ＨＩＶ感染者 「安らかな最期」に壁 ホスピス半分が入院渋る

半数はＨＩＶ感染者不可　ホスピスの全国調査 (共同 2005/09/08)

　エイズウイルス（ＨＩＶ）に感染した人ががんの末期症状になり、緩和ケア病棟（ホスピス）への入院を希望しても、４８％の施設は感染を理由に「受け入れは困難」と考えていることが８日、国立病院機構東京病院の永井英明緩和ケア病棟医長の調査で分かった。

　国内で報告されたＨＩＶ感染者とエイズ患者の累計は１万人を突破。発症を抑える治療法は進んだが「安らかな最期」を迎えられる体制は整っていない現状が浮かんだ。

　調査は１－２月、全国の１３９施設に実施し、９８施設が回答。７月の日本緩和医療学会で報告された。

　余命半年以内と診断されたがん患者がＨＩＶ感染者だった場合、受け入れ可能としたのは５２％。残りは「受け入れは困難」とし、理由は「経験がない」「体制が整っていない」などだった。

一方、回復の見込みがないエイズ末期の患者から入院の申し込みを受けたことがあるのは全体の17％に当たる17施設で、そのうち受け入れたのは5施設だけだった。ほかは、感染者の受け入れ経験がなく、ケアに不慣れなどの理由で断った。

　エイズは早期治療すれば延命が可能になり、現在ホスピスに入院するのは大半ががん患者。このため、エイズ患者の受け入れ基準を決めている施設は17％と少なく、「今後検討する」は41％。残りは「がん専門だから」などの理由で受け入れに消極的だった。

　永井医長は「ＨＩＶ感染の広がりで入院のニーズは今後増えるだろう。スタッフ研修などでＨＩＶ診療への不安を取り除き、全国で緩和ケアが受けられる体制の整備が必要だ」と話している。

Hospices cool to cancer patients with HIV: poll
The Japan Times: Sept. 9, 2005

Almost half of the nation's hospices are reluctant to accept terminal-stage cancer patients with HIV, due to lack of experience or facilities to treat them, a survey showed Thursday.

The survey was conducted in January and February by Hideaki Nagai, head of the terminal-care department at the National Hospital Organization's Tokyo hospital.

Of the 139 terminal-care facilities across Japan, 98 responded to the survey. The results were presented at a meeting of the Japanese Society for Palliative Medicine in July.

Of the 98 hospices, 47 said they can accept HIV-positive cancer patients who have less than six months to live, while 43 said it was difficult. The remaining eight did not respond.

Seventeen hospices said they had received requests to accept such patients, but only five said they did.

The 12 facilities that rejected the requests cited lack of experience with HIV-positive patients.

The lives of HIV/AIDS patients can be prolonged if they receive treatment at an early stage, but most of those in Japanese hospices also have cancer.

Only 17 of the responding hospices said they had established standards for accepting patients with HIV. Forty said they would consider the matter in the future, and the rest expressed reluctance, citing reasons such as "We specialize in cancer."

"HIV infection is spreading, and thus demand for hospitalization will most likely increase," Nagai said. "It's necessary to eliminate concern over treating people with HIV through such means as training staff, and establish a system for them to receive palliative care anywhere in Japan." Nagai said.

There are more than 10,000 reported cases of people with AIDS or HIV in Japan, according to government statistics. The survey indicates that while there has been progress in medical treatment to prevent or stall the development of full-blown AIDS, Japanese society still lacks a system where such patients can spend their last days peacefully.

Katsumi Ohira, head of a group that supports people who contracted HIV through tainted blood products, said discrimination against HIV/AIDS patients was still rife in the medical community.

"There are not enough hospitals where such patients can receive long-term care, or hospices where they can wait for the end in peace," Ohira said.