Clinics Guide to Law and HIV

posted: 23/04/2010

Have your say about the draft guidance for HIV clinics from BHIVA / BASHH about HIV transmission, the law and the work of the clinical team, 2010. The deadline for your comments is Friday 21 May 2010.

There have been prosecutions for reckless transmission of HIV in the UK since 2001 (Scotland) and 2003 (England & Wales). The prospect of prosecutions raises complex questions among medical practitioners about their ethical and legal responsibilities related to HIV transmission, particularly around disclosure of information on HIV status.
 

Although established generic ethical and professional principles continue to apply, certain features of the HIV epidemic have required special consideration.
 

An underlying principle in the provision of clinical care for people with HIV is the need for a secure and confidential environment in which extremely sensitive matters can be frankly and fully discussed. The importance of ensuring that full trust is maintained by people with HIV in their clinical services is fundamental, not only for the health of people living with HIV but also for people who may wish to seek information or testing and thus for the wider public health.
 

This guidance document sets out these responsibilities, and how these relate to the roles and responsibilities of health care professionals when caring for individuals infected with HIV.
 

Roles and responsibilities of Health Care Professionals

• Health care professionals have a central role to advise and support patients and to maintain confidentiality according to professional guidance and the law.
• For HIV positive individuals, advice must include the routes of HIV transmission, how to prevent transmission, with information about safer sexual practices and the use of condoms.
• Discussion of sexual health needs must take place regularly according to relevant BASHH guidelines to enable the giving of appropriate advice.
• There is individual and public interest in maintaining confidentiality; this may be outweighed in order to prevent serious harm to others.
• It is important when considering breaching confidentiality to weigh up all potential harms as there may be situations where disclosure of HIV status to protect a sexual partner results in considerable harm to an individual e.g. domestic violence.
• In situations where a health care professional believes that an HIV positive individual continues to put close contacts at risk their duties and subsequent action depend upon the type of contact (see figure one).
• No information should be released to the police unless there is verified consent from the patient or there is a court order in place.
• It is up to an individual patient to make a decision about complaining to the police and health care workers should remain impartial during discussions with patients.
• Those involved (complainant and defendant) in cases of reckless transmission are likely to need specialist legal advice and support and referral to THT direct would be appropriate.
• Sources of further information are listed in appendix two.

Vulnerable Groups

There are special considerations with regards cases of alleged reckless transmission in those under 18, or anyone with learning difficulties, discussed in section 5.
 

You can download the document and then submit any comments using this online form. 
 

Please make your comments here by Friday 21 May

Sustaining African Community Leadership

posted: 14/01/2010

Sustaining Community Leadership is the theme of the latest issue of the African HIV Policy Network’s Newsletter. It has pieces on

• surviving the economic downturn
• the importance of Africans and others making their voice heard by voting in the general and local elections (which will almost certainly be on May 6th)
• HIV positive people being leaders and making a community impact
• Africans disappearing from HIV clinics (by Chris Morley, George House Trust’s policy expert)
• Resources and working to improve Faith responses to HIV, (they have more information on their website)
• HIV and the workplace – meeting the needs of staff with HIV
• Their media toolkit for working with journalists – details and download it from their website
• Young people using the web and mobile phones for HIV messages
• Fighting HIV stigma
• Using SHoutloud to have your say about your local HIV and sexual health services.

This Sustaining Community Leadership issue

 Past issues of AHPN's newsletters

Lost to Care

posted: 25/11/2009

People diagnosed with HIV who drop out of HIV clinics was first highlighted as national issue by George House Trust in Insight this year. Now people lost to clinics and care is covered in more detail in an excellent leading article in the latest issue of NAM's HIV Treatment Update.

'Lost to Care - the mystery of the disappearing patients' by George House Trust policy expert Chris Morley and editor of HIV Treatment Update Gus Cairns, tells why up to 1 in 3 people disappear from HIV care at some stage after diagnosis, whether this puts people’s lives in danger, and it offers some suggestions for how to deal with clinic drop out.

Stigma too
The same issue has an article on HIV stigma – Punching Fog. It tells how people with HIV telling their own stigma experiences through the UK section of the global website HIV Stigma Index is helping the stigma fight-back.

HIV Treatment Update

People living with HIV can get HIV Treatment Update free, others have to subscribe and pay; this issue (November 2009) will be published in a few months in the online archive, also on that webpage.

HIV Clinics Use At Highest

posted: 27/11/2008

The number of people using HIV clinics has trebled in ten years, reflecting the record number of people living with HIV in the UK, according to figures released today by the Health Protection Agency. Their report also highlights continuing problems with late diagnosis and treatment of HIV, as well a rise in cases of HIV acquired through heterosexual contact in the UK.

new diagnoses stay steady

The number of new HIV diagnoses continues to be high, but has remained steady over the past four years. In 2007, a total of 7734 people newly tested positive for HIV.

Trebled in 10 years

However, much larger increases have been seen in the number of people accessing treatment and care services. In 2007, a total of 56,556 used HIV clinics, which represents a 9% increase in a single year. Moreover this is a threefold increase from the 17,911 people accessing care in 1998.

North West 4.5 times up on 10 years ago

Some regions have seen particularly marked increases in the number of people accessing care over the past decade. The East of England strategic health authority has seen its patient numbers increase seven fold, while East Midlands has had a sixfold increase. The total proportion treated in London has decreased from 63% to 48%. However in the North West of England the total number accessing hospital care has grown by 4.5 times in the last ten years (1998, excluding Cumbria 1165; 2007, including Cumbria 5212).

Striking: More Over 50s

The report also demonstrates how the HIV-positive population has aged over the last decade. Five times as many people aged 50 and over were accessing care in 2007, compared to 1998, and they now make up 15% of those using HIV clinics.

1 in 5 needing treatment have not yet started it

Whilst 70% of those attending HIV clinics were prescribed antiretroviral treatment, almost one in five of those with a CD4 cell count below 200 cells/mm3 were not. The signpost for starting treatment is now normally when the CD4 count has fallen to 350. A CD4 count of 200 or less is the level at which symptomatic HIV infections become probable. The Health Protection Agency therefore recommends that “work should be undertaken to develop new care pathways that encourage earlier commencement of anti-retroviral therapy”.

Late testing

Moreover, 31% of people are diagnosed late (they have a CD4 cell count below 200 cells/mm3 within three months of their diagnosis). The proportion varies widely by prevention group - 42% of heterosexual men and 36% of heterosexual women are diagnosed late, compared to 19% of gay and bisexual men.

Testing recommendations for Manchester and Blackpool

The report therefore highlights the recommendation from new UK HIV testing guidelines that in parts of the country where HIV prevalence is high, health professionals should offer HIV tests to all adults registering in general practice or being admitted for any medical care. These areas include Manchester and Blackpool in the NW of England.

In terms of the proportions of new diagnoses by prevention group, 55% were in people who acquired their infection through heterosexual contact (1690 men and 2570 women). However the majority of these heterosexual infections occured abroad, largely in sub-Saharan Africa. Men who have sex with men made up 41% of new diagnoses, with over 3000 men diagnosed during 2007 (compared to around 2000 men in 2002). New infections caused by injecting drug use (180 people) and mother-to-child transmission (110 babies) continue to remain low.

Gay numbers up, Heterosexual numbers down

Whereas the number of new diagnoses among men who have sex with men has once again increased, the overall number of people acquiring HIV heterosexually has decreased by almost 15% from a peak in 2004. Nonetheless, this may be due to changes in migration patterns, as the decrease is largely in heterosexual infections acquired abroad.

UK Heterosexual trends

In fact, there are clear signs of a steady increase in heterosexual transmission of HIV within the UK:

* The numbers of new diagnoses acquired from UK heterosexual transmission has increased from 540 to 960 cases over the past five years. Almost a quarter of heterosexual infections are now thought to have occurred in the UK.

* The prevalence of HIV among UK born women giving birth in London has increased from 0.03% in 2000 to 0.07% in 2007.

* The prevalence of undiagnosed HIV among UK born heterosexuals attending London sexual health clinics has increased from 0.25% in 2000 to 0.41% in 2007.

The HPA therefore recommends that sexual health interventions “should be strengthened and expanded to meet better the needs of those with high risk of HIV acquisition within the UK, especially black African heterosexuals and men who have sex with men”.

Reference
Health Protection Agency. HIV in the United Kingdom: 2008 Report. .pdf file