How often do you think about AIDS in your practice? How often do you, as a veterinarian, think you have a role in the care of HIV-infected clients? If you said never to both these questions, you might want to think again.
According to Dr. Caroline B. Schaffer, director of the Center for the Study of Human-Animal Interdependent Relationships at Tuskegee University, veterinarians have a role in their care. They also need to implement procedures in their practice to reduce the risk of possible transmission while respecting everyone's right to privacy.
If veterinarians don't get involved, HIV-infected people may be denied the powerful therapeutic effect of pets. "Many people who are infected with AIDS are told to get rid of their pets," she told attendees on July 16 at the AVMA Convention in the fourth annual Leo K. Bustad Memorial Lecture. A study by Centers for Disease Control and Prevention researcher Dr. Frederick Angulo of 2,400 men infected with HIV found that 63 percent were told by their physicians, health care workers, and others to get rid of their furry friends.
According to Dr. Schaffer, although more than 200 zoonoses exist and pets can pose a risk to immunocompromised individuals, pets are also often vital to preserving or improving a person's health. Removing an animal can often be more hazardous than having an HIV-infected owner keep it, as long as certain precautions are taken. Evidence has shown that some people's health spirals downward after they give up their pet.
"Man's best friend"—dogs, cats, or other pets—can make people feel important, give them a reason to get up in the morning, and improve their overall spirit. Veterinarians need to review the potential animal-associated infections with their HIV-infected clients as well as their other immunosuppressed clients, present the risks in an accurate way, and let each person decide whether the benefits outweigh the risks, she said. Opportunistic infections in people with AIDS are acquired more often from contaminated soil, food, water, wild birds, or infected people than from household pets.
"We can make sense out of disease transmission and life cycles," Dr. Schaffer said, pointing to toxoplasmosis as one example. Many physicians recommend that pregnant women get rid of their cat, but this isn't a necessity. Because cats shed Toxoplasma organisms in their feces for only roughly two weeks of their entire lives and because the eggs are noninfectious for the first 24 hours, minimal preventive efforts can greatly reduce the risk of human infection.
According to Dr. Schaffer, veterinarians may need to dole out a little human health advice on zoonoses to fill a gap left by physicians. A 1999 study by University of Wisconsin researchers, Sara Grant and Christopher Olsen, of 322 physicians found that only infectious disease specialists were comfortable advising patients on the role of animals in zoonotic transmission. They also believed that veterinarians should play an equal or greater role in advising patients about zoonotic diseases. Veterinarians can supply invaluable advice on pet selection, care, nutrition, and environmental management to reduce the risk of disease transmission.
Practitioners also need to think about AIDS in their workplace. Are you working with an infected staff member or colleague? Do you know for sure? Are you taking proper precautions?
To address the issue, Dr. Schaffer recommends a three-pronged strategy involving compassion, universal precautions, and education. Universal precautions provide minimum standards of behavior regarding animal handling, clothing, instrument handling, blood barriers, and first aid. If followed, these precautions decrease the risk of contracting diseases from infected blood or other sources and provide a layer of privacy for infected individuals. Requiring only one staff member to wear a mask and gloves while emptying the litter box, she said, might raise suspicion and violate that person's legal right to privacy regarding health status. All staff, including receptionists, must be educated about the hospital's universal precautions and procedures.
Veterinarians should also be aware of the federal Americans with Disability Act. People with AIDS or HIV infection are considered disabled and it is, therefore, illegal to discriminate against them. Local and state laws might also apply.
So how can you help? Besides educating your staff and yourself, reaching out to the community can be beneficial. Dr. Schaffer suggested putting informational brochures in your reception area and sharing them with physicians, nurses, and church leaders.
"We need to do a lot of outreach and a lot of education," she said. "We can do a lot more. We as veterinarians are the experts on zoonotic transmission. We must confidently assume our rightful role as valuable members of the human health care team."