not want to place myself in such a vulnerable position with this man who obviously did not want to treat me. I also felt that when I spoke to some people about this they thought that I was mistaken and had read the situation wrongly. I wish!
    We are lucky in Edinburgh that we have a dedicated dental practise running alongside our HIV clinic so the dentists know that they are dealing with people with viruses, and this is where I have had my treatment done for many years past now, I feel safe there, and accepted.
    My experiences with GP’s has always been positive, very supportive.
    My experiences with chiropodists/podiatrist has been somewhat negative, again, as with the dentists, one woman definately did not want to treat me, she could barely bring herself to touch my feet. I am now treated at a different location and have not disclosed my status to them which makes me feel bad, because I really want to, but do not want to put myself in a situation again of being in a vulnerable position around people wielding knives etc on my body, and isn’t it frightening that we can’t trust many professionals who should absolutely know better, what hope for the public at large then to understand.
    It is shocking to hear that only four dental practices over such a huge area opted for HIV awareness training, and even those who did take it up seem to be seriously lacking in basic information and when presented to them to have received it with such negative attitudes and downright stigma.
    I am looking forward to hear what others have to say and to hearing more about your experiences in delivering this awareness training.
    Love and regards, Maureen.xx

  2. Thank you Maureen for sharing your experience. You are right it was a mistake to run the trainings by myself. The next set of trainings PW is planning for GPs, I will deliver them with my colleague Angelina Namiba. Will keep you posted on the developments.
    S xx

  3. Hi Silvia & Maureen,

    I just thought that I would update you on some of my recent experiences. I had a year of root canal treatment on a previously healthy tooth that had been filed down in order to fit a bridge. After 3 attempts to fit bridges that were far too big for my mouth I was left with a crown where a healthy tooth had been and a denture where the previous crown had fractured.
    After much complaining I was eventually referred to the dental hospital. The consultant there asked if I was on any medication and I told him what I was on. He looked it up in his Nimms and then asked me if I knew how much I already cost the National Health Service per month and if I thought that I also be should be getting free dental care on top of that.
    I did challenge him suggesting that if I had not had nearly 20 years of appalling stigma, discrimination and bad practice from dentists I would not be in this position. But, I did come away thinking that he would not have said that to someone with cancer or diabetes. It makes me so frustrated and angry.

    Good luck with the training, but I have to say I am not supprised at the levels of ignorance of the GP’s and Dentists, if I am honest I think the most stigma I have experienced has come from those groups.

    PS I have a lovely dentist now.

  4. Thank you Julie for sharing this awful experience. I can not believe he had the nerve of mention the cost of your treatment, as if it wasn’t your right to have healthcare! I am so glad that you were able to answer back to him and challenge him. However I wonder how many people still suffer this kind of abuse in silence.
    S x

  5. Dear Silvia,

    I am a medical student at UCL medical school. We have been asked to look into health services available to people living with HIV in London and barriers that prevent people from accessing them. I am shocked by the attitudes of GPs and dentists you encountered in your efforts to raise awareness of HIV. Discrimination from healthcare professionals is an area I am certainly going to focus on. I was wondering whether you could tell me how many people living with HIV you surveyed in the Fulham and Hammersmith area in your research as it would be a useful statistic to include. Thank you very much,

    Laura

  6. Hi Laura,

    thank you for your comment. We had 215 questionnaires completed and returned.

    Silvia

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