HIV = The disease-which-must-not-be-named

Today was our 3rd day in the Emergency/Trauma ward. It was almost as amazing as our first two days in the ward. Our intern doctor we shadowed for the first two days moved to a different department today so we got a new intern. He is also really nice and helpful. He lets us help and doo some patient histories. However, our new intern speaks Luganda (the local language) so sometimes he talks to the patients in Luganda and only translates small parts of the histories for us. It is still good and we are learning a lot.

About half of the patients who come into the emergency ward are infected with HIV. However, in the patient chart and when they are discussing the patients with us and each other, the physicians and medical staff always say, "This patient is known to be ISS positive." ISS stands for "Immune System Suppressed" which means that the patient has HIV and their immune system is compromised. Apparently, this system was originally put in place to reduce stigma towards people who are living with HIV. However, everyone knows that ISS means HIV so it doesn't really help protect the patients. Our intern was telling us that now the medical community is beginning to think that calling HIV by all of these fake names is INCREASING stigma. They said that calling it ISS is sort-of placing HIV in its own special scary class because nobody ever says the true diagnosis. The Ugandan physician said that it has been compared to the bad wizard, in the Harry Potter books who almost everyone calls "He-who-must-not-be-named" because they think he is so scary/bad that his name can't be mentioned. Then not saying the name makes people even more scared of the bad wizard. The intern docotor says that in this way it is possible that the medical system in Uganda is making stigma towards people living with HIV worse, because they refuse to say the name. The doctors don't even say the word "HIV" when they come across a very sick patient that they think has AIDS and want them to get tested for HIV. They don't say, "I would like you to have an HIV test." Instead they say, "We would like to draw your blood so we can find out your serostatus. Is that OK?" (Serostatus is another euphemism used in the hospital for HIV).

However, after all that discussion, we still use "ISS positive" every day in the hospital instead of actually saying the words HIV and AIDS.