标题: Removing the stigma from HIV and Aids [打印本页] 作者: StephenW 时间: 2011-11-28 16:29 标题: Removing the stigma from HIV and Aids
Removing the stigma from HIV and Aids Doctors and dentists who are HIV-positive should be allowed to work with patients. Diana, Princess of Wales with her friend and HIV sufferer Aileen Getty in 1996 Photo: REUTERS
The Department of Health is launching a consultation on lifting the current ban that prevents HIV-positive doctors and dentists from practising. It is long overdue.
Whenever I talk to patients with HIV, their overriding concern is not the infection itself but the way that other people will treat them should they find out about their condition. Even now, 30 years after the virus was first identified and despite the availability of potent drugs that mean a positive diagnosis is no longer an automatic death sentence, HIV/Aids remains a disease shrouded in secrecy because of the persistent stigma attached to it.
There are around 100,000 people living with HIV in Britain. Around half of them are heterosexual, while 40 per cent are gay men and the remainder have contracted the virus through intravenous drug use or via mother-to-child transmission. They include lawyers, teachers, IT professionals, bankers, street sweepers, shop assistants, as well as doctors and dentists. People who are HIV positive are everywhere in our community and still at risk of discrimination, based on misunderstanding and half-truths. HIV attracts ignorant opprobrium, hostility and vitriol like few other diseases.
When, in 1987, at the height of the Aids crisis, Diana, Princess of Wales, was photographed shaking hands with an HIV-positive man, she showed in a single gesture that this was a condition needing our compassion and understanding, not our fear and ignorance.
Back in the Eighties, there was rampant speculation about the infection, because scientists were baffled by it. The legislation and guidance originating from that era reflects this huge uncertainty. But HIV is now one of the most scrutinised of all viruses, its transmission, spread, management, treatment and prevention understood like no other. This knowledge has rendered many of the restrictions put in place 20 or more years ago based on what was known then, massively out of date.
So, in the light of this, is it right to allow HIV-positive health-care professionals to work with patients? Is the current legislation discriminatory or sensible?
The issue of discrimination comes second, I think, to patient welfare. This must be paramount. While an HIV-positive doctor or dentist might have a right to practise, conversely a patient has the right not to be infected with a disease. To reach a decision on that, we must look at the evidence, rather than relying on prejudice or conjecture. And there is, in fact, a wealth of evidence to support a lifting of the ban.
There have been more than 25 cases in the past 12 years in which patients have been exposed to an HIV-positive doctor, dentist or other health-care professional, but not a single transmission has occurred.
Ironically, research shows the general public are far more concerned about contracting HIV than other, more common blood-borne infections, such as hepatitis. That is despite hepatitis having a higher rate of mortality than HIV and being easier to contract.
In fact, the risk of contracting hepatitis B from a needle-stick injury (accidentally piercing the skin with a needle that has been used on someone else) is estimated at 30 per cent; for hepatitis C, the figure is 3 per cent. For HIV, it is 0.3 per cent.
And what is even more important is that since the advent of antiretroviral therapy to manage HIV infection, even this risk has been reduced. When a person is taking antiretroviral medication, their viral load – the number of viral particles in their blood – becomes undetectable and therefore the risk of transmission is so small as to be statistically unquantifiable. For this reason, other countries, such as the US and France, impose no such ban on health-care professionals working with patients.
I cannot see why doctors and dentists with HIV shouldn’t be allowed to practise, especially if conditions are in place to ensure they are on antiretroviral medication and to monitor their viral load to ensure it remains undetectable. Certainly, there are procedures that I don’t think appropriate for an HIV-positive surgeon to conduct: open bowel surgery, for example, where bleeding directly into an open wound could occur. But for teeth extractions or taking blood or doing a lumbar puncture – all of which must be done with gloves anyway – there is simply no evidence to support a ban.
Of course patients should never be put at undue risk by a health-care professional. But the latest evidence shows that a ban on HIV-positive doctors and dentists is unnecessary. Lifting the ban is about redressing this balance, about allowing dedicated professionals to continue with their work and, above all, about listening to facts, not prejudice. 作者: StephenW 时间: 2011-11-28 16:33
The ban should also be lifted for HBV. The statistics that indicated HBV is more infectious than HCV and AIDS should be challenged.
Diana, Princess of Wales with her friend and HIV sufferer Aileen Getty in 1996 Photo: REUTERS