This week the U.S. Centers for Disease Control is expected to publish its long-awaited new recommendations for preventing HIV transmission by health workers. Apparently much like a draft circulated last April, the recommendations won’t call for mandatory testing. But they will very probably encourage practitioners who perform “exposure prone” procedures - for example, using a sharp instrument in a visually obscured or confined body cavity - to find out their HIV status. Those who test positive would be urged to refrain from such procedures unless they get permission from an expert review panel.
Already last week AIDS activists were voicing dismay over the new guidelines. “Every day, HIV-positive practitioners are being forced out of their jobs,” says attorney Ben Schatz, director of a program for infected health workers sponsored by the American Association of Physicians for Human Rights in San Francisco. “The CDC guidelines feed into misplaced fears about these people.”
Most public-health experts believe rigorously enforced infection-control measures, not testing, will best prevent HIV transmission between health practitioners and patients. Still, the American Medical Association recently called for voluntary testing of all health-care workers, and in a recent NEWSWEEK Poll, 94 percent of Americans surveyed said physicians should be required to tell patients if they are HIV infected.
Although the CDC recommendations won’t be legally binding, they will become the de facto standard of care. “Hospitals will be leaving themselves open to liability if they don’t adhere to the standard,” says Carisa Cunningham of the AIDS Action Council, “and that will effectively mean testing their health-care workers.” Similarly, malpractice insurers may well require doctors to be tested.
Despite concerns that the CDC guidelines will cause discrimination against HIV-positive health workers, some legislators want regulations banning them from practicing altogether. This week the Senate is expected to vote on Sen. Jesse Helms’s proposed amendment to an appropriations bill that would make it a federal crime for HIV-positive health practitioners not to tell patients they are infected before treating them. Sens. Edward Kennedy and Orrin Hatch are working on countermeasures. But the fight on Capitol Hill is just a skirmish compared with the raging battle between patients and the deadly virus.
