Undetectable viral load continues to transform and modernise the HIV rules of engagement. On August 15th the UK Department of Health announced that healthcare workers living with HIV will from April 2014 be legally sanctioned to perform exposure-prone surgical and dental procedures.
Patient safety will be secured by ensuring healthcare workers with HIV are on effective treatments, have an undetectable viral load and are regularly monitored. U.K. Chief Medical Officer Professor Dame Sally Davies said “Many of the UK’s HIV policies were designed to combat the perceived threat at the height of HIV concerns in the 1980s and have now been left behind by scientific advances and effective treatments. It is time we changed these outdated rules…”
It appears that Australia is very similar to the UK in having outdated rules. The Department of Health and Ageing have published the ‘Australian National Guidelines for the Management of Health Care Workers Known to be infected with Blood-Bourne Viruses (2012)’. It states healthcare workers “must not perform Exposure Prone Procedures if they are HIV antibody positive even if virus levels become undetectable on appropriately monitored anti-retroviral therapy”.
It seems bizarre that given both the UK and Australia have the same evidence based scientific approach to medicine, that the Australian HIV response would be so out of step with the new international norm.
UK Chief Medical Officer Professor Dame Sally Davies is quoted saying that you have more chance of “being struck by lightning” than acquiring HIV through a healthcare worker with HIV on successful treatments, the risk of being struck by lightning is one in 5 million. Even the Australian Department of Health Ageing guidelines quotes the overall risk range from healthcare workers with HIV as being one in 2.5-24million per procedure, an extremely low level indeed. We drive our cars with a risk of death per year of approximately 1 in 10,000. It would be easy to label the Australian HIV response as too paternalistic or based on irrational fear. More probable is an Australian preference to wait and see how it all plays out in other western countries first, before we jump onto the conga line of undetectable viral load reform. Which already includes Sweden, France, Canada, and yes how embarrassing for us, New Zealand (strange it sounds like gay marriage all over again).
To gain some insight into how these changes might impact real people we may know, I interviewed Chris (not his real name) a healthcare worker living with HIV in Perth. Upon graduating as a Registered Nurse Chris aspired to eventually become a Nurse Practitioner. His high level of competence and natural curiosity for theatre had surgeons inviting him to participate in further skill advancement. However Chris was diagnosed with HIV a couple of years after his graduation. His regular local GP was not up-to-date and incorrectly counselled him to change careers’ altogether, that it was no longer appropriate for him to be a nurse.
Fortunately for Chris, although shocked, he thought “that doesn’t sound right” and on that same day sought support from the WA AIDS Council. “Where I was reassured that there was no law that prevented me from working as a nurse”, Chris also conducted his own research “I was so glad I didn’t have to change my job, nursing has always been my passion”. Chris progressed in his career and made conscious choices to completely separate himself “from any legal binding job risk”. This included avoiding positions that might have him engage in any exposure prone procedures. Chris welcomes the changes being made by the UK saying, “it definitely reassures you, unfortunately stigma is a big issue…a lot of people are still not educated on the subject”.
Chris’ resilience to continue his original career aspirations is inspiring, “my path has been slightly altered but I’ve always thought that I’ve been a leader… I’m still on the path of growth”, Chris believes that sexual health and occupational health go hand in hand, “people need to earn a living and not only require sex but require an income… it’s important to raise awareness not only of safe sex but that it’s ok to have HIV in your workplace… You shouldn’t have to lose your job you shouldn’t have to change your job”.
On whether to adopt similar UK protocols in Australia Chris comments, “definitely, it’s really about setting a precedent, other countries have recognised that it’s not a risk… What’s the big issue if these well established developed countries have these protocols in place, thus why are we any different? Why are we unique in Australia?” Chris remains hopeful of the future and expects to be performing exposure prone procedures eventually.
WA AIDS Council Chief Executive Officer Andrew Burry has made comments with similar sentiments as Chris, “It is always good to see barriers removed, or at least reduced so that people living with HIV face minimal impediments to enjoying their lives as they wish. Access to avenues of employment is obviously a good example. In terms of this particular change for UK healthcare workers, we need to give regard to what science tells us and we will ask that the Australasian Society of HIV Medicine is actively investigating whether a similar approach can be considered for Australia.”
It is undeniable that an undetectable viral load and the virtual elimination of risk that is afforded to people with HIV when on effective HIV medication is having a profound effect, not only on their sexual lives but now in their career aspirations too.
Cipriano Martinez
