Attitude and perception of cardiothoracic surgeons in Nigeria and Ghana to patients with human immunodeficiency virus infection

Abstract

Cardiothoracic operations are associated with increased exposure and risk of blood and blood borne diseases. 
This is true in the West African Subregion where HIV/AIDS is endemic. We aimed to survey the attitude and 
perception of cardiothoracic surgeons in Nigeria and Ghana to patients with HIV/AIDS who presented with 
common cardiothoracic and vascular pathologies that would otherwise normally have low mortality rate. Data 
collection was by a structured questionnaire which was sent to all consultants/specialists and senior registrars 
practising cardiothoracic surgery in Nigeria and Ghana. Survey response rate was 64 and 70% for consultants 
and senior registrars respectively. The majority of surgeons were more willing to operate on emergency cases 
than elective cases. Patients with HIV infection and those on antiretroviral drugs were also more likely to be 
operated upon than AIDS patients. Eighty-seven percent (87%) of surgeons supported preoperative screening 
for HIV antibodies. The majority of surgeons (92.9%) also supported preoperative screening in high risk 
patients. Some 21.4% of surgeons wrongly believed that cardiopulmonary bypass (CPB) has an adverse effect 
on HIV-positive patients and 42.9% of surgeons believe there is a difference in the cardiothoracic surgical 
outcome between HIV-positive patients and HIV-negative patients. Some 82.1% of surgeons reported having 
modified their surgical practice to reduce the risk of blood-borne infection, adopting the universal precautions. 
The surgeons that have refused to operate on HIV/AIDS patients did so mainly for the fear of contracting the 
infection and the absence of an insurance policy covering the surgeon in the event of acquiring the infection 
from HIV-positive patients. Despite the low risk of transmission of blood-borne infection when adequate 
measures are taken during surgery, denial of surgical intervention in HIV-positive patients has continued. It is 
also disturbing to know that some surgeons still believe that there is a difference in outcome after surgical 
intervention in HIV-positive patients compared with HIV-negative patients and that CPB has an adverse effect 
on HIV-positive patients. There is need to educate these surgeons and provide adequate insurance cover for 
them, to enable them take the risk of operating on HIV/AIDS patients.