Risky Business: Setting Public Health Policy for HIV-Infected Health Care Professionals

Abstract

An analysis of the restrictive proposals provoked by the case of Kimberly Bergalis and four other patients apparently infected with HIV during the course of dental treatment reveals that they resulted from an inability to evaluate appropriately the infinitesimal risk of HIV transmission from practitioner to patient. The proposals also resulted from an effort to create risk prevention policy without appreciating the distinction between regulating things or procedures, which have no human rights, and regulating people, who have rights that should not be infringed without serious justification. This analysis demonstrates that the proposed restrictive policies are not justified because they do nothing to prevent the spread of HIV, and they cause unnecessary and substantial harm to health care practitioners.

Turning Fantasies About Positive and Negative Futures into Self-Improvement Goals

“…Such intervention studies might also be beneficial in the health domain. As previously discussed, Glantz et al (1992) showed that fear leads to unjustified discrimination against those with HIV infection. Teaching mental contrasting as a meta-cognitive strategy might thus help health care providers, relatives, and friends of HIV patients to overcome their unjustified fears about HIV infection.…”

“…Gaines and Reed (1995), as well as Corenblum and Stephan (2001), showed that prejudicial hostility led to unfounded fears of negative future interactions between members of different races, religions, and ethnicities. Another domain of previously studied unjustified fear is in the realm of HIV infection (Glantz, Mariner, & Annas, 1992), wherein it was shown that HIV-infected medical praciitioners may be barred from practicing due to policy decisions based on fear rather than actual risk.…”

Carrots, sticks and tuberculosis

“…What is clear is that the burden of proof that individuals pose a threat to the public should be more demanding when the consequences of regulation include detention than when economic encumbrances are created 14. Furthermore, we need to recognise that, when people feel threatened, they focus inappropriately on external sources such as stereotyped minorities and blame them, rather than assessing other threats which are perhaps closer to home 15…”

Infectious health care workers: should patients be told?

“…The American Medical Association has issued guidance that HIV-infected practitioners undertaking exposure-prone procedures must either disclose this to their patients, obtaining their informed consent prior to treatment or must withdraw from treatment. 15 16 The New York State Department of Health issued contradictory guidance which did not require disclosure because of the very low risk of transmission of HIV. Similar statements have been made by other American medical authorities.…”