Are HIV-positive doctors discriminated against in their professional work?

Justo Aznar
Bioethics News
Universidad Catolica de Balencia
December 7, 2012
Reproduced with Permission

As discussed in the BMJ (344; 41, 2012), the English Department of Health is promoting a campaign to improve the treatment accorded to healthcare workers who are infected with HIV. Guidelines published to that end recommend that more tolerance be shown towards these professionals, since if they are taking antiretroviral therapy, are regularly reviewed to check their circulating virus counts, and these counts are low or undetectable, the chances of infection are minimal.

This recommendation responds to proposals made by the English Health Department's "Expert Advisory Group on AIDS" (EAGA), which in 2007 suggested that existing restrictions for dentists with HIV be reviewed. A working group, which includes the EAGA and a group from the English Department of Health responsible for the prevention of hepatitis, is reviewing national guidance on the restrictions imposed on healthcare workers infected with HIV or hepatitis viruses B and C.

The United Kingdom has one of the strictest regulations in the world in these matters, together with Australia, Ireland, Italy and Malta.

The purpose of this working group is to facilitate the work of these HIV-positive professionals. The new guidance takes fully into account the small number of healthcare workers infected with HIV. There are only nine cases of people infected by four HIV-positive healthcare professionals worldwide.

In the 30 years between 1988 and 2008, during which more than 10,000 patients were evaluated, no cases of HIV transmission from healthcare staff to their patients were detected in Great Britain. This is consistent with the low likelihood of transmission of this virus, which is estimated to vary between 1/1,672,000 and 1/4,680,000; furthermore, this risk can be substantially reduced if all infected healthcare workers are treated with antiretrovirals.

Despite the low likelihood of infection, the perception that the public has of this should not be underestimated. According to the Daily Telegraph and Daily Mail websites, many people do not want to run the risk of possible infection, even though this risk is low. Some even propose more radical measures, such as suggesting that HIV-positive professionals wear identification indicating their condition. However, the health authorities proposing these preventive measures against HIV infection believe that the measures are safe, and they should come into effect from next July. In any event, to the low risk of infection must be added the low number of professionals infected. Although there are no specific data on the prevalence of HIV infection in these individuals, if the prevalence in the general population is extrapolated, it is estimated that the number of professionals infected in Great Britain could be 110, although according to the health authorities, this figure could be higher, as in the United Kingdom, 1 in 4 HIV-positive people have not been diagnosed.