Canadian Medical Association Journal 1995; 152: 1881-1882
However, the CMA says some things -- especially physicians' dedicated but sometimes-unsung commitment to their AIDS patients -- have not changed. In a Mar. 28 appearance before the House of Commons Subcommittee on HIV/AIDS, Dr. Carole Guzmán, the associate secretary general, and Dr. David Walters, the director of health care and promotion, said that during the epidemic's second decade Canadian physicians continue "to show a dedicated commitment on the front lines of prevention, care and research, often in the face of fiscal restraint".
The CMA delegation said the role of physicians has changed little since HIV first appeared in Canada. "We must not lose sight of the importance of physicians' role in assisting new HIV patients and their partners, families and advocates in meeting their needs. Answering questions from people, often when there are limited treatments and no clear answers, is an extremely challenging and stressful task for physicians who work in this field".
That latter remark has special meaning for Walters, the former director of the AIDS Education Awareness Program of the Canadian Public Health Association who today combines his work at the CMA with part-time duties as a clinical associate at the Ottawa General Hospital's Immunodeficiency Clinic. He said doctors on the front lines of AIDS treatment need continued support because they have to deal with the impact of both the infection and disease. "Local medical officers of health and public-health staff from across Canada must also continue to be supported in all their roles by provincial and territorial programs," he said. " This will enable them to further study the main components of the HIV/AIDS epidemic and educate the general public, local communities, schools and at-risk populations."
The CMA said the disease poses seldom-encountered problems for medicine and this means the epidemiologists who track it must further delineate the rapid emergence of the epidemic in hard-to-reach sectors of the population, including drug-using street people and criminals.
"The recent emergence of HIV/AIDS in women and aboriginal peoples must be researched and appropriate preventive-care strategies must be implemented." the association brief said, noting that primary-care physicians have borne the brunt of clinical needs associated with test-related counselling. The issues these doctors have dealt with include partner notification, diagnosis, treatment and palliative care.
The CMA said that providing required medical education and training needed to cope with the AIDS epidemic to both trainees and practising physicians is a major challenge. Efforts by the Association of Canadian Medical Colleges and College of Family Physicians of Canada to update physicians on the latest developments in treatment "must be recognized as an important step toward eventual control of this epidemic."
The delegation said that as disease patterns continue to develop, the primary care provided by physicians will have to adjust to "patterns of care seeking by street-involved populations. Support to clinics and practitioners for this community focus is a necessary adjustment that may not be adequately built into current programs."
The CMA noted that specialists in infectious disease, immunology, pediatrics and psychiatry also play crucial roles in the fight against AIDS and HIV, but their roles are different from those of primary-care physicians. "They make difficult diagnoses concerning opportunistic infections and other health-related problems and recommend treatment strategies that prevent problems and improve the quality and quantity of life for people living with HIV."
The association said these clinical teams must be supported by adequate operative and research funds if Canadian medicine is to play a leading role in overcoming the epidemic.
The CMA outlined several "extremely important" aspects of Canada's response to HIV/AIDS: