John Gill, of the Southern Alberta HIV Clinic, spoke to us at the HIV Endgame conference and answered questions about screening patients living with HIV for intimate partner violence and other determinants of health.
The HIV Endgame logo appears. Text reads: John Gill answers questions about screening patients with HIV. John Gill sits in front of a wood-paneled wall and answers questions from off-screen interviewers. The text of each question appears in between clips.
John Gill: I’m Dr. John Gill. I’m an infectious disease specialist and I’m the Medical Director of the Southern Alberta HIV program in Calgary.
Q: What should family physicians be watching out for?
Gill: Well, I think you need to not just look at the laboratory test that we’ve been trained for the last 20 years — we see an HIV patient we look at their viral load their CD4… We may look at their kidney function and their cholesterol levels. But I think we’ve got to think more holistically, now. We need to look at their social environment. Have they got stable housing? Have they got a job? Have they got food security? Are they safe in their environment? Are they socially isolated? And that’s one of the new components of chronic HIV management.
And then we need to look to see what other problems, medical, they have, often associated with aging, to make sure that we coordinate with other caregivers. Certainly now we’ve got to manage, co-manage, comorbidities such as hepatitis C, neurocognitive decline, perhaps, from Alzheimer’s disease, diabetes management… it’s becoming a complex medical management with the aging HIV patient.
Q: Should doctors ask patients about intimate partner violence?
Gill: I think we’re seeing increasing comfort that — and recognition that this is something we cannot do the ostrich approach, put our heads in the sand, hope the patients will tell us if it’s important. We need to be a tad more proactive and, certainly, in Ontario, more doctors are doing it. I know several other clinics that are feeling increasing comfort in actually addressing this very delicate issue with their patients.
Then, of course, we need to figure out what we do the with the information. Sometimes you have to extract a patient from a very unsafe home environment. Other times you need to help them maybe with counseling or just understanding how it helped them get over a previous traumatic event. But you can’t deal with it unless you know it’s there.
Q: What if patients experiencing violence don’t want to leave?
Gill: One of the questions in one of the concurrent sessions was culture. There was a lady who said, “In some cultures, a little bit of physical violence is normal. It’s been the norm in that society for centuries. Should we impose Western Canadian values and say that’s totally unacceptable?”
And that is delicate, because you don’t want to extract someone from their community because of a value that they’re not really — if they’re not — life’s not in danger, and it’s a bruise here or there — if they’re not that unhappy about it, are we correct in imposing our Western values? And that is delicate and it requires a lot of forethought because you can injure people if you do an unwise action. So, it’s very difficult. But recognizing the issue is the first step.
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Note on content: Interview questions have been edited for brevity.