A 37-year-old HIV-positive patient in Mumbai was referred between three civic hospitals before receiving surgery for appendicitis, prompting the Mumbai District AIDS Control Society (MDACS) to order an inquiry. The case raises questions about referral practices, timely emergency care, and the need to prevent discrimination in healthcare settings.
A 37-year-old man living with HIV arrived at Shatabdi Hospital in Kandivali, Mumbai, on October 31 with abdominal pain. Clinical assessment and ultrasound findings suggested sub-acute appendicitis, a condition that generally requires prompt surgical intervention to prevent complications such as perforation. Rather than proceeding with surgery, the patient was referred to Cooper Hospital. At Cooper, the referral decision was questioned, and the patient was asked to return to Shatabdi. He was later directed to Nair Hospital, where an appendectomy was eventually carried out.[1]
Given that the patient was already living with a chronic illness that carries social stigma, the situation added significant emotional strain. "I was in pain and needed help. But instead of surgery, I was told to go from one hospital to another. Shatabdi is the only civic hospital near my home. Travelling long distances while in pain and scared made everything worse. I kept wondering if it was happening because of my HIV status.", said the patient to Hindustan Times.
The patient is in a stable condition and is now recovering at home.
The Mumbai District AIDS Control Society (MDACS) has ordered an inquiry to determine why the patient was shifted between multiple hospitals before treatment. The review aims to establish whether the referrals were based on logistical constraints, such as operating theatre availability, or whether the patient’s HIV status played a role in delaying surgery.
We are examining whether the referral was guided by clinical considerations or if there was any form of discrimination. We will issue findings once the inquiry is complete. No patient should face delays in life-saving care due to their health status.
Senior MDACS official
The situation has also highlighted internal concerns at Shatabdi Hospital regarding workforce management and supervision. According to several employees, senior doctors are said to sign attendance, step out for long periods, and come back mainly to log their departure.
Basic emergency surgeries get delayed because senior surgeons are not consistently available, said a working Staff at Shatabdi Hospital.
Shatabdi Hospital’s medical superintendent, Dr. Ajay Gupta, rejected allegations of improper handling, according to Hindustan Times. According to him, the referral decision was guided only by the patient’s clinical condition.
The patient required an emergency appendectomy. However, due to his concurrent medical condition and because our operation theatre was undergoing scheduled sterilisation that day, we referred him to a higher centre. There was no intent to deny treatment.
Dr. Ajay Gupta, Medical Superintendent, Shatabdi Hospital
HIV affects the immune system by reducing CD4+ T-lymphocyte counts. With consistent antiretroviral therapy (ART), individuals can maintain stable immune function and safely undergo both routine and emergency surgeries. Clinical guidelines indicate that an HIV-positive status alone should not delay essential surgical procedures, including appendectomy, when the patient is medically stable.[1]
Sub-acute appendicitis is time-sensitive. Delayed intervention increases the risk of appendiceal rupture, infection, and prolonged hospitalization. Therefore, timely surgical decision-making is considered standard practice.
The HIV and AIDS (Prevention and Control) Act, 2017 prohibits discrimination in healthcare based on HIV status and mandates equal access to medical services.[3] Healthcare providers are required to ensure confidentiality and non-discriminatory clinical decision-making.
Discrimination against persons living with HIV remains documented in healthcare settings, and when it results in hesitation or delay in providing necessary care, it may lead to serious medical consequences. This case highlights the importance of ongoing professional training and stigma reduction strategies.
Public hospitals sometimes refer patients due to emergency caseload, surgeon availability, or operating theatre scheduling. However, coordinated communication is essential in urgent conditions to avoid preventable delays. This case underlines the need for:
Clearly defined referral protocols
Proper documentation of referral rationale
Training on HIV care to prevent bias
Strengthened coordination between civic medical institutions
The MDACS inquiry will determine whether the patient’s transfers were clinically justified or avoidable. The outcome may help improve referral frameworks and reinforce adherence to clinical and ethical standards. Ensuring timely and equitable care, regardless of HIV status, remains central to sustaining trust in public health systems and maintaining patient safety.
World Health Organization. “HIV/AIDS: Key Facts.” WHO, 2023.
National AIDS Control Organization. HIV and AIDS (Prevention and Control) Act, 2017: Operational Guidelines. Ministry of Health and Family Welfare, Government of India, 2018.
(Rh/SS/MSM)
