Erection killers

There is a paucity of data concerning the intricate medical, legal, and ethical issues relating to the treatment of erectile dysfunction in patients who are HIV-positive or who have transmissible diseases.

This is a particularly challenging scenario in which the physician's ethical responsibilities go beyond the typical doctor/patient relationship and involve the patient's current (and possibly future partner(s). Another added challenge is the increasing incidence of HIV infection in the elderly population, a group that has different risk factors for contracting HIV than younger men and is also more likely than the latter to be suffering from ED. The older patient may not only be more susceptible to ED but, if HIV-positive, may be more prone to engage in unprotected intercourse because of freedom from fear of causing pregnancy and lack of information/education on HIV infection.

The role of urologists in managing sexual dysfunction in patients with HIV and sexually transmissible diseases is especially important and amplified by the fact that many of the problems affecting this group of patients (voiding dysfunction, urinary tract infections, and fertility issues) fall within the realm of expertise provided by urologists. There is a growing need for further education pertaining to the interactions of therapies for ED (i.e. phosphodiesterase inhibitors) and therapies for HIV and other transmissible diseases (i.e. highly active antiretroviral therapiesHAART).

Urologists and general practitioners caring for this group of patients will also have to consider legal precedents governing delivery of care in a new scenario in which the traditional physician patient encounter is affected by a third partythe patient's current and future partner(s) and his or her respective rights ion various parts of the world.

The roundtable session will be divided into two segments. Initially, a brief overview of the general medical, legal, and ethical issues surrounding this condition will be presented. The second half of the program will focus on a few relevant case presentations and a discussion of these cases with audience participation. During the program, an attempt will be made to pose probing questions and address some of the following issues:

Ethical issues

• What is the physician's responsibility toward the unknowing partner, the unborn child at risk of contracting HIV, and the society in general?
• How do these concerns affect the traditional doctor-patient relationship?
• Can one ethically refuse therapy? Can one legally refuse therapy?
• Chances of HIV transmission with each act of unprotected intercourse
• Safe sex Counseling and the role of contraceptives in prevention of disease transmission
• Issues specifically relevant to HIV and sexual transmission of STDs in the elderly population
• The role of highly active antiretroviral therapies (HAART) in HIV transmission
• A review of the effects of protease inhibitors on commonly prescribed ED oral pharmacotherapies (phosphodiesterase inhibitors)
• Special considerations pertaining to intracavernosal injection therapy:
• Will the injections increase the chances of blood-borne transmission?
• Surgical implantation of penile prostheses in those with transmissible diseases and HIV: the risk confronting the surgeon

• The Americans with Disabilities Act in the USA
• Bragdon vs. Abbotthe Landmark US Supreme Court case
• Global laws pertaining to unauthorized HIV testing of the patient: Is the physician allowed to do HIV (and other transmissible disease / e.g. hepatitis) testing prior to restoring sexual function to an infected male?
• General recommendations for reduction of liability against third party law suits