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Since the recognition of the human immunodeficiency virus (HIV) as the cause of HIV infection and the acquired immunodeficiency syndrome (AIDS), studies have determined that the risk of infection to the health care worker through occupational exposure is extremely low. However, the perception of risk can have potential psychologic consequences for health care workers providing medical care to HIV-infected patients. What is it that makes caring for HIV-infected patients an unsettling emotional experience? While occupational risks accompany all work, physicians have in the recent past perceived themselves with little vulnerability to a devastating disease. Medical professionals at the turn of the century had alarmingly high rates of mortality from tuberculosis, and today, if not immunized, they are at increased risk for hepatitis B. HIV infection carries formidable biologic and social consequences that contribute to the psychologic stress that may accompany caring for infected patients.
Because H1V-infected patients are dealt with extensively in tertiary centers, there are significant implications for resident and medical student training, especially in urban locales where the rate of HIV infection is high.
The emotional risks of caring for patients with HIV infection have had scant documentation, but there is growing evidence for concern. A study of 250 residents in New York City documented that 19% of pediatric residents and 36% of medical residents had needle-stick exposure to HIV in 1986. A 1988 study of 294 pediatric residents in 11 New York City programs revealed that 205 of the residents (69.7%) had been stuck with a blood-contaminated needle on 588 separate occasions. While there was considerable concern expressed by residents over acquiring HIV, more than half did not want to know whether they were HIV seropositive.
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