Advantages and Disadvantages of Special Hospitals for Patients with HIV Infection

Abstract

In the USA, concentration of HIV and AIDS patients in a few cities and in a few hospitals within those cities has led to calls for the establishment of separate health-care institutions for AIDS and HIV patients. This would in theory make it possible to provide better treatment, alleviate hospital overcrowding and prevent the treatment of other patients from being compromised. The authors contend, however, that "specialization might turn into segregation, increasing the stigma associated with HIV infection, constricting patients' freedom of choice, and ultimately producing substandard care". They review the history of single-disease hospitals, especially for tuberculosis (TB) and mental illness. TB patients developed effective strategies for avoiding such facilities and were able to circumvent official policies requiring treatment for TB; and the isolation of patients in sanitoria made their reentry into society more difficult. Mental hospitals were unable to attract qualified staff, because of low pay and because they did not want to work in "isolated settings with troublesome patients". The authors conclude that requiring patients to use single-disease hospitals may produce substandard care and make reentry to society more difficult; in addition, single-disease facilities may be vulnerable to budget cuts and have difficulty in recruitment of good staff. There are no clinical characteristics of HIV infection that justify creation of special facilities. The authors state that HIV hospitals would increase stigmatization and negative stereotyping; they recommend designated HIV/AIDS units within general acute-care hospitals and within mixed-use nursing homes. "Every effort should be made to integrate the treatment of persons with HIV disease into the mainstream of health care facilities." [These considerations and factors are, if anything, even more true at single-disease hospitals in developing countries, and the arguments advanced by the authors should be of interest to anyone involved with planning the provision of health care for HIV-positive persons in developing countries.]