End to HIV Health Staff Ban?

posted: 10/02/2011

The much criticised ban on surgeons and dentists with HIV from working could be lifted this year. At long last, the government is acting on HIV campaigners’ calls to end the employment ban.

Department of Health rules stop HIV-positive health workers from carrying out what are called ‘exposure prone procedures’ which are thought to risk HIV and hepatitis transmission. Basically 'exposure-prone procedures' are treatments where the healthcare hand goes inside the patient body, especially when there are sharp things like bones and surgical tools around - like when a dentist is extracting teeth.

But the rules are old and there is very little solid evidence of actual HIV transmissions from health care workers to patients. Despite this, the UK rules mean no dentist with HIV can carry on working as a dentist, and many midwives, surgeons, some nurses and ambulance workers have also had to end or change their careers.

Rules review

The Department of Health has now said there will be a review of the rules. HIV charities have been invited to join the working group that will draw up new guidelines.
 

The British bans on healthcare workers with HIV and hepatitis are stricter than in many European countries and the USA and Australia, where dentists with HIV can work, so there are alternative rules ready to be adapted for Britain.

Evidence gap

With effective HIV treatments there is usually almost no virus in healthcare workers’ blood, so whatever risk there was, is even smaller now, say campaigners. It is extremely unusual for blood-borne viruses to be passed between doctors and patients. Only four patients worldwide are thought to have contracted HIV from health workers. There have been no transmissions from healthcare workers in the UK. And there are significant doubts about the evidence even for these few transmissions. 

Deborah Jack, chief executive of the National Aids Trust, said ‘advances in testing technologies and treatment’ and ‘high levels of infection control’ supported calls for change.

Catherine Murphy, of the Terrence Higgins Trust, added: ‘We’re not saying entirely lift restrictions but it is time for another look – especially for dentists.’ The British Dental Association has backed calls for change.

UK healthcare workers and exposure prone procedures policy

Source

HIV+ Working Surgeon

posted: 14/01/2009

An HIV-positive surgeon in Israel is being allowed to continue working. He or she is taking HIV treatment and has an undetectable viral load. The Israelis have effectively issued a statement, rather like the Swiss statement we have been reporting on over the last year. Both statements are about how effective HIV treatment can reduce infectivity to close to zero.

simple precautions are enough

The Israeli Ministry of Health has decided that the surgeon with HIV who is receiving antiretroviral treatment may return to carrying out invasive surgical procedures, providing that he or she maintains an undetectable viral load, follows infection control procedures and uses two layers of surgical gloves when operating. 
 

Time for UK HIV+ healthcare workers ban to be reviewed

Healthcare workers with HIV are routinely banned from surgical procedures of any kind, even very minor ones such as stitching wounds. This affects some doctors, midwives, some nurses, dentists, and some ambulance staff, among others. 
 

The Israeli decision is increasing the pressure on bodies regulating UK and other countries' healthcare employment to review their guidance on healthcare workers with HIV engaging in exposure-prone, invasive procedures.

In the United Kingdom, for example, the General Medical Council and the General Dental Council require that HIV-positive healthcare workers desist from carrying out exposure-prone procedures – anything that involves cutting, suturing, use of needles or delivery of babies using forceps or suction, and almost all dental work, – and all healthcare workers recruited to the National Health Service who will be carrying out these types of procedures are tested for HIV. Many healthcare workers have been forced to retire or change careers as a result of the guidance, including several in the NorthWest of England.
 

The Israeli statement is the first official acknowledgement that HIV treatment reduces the risk of bloodborne HIV transmission to such low levels that a doctor, dentist, nurse or midwife can continue working.
It could help reduce stigma for people with HIV, as long as media storms about fears of HIV transmission from healthcare workers can be avoided.
 

NAM's HIV Treatment Update in August/September took a detailed look at whether healthcare workers should be allowed to carry out surgical procedures.
 

HIV is present in potentially infectious quantities in blood, semen, vaginal fluids and breastmilk and, as a result, HIV can be passed on through injecting drug use, unprotected sex, and from a mother to her baby.
 

It’s not inevitable that a person exposed to HIV will become infected with the virus. One of the factors that affects this risk is the viral load of the person with HIV. HIV treatment lowers viral load both in blood and genital fluids.
There’s recently been a lot of debate about the infectiousness of people taking HIV treatment who have an undetectable viral load.
 

Swiss doctors kick-started the debate about a year ago. In a statement, they said that a person taking HIV treatment, who’d had an undetectable viral load for at least six months, who took all their medication and who didn’t have a sexually transmitted infection, was not infectious to their heterosexual partners.
 

The current consensus seems to be that HIV treatment, and all the Swiss conditions, reduces the risk of sexual transmission, but that a small risk may still be present.
 

Full report in the USA's Morbidity and Mortality Weekly Report
Some further details are in the aidsmap report
Source