HIV positive healthcare workers to be involved in more clinical care

Posted: 22/08/2013

The NHS has announced this week that a 20 year ban on HIV-positive healthcare workers performing higher risk procedures is to be lifted next year. Under current rules introduced in 1993, medical professionals, including doctors and nurses, were prevented from working in areas such as surgery, obstetrics and dentistry, which were thought to carry a higher likelihood of patient exposure. Professor Dame Sally Davies, the UK’s Chief Medical Officer, praised the change and described the previous system as 'outdated'.

The new rules come in recognition of advances in medical science and the management and treatment of HIV. Professionals affected will need to be taking combination anti-viral therapies and demonstrate upon testing that these medications have reduced the viral load of HIV found in their blood to undetectable levels – making the risk of transmission in the event of patient exposure negligible. Professor Davies described this likelihood as, 'a risk that is more remote than being struck by lightning. The risk is absolutely negligible; we are talking about people being treated so they are not infectious'. Only four recorded patients worldwide have caught HIV from those treating them, none of which were in the UK, and it is believed that none of these workers were on drug therapies at the time of transmission.

Under the new proposals a confidential database of healthcare workers living with the condition, currently believed to number approximately 110, will be established. Regular monitoring will be mandated for these healthcare workers with testing taking place every three months to ensure that they are compliant with medications and have viral loads at safe levels. It is also thought that in the removal of this barrier, and the destigmatisation of HIV diagnoses for NHS staff, the new system will encourage those in affected specialties to undergo testing more readily – improving patient safety by allowing infections to be controlled at an earlier stage.

These changes move the UK in line with most other countries in the world, with only four others still imposing the outgoing restrictions. The move has been welcomed by HIV charities who echoed Professor Davies’ statement that it will encourage public opinion to move away from viewing HIV as 'positive or negative and thinking about HIV as a death sentence'. Instead it could help lead to a perspective based on greater understanding of infectiousness. Sir Nick Partridge, Chief Executive of the Terrence Higgins Trust, commented: “Legislation plays a vital role in shaping attitudes. We hope these changes continue to improve public understanding of HIV and support for those living with the virus”.

Alison Johnson, senior associate in the clinical negligence team at Penningtons, said: “Whilst understandably patients have concerns about picking up any form of condition whilst in hospital, the reality is that with good systems and risk management of HIV positive staff there is no danger from them practicing and potentially good practitioners have been limited in their scope over the past 20 years. These proposals should have the positive benefit of encouraging those with HIV to be open about it and receive pro active input. The reality is that we see more clinical negligence claims of contracting infection or similar from failures of basic procedures such as sterilisation or disposal and this is what needs careful attention – the safety measures for professional to patient contact are clear and should present very, very low risk.”

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