The HIV-infected health care professional: public policy, discrimination, and patient safety

Article Abstract:

Proposals on how to handle the problem of health care professionals who are infected with HIV, the virus that causes AIDS, range from doing nothing to requiring mandatory AIDS testing of all health workers and dismissing any whose test results are positive. One proposal suggests that testing not be mandatory, but that those who know themselves to be positive for the virus voluntarily refrain from practicing invasive procedures, which carry a reasonably high risk of transmission. This policy raises several questions. Can health care workers be required to tell patients of positive test results? By so doing, a health care professional gives up all right to privacy, for this information would soon become public knowledge. By extension, the professional would almost certainly lose his or her livelihood once this information became known. Should noninvasive procedures be restricted as well? If a procedure does not involve any blood or body fluid contact between the professional and the patient, there is no risk of transmission, as shown by studies of household contacts of AIDS patients, and thus, noninvasive procedures should not be restricted. Should invasive procedures be restricted? While the documented risk of transmission from HIV-infected practitioner to patient in a given procedure is low, the cumulative risk over time that a health care worker might infect a patient is such that seriously invasive procedures should be restricted. However, if HIV-positive practitioners are restricted from performing invasive procedures, must all those who perform invasive procedures be tested for HIV? The enormous cost in both economic and emotional terms of screening all health care professionals for HIV does not justify mandatory screening. Finally, would restricting the right of HIV-infected health care workers to perform invasive procedures violate antidiscrimination statutes? Legal precedents to answer this question are scarce, but the few that exist suggest that proving significant risk of transmission to those exposed to an HIV-infected practitioner in an invasive procedure would probably satisfy the courts that antidiscrimination statutes were not being violated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Civil rights, HIV seropositivity, HIV positive, editorial

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The HIV-positive health professional: policy options for individuals, institutions, and states

Article Abstract:

Much controversy exists over how to deal with health professionals who test positive for HIV, the virus that causes AIDS. No consensus exists regarding whether to test health care workers for AIDS, or whether to prevent them from practicing if they test positive. The activities that generally spread the AIDS virus are sex and drug use, which are private activities not easily regulated by the state. Attempts to control these behaviors are generally regarded as coercive, and seen as a violation of civil liberties by some. Policies on AIDS are still largely created by public health officials, without legislative intervention. Public health efforts have largely calmed public fears of casual transmission of the AIDS virus. No mechanism currently exists for physicians to mandate that their patients be tested for AIDS before they are treated, so universal precautions were adopted. These constitute a policy based on the assumption that any patient could be infected with HIV, and that stringent precautions be employed when dealing with high risk treatments and procedures. The lack of consensus among public health officials about whether to test or regulate the practice of HIV-positive health care workers cannot moderate the fears of the public. Honesty must be the cornerstone of public health policy on this issue. The risk of transmission from a surgeon to a patient is estimated at somewhere between 1 in 40,000 and 1 in 400,000. Whatever policy is adopted should be the least restrictive, while protecting both the public and practitioners. The fears that AIDS seems to incite are of tremendous magnitude, and this must be remembered by public health officials in making policies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Public opinion

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Incidence and risk factor for heterosexually acquired HIV in an inner-city cohort of women: temporal association with pregnancy

Article Abstract:

The rate at which heterosexual women in the United States are acquiring HIV infection is becoming equal to that of other countries where heterosexual, rather than homosexual, transmission is endemic. The women studied, some 449 who were initially HIV-negative, were evaluated each six months. These women were not injectible drug users. At the end of 30 months, four of the women had become HIV-positive, a cumulative rate of 2.4% in that period of time. Three of the four who became HIV-positive also became pregnant, and association which had been previously unreported, and which may or may not be an anomaly of this study.

Women, Statistics, HIV infections, Diseases, HIV infection in women, Heterosexuals

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