my assessment of mina ming.

so regarding mina ming, it is her primary care physician who is in part fucking her up, as well as, obviously, mina does not know enough yet about how to maintain her own health and enjoy the things that she wants to do, i.e. sex, on some level.

her primary care physician sugggested that mina will not know that she is absolutely devoid of hiv infection until six months out.  that is not true given the testing that mina has already done, and also given her health behaviors, and her medical history.

the parameters of the test include a window period of about 4 weeks.  and traditionally since the 2000's window periods have been in the 9 week to 12 week period as far as I remember.  so 6 months was not the best counsel.

what I really suspect though, is that her primary care physician, simply did not do an adequate job of taking a thorough, accurate and adequate history.

the details of mina's story makes it very unlikely that she would contract hiv, regardless of mina's overwhelming concern, anxiety, and worry.  this actually opens the possibility of a false positive test confusing the picture even more.  which can result in even more testing.

furthermore, if the primary care physician were really certain that it would only be a definitive test at 6 months, then there is no reason to test prior to 6 months from the date of exposure.

mina has had 3 tests already since that exposure.  and according to her pcp she would require a fourth test.  that is a lot of testing for a simple confirmatory test of hiv status.  her pcp should have counseled her to wait until six months out to have 1 test rather than have to remove blood from her 3 to 4 times as this testing does hasten death too.

it is not like the tests do not hasten death, you know.

I do agree though, that testing for hiv and starting treatment early will be beneficial for patients who are at risk for hiv.

Mina is not really at much risk or almost any risk of hiv,  and that was discerned from taking about 20 to 30 minutes to do an accurate history over skype.

so her pcp could have spent more time taking a history and educating mina and less times calculating which test to select.  But, I do know that with the constraints and pressures of most healthcare systems, this becomes more difficult to do, as physicians are also concerned about completing things in a timely manner, and also about malpractice.  they are also aware of health care and health outcomes indicators which bias them towards what is most studies and most written about.  this does vary a little bit from country to country.  or health system to health system.

in the case of mina ming, mina is not the most knowledgeable of hiv and std's and this is another barrier to excellent health outcomes, since many pcps will not take the time to educate ignorant people or even naive people.

mina ming is middle eastern.  I am quite sure that there are some cultural influences that are challenges to mina becoming more educated about her sexual preferences and her sexual health.  In the middle eastern cultures, without a doubt, open sexual lifestyles are often and usually 'looked down upon'.

middle eastern cultures are not the only ones with these cultural choices that can and do make life more difficult.

Fereshteh. 





Adrian Dane Kenny, M.D.
Jamway Hospital