From: MShernoff@aol.com
Date: Thu, 14 Nov 1996 05:47:35 -0500
Subject: physicians with HIV/AIDS

Attached is a recent article I had published on physicians living
withHIV/AIDS.  It is in ASCII generic word processing.

Thanks

Michael Shernoff


Physicians Living With HIV/AIDS
Michael Shernoff
Published in
The Journal of the International Association of Physicians in AIDS Care
November, 1996
=0D

"Once I was diagnosed with full blown AIDS, the administration of my hosp=
ital verbally and in an unsigned and undated document immediately forbade=
 me to continue performing any surgical procedures, change dressings, dra=
w blood, give injections, or do rectal exams. Any patient examinations I =
did I would have to wear gloves. I was told that if I failed to agree to =
these conditions I would be dismissed by the hospital."   (An east coast =
urologist)
=0D
In 1991, a frail and failing teen aged Kimberly Bergalis garnered nationw=
ide media attention as she was helped into a congressional meeting room w=
here she haltingly told the story of how she was infected with HIV by her=
 dentist, Dr. David Acer.  There was hardly a dry eye for this "innocent =
victim" of AIDS. Angrily she asked the nation's law makers to enact legis=
lation that would make it mandatory for any healthcare worker who is infe=
cted with HIV to inform his or her patients of his/her condition in order=
 to spare others the suffering that she was undergoing. Outraged legislat=
ors angrily denounced and vilified Acer's irresponsibility.
 In 1991, largely in response to the outcry over the Acer case, Acer havi=
ng supposedly infected six of  his patients with HIV,  the Centers for Di=
sease Control and Prevention (CDC) issued a guideline recommending that d=
octors who are HIV-antibody positive notify patients about their HIV stat=
us in advance of their performing "exposure prone procedures." The guidel=
ine calls on hospitals and other healthcare institutions to form special =
panels to determine which medical procedures would warrant a physician's =
disclosure of  his or her HIV status to patients.  Many of the hospitals =
and healthcare facilities in the Untied States have adopted the recommend=
ation in the form of rules imposed upon doctors and other health care wor=
kers. It is noted that  Acer "supposedly" infected several of his patient=
s because CDC investigators have never been willing to state definitively=
 that he transmitted HIV to any of his patients.
In a report published in the June 28th, 1996 edition of Annals of Interna=
l Medicine, experts examined HIV test results for 22,171 patients treated=
 by 51 infected healthcare workers.  They discovered that 37 of the healt=
hcare workers had no patients who tested HIV positive for HIV infection. =
One hundred and thirteen (113) patients out of 9,108 examined by 14 healt=
h care workers were infected with HIV.  Epidemiological and genetic evide=
nce showed all 113 infections came from sources other than the health car=
e worker.  The researchers noted they were not able to investigate every =
patient treated by each of the infected workers.  But "If HIV was easily =
transmitted from healthcare worker to patient, evidence of such transmiss=
ion would have been detected in these investigations," says the report.  =
In light of this, CDC scientists say that they may never be able to expla=
in how and if  Florida dentist David Acer transmitted HIV to six patients=
, including Kimberly Bergalis.  "The science doesn't provide us with a co=
nclusive answer [on Acer], but it does reiterate the overall safety for b=
oth healthcare provider and patients," says Dr. Donald Marianos, a CDC re=
searcher.
In a meeting on February 16th, 1996 between US Health and Human Services =
(HHS), Secretary Donna Shalala and leaders of the San Francisco based Gay=
 and Lesbian Medical Association, Benjamin Schatz, executive director and=
 Valerie Ulstad, a Minneapolis cardiologist, who is president of the asso=
ciation, urged Shalala to consider changing the HIV reporting guidelines.=
 Schatz said the guideline, which CDC adopted under pressure from members=
 of Congress, is unnecessary because there are no proven instances where =
a physician or other healthcare worker has infected a patient with HIV.  =
In a February 26 press release announcing the meeting with Shalala, Ulsta=
d said Shalala promised to instruct HHS officials to "examine whether cur=
rent CDC guidelines that restrict infected health professionals are scien=
tifically valid and whether they have resulted in unnecessary discriminat=
ion." Naphtali Offen, director of the Medical Expertise Retention Program=
 of  the Gay and Lesbian Medical Association, stresses that "It is offens=
ive as well as very bad public health policy to have something on the boo=
ks that is based on unsubstantiated science like the current CDC guidelin=
e regarding physicians infected with HIV."  =

Dozens of physicians around the United States, Canada and western Europe =
were contacted to research this article. Every doctor interviewed stated =
that issues surrounding his or her  health status are of  paramount conce=
rn. All the professionals except two, responded that they would not discl=
ose their health condition to patients or department chair people due to =
fears of being forced to retire from practice before they believed this w=
as a medical necessity. Asymptomatic physicians in clinical practice in s=
tates that have mandatory reporting of infected health care workers live =
in fear of a forced disclosure of their health condition that may result =
in their having to leave direct patient care.  Some of them go to great l=
engths to keep their medical conditions secret including going out of sta=
te for medical care and paying for HIV- related blood tests, doctors visi=
ts and prescriptions out of pocket so there will not be any computerized =
record of their condition that might potentially  come to the attention o=
f their employers or state medical board. =

One eminent internist and researcher in the Midwest literally told no one=
 about his infection with HIV other than his lover and doctor.  For four =
years after first learning  he was infected (but asymptomatic) he was not=
 tenured. He felt a necessity to maintain the secrecy about his HIV sero-=
positivity because he feared that his university would not choose to tenu=
re someone they viewed as having a life threatening condition, even thoug=
h he brought hundreds of thousands of research dollars into the instituti=
on each year.  (He has since received tenure, and still chooses not to di=
scuss his health status publicly or privately with individuals in the sta=
te where he lives and works.)
Among the physicians who were interviewed for this article are three who =
are still working and have disclosed their health status to employers. On=
e is an administrator at an East Coast state-wide AIDS policy agency and =
has no direct patient contact. "Being open as an HIV positive doc hastene=
d my departure from clinical practice. I wanted to make a contribution to=
 the communities impacted by HIV/AIDS, so I applied for a job at a major =
policy institute and during the interview process disclosed my health sta=
tus.  After inquiring about my health, my potential boss offered me the p=
osition and told me that my being a person living with HIV could only be =
beneficial to the job I was being interviewed for.  We both agreed that m=
y being openly HIV positive would help insure that the work this agency w=
as mandated to do had a continuous positive human impact."   	A Chicago p=
sychiatrist, exclusively doing AIDS patient care and research into mental=
 health issues of people with AIDS also disclosed his HIV status to super=
visors. "I felt that though completely asymptomatic, informing my departm=
ent heads that I was HIV sero-positive was the only way to keep work rela=
ted stress at more manageable levels."  This psychiatrist is also the onl=
y physician surveyed who disclosed being HIV+ to patients.  "I only share=
 the information about my being HIV+ during the course of  treatment when=
 a patient clearly needs the example of a role model and slow progressor =
living productively with HIV to provide a contrast to their hopelessness =
regarding their own diagnosis."
 Another Washington, DC physician who disclosed to his department head th=
at he has AIDS, worked in emergency medicine in a large public hospital. =
Due to his declining health, he had just made the decision to retire from=
 clinical practice.  The same day that he told the chairperson of his dep=
artment that he has AIDS, he was asked to come to the personnel office, c=
omplete the forms for permanent disability and not return to work the nex=
t day. "Though I felt some concern for my welfare on the part of the hosp=
ital administration,  it was apparent to me they were more concerned abou=
t avoiding potentially litigious situations." Thus six years after the in=
itial hysteria generated by the Bergalis and Acer case, physicians who ar=
e infected with HIV and are asymptomatic or have full blown AIDS are stil=
l struggling with the question of how to pursue their careers in a manner=
 responsible both to their own professional goals and to their commitment=
 to patient care and safety.  =

Bertram Schaffner, MD is medical director of HIV Clinical Services at the=
 William Alanson White Institute of Psychoanalysis in Manhattan. Stuart N=
ichols, MD is former director of addiction services at Beth Israel Medica=
l Center. Both are psychiatrists who have been co-leading a biweekly grou=
p for physicians with HIV/AIDS in Manhattan since 1985. In that period ap=
proximately one hundred doctors attended the group at some point. Until 1=
991, this was the only group for physicians with HIV/AIDS in all of New Y=
ork City. People generally attend the group for three to five years, thou=
gh one doctor who is healthy and still working has been an active member =
for ten years. Schaffner states that "Most members of the group have vary=
ing symptoms of clinical depression and/or anxiety. All members of the gr=
oup are frightened of having patients, colleagues in groups practices and=
 department heads discover that they are infected with HIV. Having their =
careers destroyed and fears of potential lawsuits were the most frequentl=
y cited concerns."  Cries from legislators mandating that all physicians =
be tested for HIV, and that the results be made public, contribute to hig=
h anxiety levels and fears by the men who attend this group. The vast maj=
ority of HIV-positive physicians contacted for this article discussed fee=
ling some level of a moral dilemma regarding disclosing their health stat=
us.  "I feel in a real quandary," one cardiologist from Arizona states. "=
I feel that I owe it to the hospital, my patients, colleagues and partner=
s in my practice to disclose, yet these feelings are  in direct conflict =
with the realistic need for me to be self-protective."
The members of the group were predominantly gay men who had been infected=
 through sexual activity.  The few nongay physicians who attended claimed=
 to have no idea of how they became infected with HIV, and they emphasize=
d that they had no history of homosexual contact, sharing intravenous dru=
g using paraphernalia, or needle sticks from HIV- infected patients.  In =
general, the nongay members were at first uncomfortable attending the gro=
up and had some difficulty feeling like members of the group.  Though all=
 of the members had their infection with HIV in common, the nongay physic=
ians felt that they had less in common with other group  members. They ge=
nerally terminated with the group after attending a maximum of four to fi=
ve group sessions, having gathered professional support as well as some t=
echnical advice on management of the illness and/or their careers. The no=
ngay doctors felt they had fewer resources to fall back upon than the gay=
 physicians living with HIV.  They anticipated and/or experienced more di=
sapproval from their professional and social communities in relation to h=
aving HIV than did their gay colleagues.  =

In the early days of this group, the doctors who came expressed panic as =
to how they were going to continue practicing medicine as HIV positive do=
ctors.  Literally each member felt that the most essential thing in his l=
ife was to continue practicing medicine.  Their concerns included: fears =
about their own life and health; how to handle the crisis of diagnosis as=
 HIV positive, since especially in the early days of the epidemic the maj=
ority of physicians felt that they couldn't share this information with a=
nyone other than a therapist; not being out as gay to families or colleag=
ues, and now being HIV positive on top of this, made them feel extraordin=
arily isolated;  how to avoid exposure of the fact that they were sero-po=
sitive for HIV; how to keep patients in their practices; what to do if th=
eir HIV status was exposed; and when to go on disability.
Schaffner said that, "Often discussed was the best timing regarding selli=
ng one's practice, and how and when to explain it to patients without aro=
using their fears."  Most felt that if the clinician's health deteriorate=
d to such an extent that he or she could no longer do a good job, that wa=
s the time to retire and sell or close a practice. There was nearly unive=
rsal agreement that when an individual no longer had the strength or stam=
ina to conduct a medical practice,  it was then time to retire."  Several=
 of the physicians agonized over whether or not to stop practicing during=
 the period of recovering from initial opportunistic infections. There wa=
s universal fear about the onset of neuro-psychiatric symptoms, and all a=
greed that as soon as there was any indication of incipient dementia, a d=
octor had to cease practicing.
One New York surgeon retired from practice immediately after discovering =
that he was HIV positive.  After stopping work, he became seriously depre=
ssed, and then came to the group as a place to discuss how to remake his =
life.  Several years later, he remains asymptomatic and regrets his decis=
ion to retire from practice.  "In hindsight, I clearly feel that I left m=
y surgical practice prematurely, specifically since I have never had any =
AIDS defining condition." Another surgeon attending the group continues t=
o work a full schedule while remaining completely healthy except for a dr=
op in his CD4 cells.  Several anaesthesiologists who have attended the gr=
oup spoke of their concerns regarding patient safety,  and their own expo=
sure to disease- causing pathogens since they work almost exclusively in =
operating rooms where their exposure to blood was heightened.
 An ophthalmologist was inadvertently exposed as being HIV positive to th=
e partners in his practice.  Even though he was well liked and extremely =
well respected by the partners, they initially wanted him to leave the pr=
actice.  However, the members of the HIV doctors support group urged him =
to hire an attorney and not give in to the pressure that was being exerte=
d on him to give up the practice of medicine.  Ultimately a compromise wa=
s reached where he was allowed to stay on at full salary, but with the co=
ndition that he not perform surgery or do any invasive procedures on pati=
ents.  =

 Schaffner says, "So many doctors' chief feelings of worth, value and ide=
ntity resides in their being an MD. The status which accompanies this is =
such a crucial aspect of self- definition for large numbers of doctors, t=
hat the sense of loss of identity which  accompanies retiring from a care=
er in medicine young or old,  due to illness is a major psychological ass=
ault on the physician with AIDS that can not be ignored. This has to be r=
ecognized and addressed when working with doctors who have HIV/AIDS."  Sc=
haffner explained that the lengthy process of acculturalization to becomi=
ng a physician, and the many sacrifices incurred in order to complete tra=
ining, help account for why being a doctor is such a core component of ph=
ysicians' personal identity.  To have this identity abruptly and prematur=
ely taken away is a very real trauma. Most physicians living with AIDS ne=
ed specialized psychosocial support in order to create a new sense of who=
 they are following the dual crises of an AIDS diagnosis and having to ce=
ase practicing medicine.  =

 Schaffner noted that several of the doctors in his group described at ti=
mes feeling as if  they had betrayed their profession by contracting HIV.=
  "As irrational as it sounds, I just feel like I should have known bette=
r, though I was infected before we knew how HIV was transmitted," lamente=
d one individual. Schaffner also said that many of the men in his group d=
iscussed feeling as if their core identity had been bruised by becoming s=
ick, especially with a sexually transmitted disease. He commented on how =
this seemed to clearly be a vestigial American Puritanism still impacting=
 even contemporary men of science.
For the first several years of the group there were many more people who =
were at the end stages of the illness than in recent years. As a  result =
of this, in the earlier years of the group there was more discussion of d=
ying, combined with guilt about being infected with HIV and guilt about b=
eing gay.  Schaffner explained: "Today there is less guilt expressed in t=
he group, and the focus has shifted from dying of AIDS to living with the=
 chronic illness of HIV, and how to have an active social, sexual and pro=
fessional life as a person with HIV. Thus there has been an increase in t=
he shift of members of the group from being an MD with AIDS to a person w=
ith a profession as well as other aspects of his life who also has HIV.  =
With all of the current advances in treatment of opportunistic infections=
 and with combination anti-retroviral therapy, most of the men who attend=
 the group are in relatively good health.  Two men who met in the group h=
ave fallen in love, begun a relationship and have recently purchased a ho=
me together."   =

One dynamic contributed both to a sense of shame at having HIV/AIDS, as w=
ell as isolation regarding the illness. This was the universally held opi=
nion that if they had any other medical condition, they would certainly s=
eek out colleagues in their institution for consultation and treatment.  =
No physician with HIV/AIDS contacted for this article sought out treatmen=
t at an institution where they were on faculty or staff.  There were time=
s that this presented a serious conflict -- the best person to treat an A=
IDS-related ailment was indeed a colleague at their own institution, they=
 were in the closet about having HIV, and could not trust the medical off=
ice to protect the confidentiality of their condition. =

Many of the men had been open about being gay men since medical school an=
d throughout their post-graduate training.  Feeling the need to be in the=
 closet as an HIV-positive health care professional created a sense of sh=
ame that was a new experience for them. While the physicians who were not=
 openly gay in their professional lives felt additional shame from the bu=
rden of feeling the need to keep both their sexual orientation and health=
 status secret.
Physicians with HIV/AIDS who were also gay and on active duty in one of t=
he branches of the United States armed forces complained of feeling parti=
cularly vulnerable, and isolated by both their sexual orientation and the=
ir medical condition.  The four doctors in this situation all described g=
oing to extraordinary lengths to avoid having their health condition disc=
overed.  This included drawing blood from a trusted friend who was uninfe=
cted and submitting this blood sample at the time of the mandatory blood =
testing of all US military personnel.  In addition, none of these individ=
uals felt safe or comfortable seeking out medical care for their conditio=
n within the government facilities available to them at no cost.  Thus th=
ey sought out a private physician to treat them on an anonymous basis, so=
metimes using a false name, and incurred not inconsiderable expenses of l=
aboratory tests, office visits and medications.
A diagnosis of HIV/AIDS usually precipitates some form of an intrapsychic=
 as well as inter-personal crisis.  When the person who has HIV/AIDS is a=
 doctor, the intrapsychic distress is compounded.  Many physicians with H=
IV/AIDS told of seeking and currently being in psychotherapy and taking p=
rescribed anti-anxiety and anti-depressant medication to help alleviate t=
heir mental and emotional distress. =

Adding to the psychosocial distress of physicians with HIV is their inabi=
lity to utilize the existing supports of community based organizations.  =
Doctors who had not publicly disclosed their health status, avoided commu=
nity organizations out of fear of running into a patient or someone else =
who knew them as a physician while attending a support group.  "For this =
reason," explained Schaffner, "we held the group meetings only in my apar=
tment to eliminate recognition that could occur in an institutional setti=
ng."Thus doctors are unable to avail themselves of one of the most effect=
ive supports available to all other people living with HIV/AIDS. Naphtali=
 Offen states that he has known about the existence of ten support groups=
 specifically created for physicians with HIV or AIDS.  "Many groups didn=
't last that long," explained Offen, "because of differences in interest =
level and/or declining health of its members."It is only large cities lik=
e New York, Los Angeles and San Francisco that are able to have long term=
 groups like the one run by Drs. Schaffner and Nichols."
All the doctors interviewed for this article said that having HIV/AIDS  h=
as significantly influenced the direction of their careers.  They describ=
ed some involvement in AIDS work either professionally or as a volunteer =
at clinics that serve people with HIV/AIDS.  The administrator referred t=
o earlier decided to move away from clinical practice, fearing that he wo=
uld find himself becoming overwhelmed, flooded and too vulnerable as a re=
sult of working with large numbers of patients who had the same condition=
 as he, but who were more progressed.  "My professional goals for the nex=
t ten years focus around becoming increasingly involved in setting HIV- r=
elated health policy on a state-wide basis."  One of the primary care phy=
sicians administers a large prevention and treatment program for people w=
ith HIV/AIDS.  When asked about his professional goals he stated, "I want=
 to expand the scope of the work I'm currently doing so it will impact up=
on increasing numbers of people both at risk for HIV and those already in=
fected or symptomatic."
One  pediatrician with a large and successful urban practice told me, "I'=
m trying to reduce my work load and possibly ultimately change careers to=
 something less demanding and stressful. Being HIV infected pushed me to =
try and accomplish a lot earlier in my career than I might have had I not=
 been diagnosed with a life threatening condition.  Immediately after bei=
ng diagnosed with HIV ten years ago, I didn't think I had a long time lef=
t to live, and as a result paid no attention to long range planning since=
 I was trying to cram a lot into a supposedly shortened life span.  Now t=
hat I am in my forties and remain asymptomatic, I am reassessing both my =
professional and personal lives."  Several of the doctors who retired fro=
m practice, but remain asymptomatic, or whose health has greatly improved=
 due to current treatments spoke of wanting to leave retirement to resume=
 careers as physicians specializing in caring for people with AIDS.
In 1990,  Alvin Novick, of Yale University's Department of Biology and a =
board member of the Gay and Lesbian Medical Association, (GLMA), then kno=
wn as American Association of Physicians for Human Rights, feared that as=
 a result of the Acer case there would be a backlash against physicians w=
ith HIV/AIDS. At Dr. Novick's initiative, the Medical Expertise Retention=
 Program of the Gay and Lesbian Medical Association was born in order to =
provide professional support for doctors with HIV/AIDS. By November of th=
at year enough funds had been raised to hire a part time staff person to =
coordinate the program.  Funding for this program comes from contribution=
s from GLMA members and from pharmaceutical companies such as Glaxo-Wellc=
ome, Genentech, Pfizer and Sandoz. The program offers telephone crisis co=
unseling for any health care professional who has HIV/AIDS and needs to s=
peak about their situation safely with a guarantee of confidentiality.  T=
hough the service is available to any health care professional, over 90% =
of the calls have been from doctors. =

Offen, director of  the program, said that by the end of August the progr=
am had fielded over 1,400 calls from more than 1,000 different individual=
s. He states that the vast majority of the callers have just tested HIV p=
ositive and are in shock.  They call inquiring about their legal obligati=
on to inform patients, colleagues and employers.  Offen advises them that=
 these obligations  differ from state to state. "In the climate created b=
y Kimberly Bergalis,  physicians disclosing that they are HIV positive ru=
n terrible risks in terms of potential legal and public relations issues.=
 As long as they practice universal infection control every time they are=
 with a patient, they pose no threat to the health of their patients," co=
unsels Offen.  Thus, in this present climate, and with the draconian CDC =
guideline still in place, he advises anxious callers  to seriously consid=
er the consequences of divulging their HIV status to others in their prof=
essional circles.
Offen describes most of the callers as experiencing a terrible sense of i=
solation and as being in need of  telephone crisis counseling. Many are s=
eeking assistance, advice and sometimes just a sympathetic and understand=
ing colleague. Thus, the program often puts HIV positive health- care pro=
fessionals in touch with other positive providers who live nearby, or who=
 share the same specialty so they can develop an understanding support sy=
stem. When necessary, referrals are made to ongoing counseling with a sym=
pathetic and knowledgeable professional near to where the caller lives.  =
The program offers advice on how the physician can best advocate for him =
or her self, like referring him or her to appropriate legal experts who c=
an help when the physician feels that he or she has been the victim of di=
scrimination due to either sexual orientation or HIV health status.  =

Doctors revealed a spectrum of supports and services that they would like=
 to see available for physicians who have HIV/AIDS.  They were unanimous =
in voicing a desire for peer support groups where they could meet and tal=
k with other MDs who have similar personal and professional concerns rega=
rding having HIV. "Before learning about the group run by Stu (Nichols) a=
nd Bert (Schaffner), I had only heard that there were other docs who had =
HIV in Manhattan, but I had never met any. I think that I would have gone=
 crazy trying to manage this alone if I hadn't begun going to their group=
," one psychiatric resident explained. Several felt that a particularly u=
seful support group would be one composed of other asymptomatic individua=
ls that was specifically focused on issues relevant to living with HIV an=
d continuing to practice medicine,  rather than winding down a practice a=
nd preparing to retire.  Many of the physicians discussed wishing they co=
uld be open professionally about having HIV, and not feel ashamed about t=
heir condition nor fearful of discrimination and limitations being impose=
d upon them professionally.
 A number spoke of the need for additional lobbying of professional medic=
al societies and organizations regarding advocating for not limiting the =
scope of practice of physicians who are infected.  These same individuals=
 felt that the American Medical Association was being its traditional con=
servative self in regard to taking  moral and leadership roles in advocat=
ing for physicians who have HIV, and offering support to infected and sym=
ptomatic doctors.  "I often feel that the AMA is not interested in those =
of us who are infected with HIV.  It is as if officially the AMA is embar=
rassed simply by our existence, and as a result has not taken a leadershi=
p or advocacy position for its members with HIV or AIDS.  I guess we are =
viewed as expendable, and not part of their good old boy network," lament=
ed one radiologist from Georgia. =

GLMA's Offen sounds a sobering note regarding forced retirement of HIV- p=
ositive physicians. He described how most hospitals and institutions are =
completely unsupportive of HIV positive physicians continuing to practice=
 medicine.  "A disproportionate number of doctors treating people living =
with HIV and AIDS are themselves gay, lesbian or HIV positive. Even thoug=
h there are absolutely no documented cases of transmission of HIV from a =
physician to a patient, society is willing to capitulate to panic and ram=
pant homophobia sacrificing some of the most experienced providers of med=
ical care to people with HIV/AIDS. This can only contribute to the alread=
y significant crisis of  lack of access to quality medical care during th=
is epidemic, especially for inner city and gay patients," Offen sadly sta=
tes. He recalled one example of a brilliant heterosexual emergency room d=
octor who due to his skill and the speed with which he was able to functi=
on, had literally saved the lives of  hundreds of patients. This man had =
a reputation as one of the finest emergency room physicians on the entire=
 West Coast and had become infected from a needle stick. But when his emp=
loyers learned that he was infected with HIV,  he was forced to retire.  =
"This man had been a medical hero countless times, but he died enraged at=
 and feeling betrayed by the complete absence of support offered to him b=
y his hospital," laments Offen. "The cost to society of junking these exq=
uisitely trained professionals, with their incredible expertise is stagge=
ring."
=0D
For information about the Medical Expertise Retention Program call 415-25=
5-4547.
Michael Shernoff, MSW is a psychotherapist in private practice in Manhatt=
an and teaches at Hunter College Graduate School of Social Work. He is a =
board member of The National Social Work AIDS Network, and has treated se=
veral physicians with HIV and AIDS in his practice. He can be reached via=
 e-mail at mshernoff@AOL.com, or at his web site http://members.aol.com/t=
herapysvc.  =