AIDS Phobia – The new HIV?
While running a clinic that is part of the MOH anonymous HIV screening program, it is inevitable that I end up conducting a fair bit of HIV screening. In the course of my work I have noticed what I feel is a worrying trend of an increasing number of young Singaporeans with what is described as AIDS Phobia. It is an excessive and irrational fear of HIV/AIDS that is affecting their lives and function. A short history of HIV in Singapore will help us better understand the emergence of this consequence.
1985 was the year HIV first reared its ugly head in Singapore. Back then the medical community was brimming with confidence some might even say complacency, over our seemingly unstoppable successes against infectious diseases. From the advent of Penicillin to the eradication of smallpox, we were basking in the glory of our victories. No one even heard of the concept of the superbug and MRSA was but a mild irritant. Then this contagious and deadly disease that we had nothing against came.
All our antibiotics were utterly useless and vaccine development met with failure after failure. It chewed through the very thing that helps us fight infections, our immune system. This left HIV sufferers vulnerable to bacteria that the healthy would normally brush off without a second thought. We saw patients literally dissolving around us and there was nothing we could do.
We quickly fell back on age old proven strategies to combat an infectious disease, epidemiology and education, isolation and prevention. An initial trend that was established found that HIV was more prevalent amongst homosexual men. It was also found to be spread amongst drug users who shared needles. This quickly established a notion in the conservative majority that HIV was a disease of the sexually or socially deviant. Education was focused on a campaign of fear. HIV is incurable, HIV is contagious, HIV is invisible. These were the catchphrases of the times.
Perhaps our efforts were too effective. Even at this day and age, misconceptions, incorrect ideas and social stigmas are as rampant despite our efforts at re-educating the public. This has led to the emergence of this new phenomenon. It has many names: AIDS phobia, AIDS anxiety, FRAIDS (fear of AIDS) etc. Psychologists argue over its technical definition. Is it a phobia? Delusion? OCD? Paranoia? Hypochondriasis? Whatever you wish to call it, it is a problem that is growing in size.
The internet is awash with examples of people not daring to go home for months because they are convinced they have HIV and will spread it to their family. And of people who bathe in the dark afraid of spotting lesions of their skin that are caused by HIV. And of people who wash themselves with bleach everyday to prevent HIV. All of them have had multiple tests for HIV and were found to be negative. In medical parlance they are known as the ‘worried well.’
I read with interest a report from China earlier were many people claimed to be suffering from a mysterious AIDS like illness. They were convinced the medical authorities were lying to them about their negative HIV tests.
A few eminent experts stepped up and termed this crisis ‘prostitute guilt.’ I personally find it amazing how a new term can be conjured up to explain away the problem simultaneously placing the blame squarely on the heads of the patients. These poor souls are blamed for taking up precious medical resources unnecessarily and their underlying psychological illnesses are left to gnaw away at them.
I can however completely empathize with the Chinese medical authorities. In the course of my work I have encountered many patients suffering from this so-called AIDS phobia. It is challenging and extremely time consuming to help them and treat them. Each consultation becomes wearying task of addressing repeated fears and doubts, of reassurance, support and encouragement and of answering the same oft repeated questions.
I had a patient who, when he came to me, had been regular testing himself for HIV for the past 1 year. After each test he would feel relieved but within a few days, he would inevitably find another reason to believe he has HIV. Any and all symptoms he interprets as caused by HIV from the mundane (my tongue looks white) to the ridiculous (my semen smells like the prostitute). Despite numerous efforts to get him to seek and start psychological help, he was adamant in his pursuit for a diagnosis of HIV. He is of a group of patients who I describe as ‘wanting to test till they are positive’.
Fortunately most of my patients who suffer from AIDS phobia are hardly as recalcitrant. They have insight to the fact that their fears are irrational and respond very well to treatment.
So here we are stuck in this conundrum. We want everyone ‘at risk’ to test regularly for HIV yet we do not want people to worry excessively about it. This places serious challenges in public education campaigns as we struggle with the balance of instilling concern, awareness and just the right dose of fear. We want patient to trusts our tests yet understand the window period. All this is made even more exigent by the deluge of information on the internet which is generic at best and outright lies at its most awful.
Of course the focus of our efforts should remain on creating awareness, pushing education and eventually, we hope, to eliminate HIV from our shores. But in our pursuit of this admirable quest, we should not forget this group of people who also suffer from HIV albeit from a completely different angle. Moreover, the majority of such sufferers are prime active economic contributors and the loss of their economic efficiency would mean a blow to our economic capability.
I hope we can strive to increase the awareness of this condition among Singaporeans and our primary care doctors. We can all guard against it by educating ourselves on the facts of HIV, trusting our Doctors and our tests and being more aware.