If the overworked and undertrained doctors in AIDS referral hospitals in Indonesia are confused by symptoms, some of them take the easy way out: "you have HIV, that's normal." Let me give an example from a few years back.
A young man with HIV (let's call him Robby) but still with a high CD4 count (showing that his immune system had not yet been badly damaged by HIV) collared me one evening. "I've been suffering from mild diarrhoea for months; not really bad, but I have to poop two or three times a day. I reported this to my doctor several times, but he just tells me, 'with HIV, you must expect that sort of thing.'" I told Robby he must be firmer with his doctor; HIV rarely causes diarrhoea, particularly at high CD4 counts. It should be possible to find (and treat) the real cause.
Robby agreed but (like so many of our friends), once in front of the doctor, his courage left him, and he reverted to the normal 'yea, Doc' form of communication. However, I ran into him a couple of months later. He had visited Bangkok for a meeting, and had taken the opportunity to have a thorough check-up by an HIV doctor there. The result? Worms! A dose of Combantrin and the diarrhoea was gone.
Cause and effect: always dangerous ground...
Babé
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