Martin Tröbs had been involved with the AIDS organization in Nuremberg for six years, distributing condoms and explaining the risk of infection – until it hit him himself: HIV positive.
In 1994, when Tröbs received his diagnosis, fewer than 5,000 people in Bavaria were infected with the virus, according to the Robert Koch Institute. Today around 12,000 HIV-positive people live in Bavaria. In so-called HIV specialist practices, doctors regularly check the state of health of the patients and provide them with medication. 25 of these medical facilities currently exist in Bavaria. 40 percent of the practices are in Munich alone, more than half in Upper Bavaria. In Upper Franconia, on the other hand, there is not a single specialized practice, in Lower Bavaria and the Upper Palatinate there is just one. This emerges from a message from the State Ministry for Care and Health at the request of the Greens. “All in all, a nationwide supply of HIV-focused practices or doctors with HIV approval is guaranteed in Bavaria,” as a ministry spokesman informed. Furthermore, “no supply deficits” were reported to the ministry.
In his practice in Fürth, Michael Weiß and his colleagues treated almost every tenth HIV-infected person in Bavaria.
(Photo: private)
Michael Weiß runs one of the few HIV practices in Middle Franconia and knows the requirements. “In order to be able to practice as an HIV doctor, you need not only relevant specialist training but also proof of relevant experience in the treatment of HIV,” he explains. Even after admission, HIV doctors would have to regularly take part in specific training courses, congresses and quality circles. The prescription of the prophylactic drug PrEP is also possible with other resident doctors, but it is usually carried out in specialist practices. In his practice in Fürth, Weiß and his colleagues treated almost every tenth HIV-infected person in Bavaria. “Our patients come mainly from the Nuremberg area. To the south, our catchment area extends to around Ingolstadt, Passau or Munich. We also have patients who come to us several times a year from Mallorca or Gran Canaria,” says the internist.
As a possible reason for the few HIV practices in Bavaria, Weiß cites the economic aspect. It would only make sense to run a specialist practice if there were a certain number of patients. The lack of sensitivity in dealing with HIV patients is also due to the lack of training. “Unfortunately, the topic of HIV is still an absolute side issue in medical studies and specialist training. Special hygiene measures that are supposedly necessary are often taken, which then lead to a different – often worse – treatment,” says Weiß.
Martin Tröbs from the Nuremberg Aids-Hilfe adds: “There are hardly any serious cases left and little potential for making a name for yourself with HIV research.” According to the State Ministry, there are no efforts to establish more specialist practices in the Free State. “It is up to the doctors themselves to decide whether they want to acquire the necessary qualifications to treat people affected by HIV,” says a ministry spokesman.
The drugs against the HIV virus that Martin Tröbs had to take in the 1990s resulted in massive side effects.
(Photo: private)
In the 90s, when Tröbs received his findings, an HIV infection no longer meant certain death, but he still couldn’t find the courage to face life at that time. “The side effects of the drugs were so bad, I would rather die than live like this.” The then 31-year-old had to take twelve tablets spread over the whole day. Every five hours, even at night. The bad metal taste of the pills made him lose his sense of taste, along with constant nausea, and he vomited several times a day.
A lot has happened since then: Modern HIV medications only have a few side effects and usually only need to be taken once a day. The preparations block HIV replication in the body and prevent the virus from developing into the deadly disease AIDS. Thanks to the therapy, infected people can no longer transmit the disease to others and have a normal life expectancy.
Weiß emphasizes that trustworthy medical care for people infected with HIV is still important despite these advances. “Good HIV treatment is more than choosing the right drug. We try to create a safe space without having to fear prejudice or alienation.” However, respectful treatment of HIV patients is still not a matter of course. One of his patients only received an urgently needed heart operation six months late because of his HIV infection. In addition, patients repeatedly reported that the hospital staff sometimes entered patient rooms completely masked.
Bernd Salzberger also knows about experiences of discrimination among those infected with HIV. He is the Head of Infectious Diseases at the University Hospital in Regensburg. Since 2001 he has been in charge of the responsible outpatient clinic and, together with his colleagues, takes care of around 400 HIV patients. Around 25 patients are with them for prophylaxis. “I have a patient who comes from a village and nobody should know that he is infected with HIV,” reports Salzberger. HIV is still stigmatized. His patients kept telling him that they were confronted with prejudices: At the dentist, for example, there was treatment in a different room or references in red on the patient file. “It’s very hurtful for people,” says the doctor. Basically, he assesses the supply situation in Germany as good and believes that the same can be said of Bavaria.
When the first people died of AIDS in the 1980s, there was a massive debate about how to deal appropriately with people infected with HIV. In particular, the then Bavarian Secretary of State for the Interior, Peter Gauweiler, drew the ire of the demonstrators because of his choice of words.
(Photo: DIETER ENDING/ASSOCIATED PRESS)
Martin Tröbs knows the concerns of those infected with HIV; he himself has not yet had to make any discriminatory experiences. “But I’m also a self-confident and honest person,” he thinks he knows the reason for this. Many do not find it as easy as him to talk about their illness. Five years ago he suffered a heart attack. The medical treatment was unprejudiced, the doctor only asked him if he was taking his HIV tablets regularly. After that, his infection was no longer an issue.
More education on the subject of HIV is not only needed among doctors. Infectiologist Bernd Salzberger estimates that between 300 and 400 people a year in Bavaria receive a diagnosis too late and that the immune system is already badly damaged. “In my opinion, the willingness to be tested is greater in Berlin than in Bavaria, for example. Topics such as drug use and homosexuality are dealt with very differently there.”
When the still unknown HIV virus appeared in the early 1980s, different opinions about how to deal with infected people clashed. In Bavaria, measures were taken that were unique in Germany: In February 1987, the state government passed a catalog of measures against HIV. The catalog provided for compulsory tests, raids and restrictions on facilities. Prostitutes, drug addicts and gays were among the “suspects of infection”. Anyone who wanted to become a civil servant or have a residence permit as a foreigner also needed a negative test. The then Secretary of State for the Interior, Peter Gauweiler, called “separation” the last resort. And the later Prime Minister Horst Seehofer was quoted with the plan to “concentrate” infected people in “special homes”. The catalog of measures remained in force until 2001.