Volume 29 - Number 11 - Thursday, February 27, 1997

Teaching doctors how to deal with AIDS

by Hélèna Katz

The doctor's discomfort is painfully obvious. He's trying to take a gay patient's sexual history, but can't bring himself to utter words like oral and anal sex--never mind asking if the patient was the giver or the receiver of these sexual acts. Some might sympathize with the physician's plight, but his awkwardness with the topic at hand isn't helping his patient any. And the patient, recently diagnosed with HIV, needs all the help he can get right now.

The doctor isn't real and neither is the patient. The two are fictitious characters in a videotaped dramatization. But the scene being depicted reflects the unease some doctors feel around issues of gay sexuality and AIDS.
Dr. Jocelyne Rowe


The video is part of a new effort aimed at medical students--an attempt to familiarize them with the psychosocial aspects of AIDS. Dr. Jocelyne Rowe, an associate professor of family medicine, is heading up the "Sex, Drugs & HIV" project, a set of teaching modules currently being used to educate medical students at McGill, Memorial University and the Universities of British Columbia and Ottawa.

Rowe says "Sex, Drugs & HIV," promotes "a whole-person approach to medical care so that [students] are dealing with the person and not just the disease."

The project is divided into three modules. The first, called "The Gay Virus," explores how HIV/AIDS stigmatizes people and affects their dealings with health care providers. "Risk Groups" challenges assumptions about who is at risk and encourages health care workers to focus on risky forms of behaviour instead of certain groups of people. It also provides students with the opportunity to develop communication skills and to feel more at ease in dealing with human sexuality and diversity.

"Harm Reduction" examines factors that put people at increased jeopardy for HIV infection and affects their access to health care--homelessness, work in the sex trade, confinement in prisons and intravenous drug use.

Rowe reached out to the world of entertainment for collaborators on this project. Greg Malone from the comedy troupe CODCO is featured in standup comedy segments and also helped write scenes humorously dramatizing doctor/patient interactions.

Those segments "brought a punch and impact to the tapes that are important," Rowe says. "These dramatizations kind of make light of the strain and angst that health-care providers go through."

The videos also include interviews with people who have HIV/AIDS and caregivers who tend to their needs. A workshop manual supports the videos, providing questions, role-play scenarios and case studies to give small groups of students a chance to discuss issues and develop skills to help them cope more effectively with patients who have HIV/AIDS.

"It gives a chance for some people in health care to deal with their fears," Rowe says. "People aren't prejudiced, but sometimes they're thrown into a situation and they just don't know how to handle it."

The need for this sort of HIV/AIDS education program came out of a 1994 meeting organized by the Association of Canadian Medical Colleges (ACMC), to review HIV/AIDS education and develop strategies for the future.

Participants identified a number of psychological barriers experienced by health-care professionals, including fear of contagion, homophobia, intolerance of diversity and discomfort with sexuality. The ACMC admitted that medical schools weren't doing all they could to prepare their charges for dealing with the complex emotional and social issues surrounding AIDS.

Health Canada and several pharmaceutical companies have funded the project. "Sex, Drugs & HIV," was introduced at McGill last year as part of a course called Selected Topics in Medical Science. The course, coordinated by Dr. Julian Falutz, is being revised so that it can be an interdisciplinary course for students in social work, medicine, dentistry and nursing.

The project is earning sterling reviews. Students exposed to the modules give them consistently high (85%-95%) ratings.

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