Removing the stigma from HIV and Aids

StephenW

        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
                                                                                                                       
                                                               
                                                       
                                                               
               
                       
                                                                                                               

                                                        By Max Pemberton

                                                                               
               

7:30AM GMT 28 Nov 2011

                               
                       
               
       
        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.

StephenW

The ban should also be lifted for HBV. The statistics that indicated HBV is more infectious than HCV and AIDS should be challenged.