Ministers review ban on health workers infected with HIV

Published on Saturday 3 May 2008 19:43

A BAN on NHS staff with HIV working with patients could be overturned under a review being carried out by the Government.

Ministers have ordered studies into the tough rules which forbid health workers who are HIV-positive from working in circumstances where the disease might be transmitted.

One leading expert on medical ethics has called for the ban to be lifted for dentists, claiming that the restriction was unfair. But patients' groups have said that they would be worried by any change in the rules.

Last month, a London-based Scottish doctor, Allan Reid, sparked a major health scare after treating thousands of patients without telling them he was HIV-positive.

The worldwide spread of Aids has led to tough rules about the use of medical equipment and personal contact in an effort to stop the virus being transmitted. HIV is spread though contact involving bodily fluids.

About 0.1% of the UK population is HIV-positive. If the 1.4 million employees of the NHS have the virus in the same proportion to the general population, then there may be 1,400 HIV-positive staff in the health service.

Ministers have ordered three teams of experts to review the latest evidence on how the virus is spread and what equipment and practices might stop the disease.

Although there is no cure for Aids, drugs are available which allow the progress of the illness to be slowed dramatically. In addition, new research has shown that in some circumstances the disease might be less contagious.

The UK has had rules restricting health workers with HIV since the early 1990s. Doctors, dentists and nurses who have the virus are forbidden from work where they might come into contact with blood.

The rules mean that dentists with HIV are not allowed to practise and other professionals may only carry out strictly limited duties. Would-be dental students have to be screened before they begin their courses.

A Department of Health spokeswoman said: "Our three advisory committees – the Expert Advisory Group on Aids (EAGA) and the Advisory Group on Hepatitis (AGH) and the UK Advisory Panel for healthcare workers infected with blood-borne viruses (UKAP) – are currently reviewing national policies to ensure that they are effective in protecting patients, supported by the latest evidence. Any recommendations will be made to the department by early 2009."

Although health is a matter devolved to the Scottish Parliament, the committees which review the evidence work on a UK-wide basis and report to the Department of Health in London. The DoH will not be obliged to agree to the committees' findings and the Scottish Government will be able to review the conclusions separately and come to their own decision.

Research suggests that in some circumstances it is much less likely that HIV will be passed between individuals. Certain tests, called viral load tests, can analyse the number of copies of the HIV virus in a millilitre of blood. Viral loads can vary from a couple of dozen to one million or more.

A low viral load is usually between 200 and 500 copies. It is much less likely that the disease can be spread in cases of low viral loads.

Patients groups have been cautious in their response to the review. Dr Jean Turner, the chief executive of the Scotland Patients Association, said: "I think that patients will be very concerned about the risk of catching something like this from the person caring for them and will want very strict rules in place.

"The Government is right to be reviewing the available science and this will need a public debate with the information to be fully revealed. The public are not stupid – give them the information."

A spokeswoman for the Terrence Higgins Trust said: "The important thing is that people with HIV should be treated as being normal.

"If the science justifies it, and the public can be reassured, then the rules should be reviewed."

Dentists are calling for the scrapping of the rule which bans HIV-positive people from practising.

Dr Susie Sanderson, chair of the British Dental Association's Executive Board, said: "The BDA believes that the evidence does not justify the requirement that dentists found to be HIV-positive must cease practising.

"As long as the appropriate infection control procedures are followed and careful monitoring is in place, the risk of transmission to a patient is negligible.

"We have written to the Department of Health in England requesting that the issue be re-examined and await a reaction. Dentists are, of course, ethically obliged to treat patients they suspect or know to be HIV-positive."

Dr David Shaw, an expert in medical ethics at Glasgow University Dental School, wrote in the latest edition of the Journal of Medical Ethics: "The current restriction on HIV-positive dentists is unethical, and unfair. Dentists are more likely to contract HIV from patients than vice versa."