Running head: HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

HIV Infected Healthcare Workers: An Issue Analysis

April K. Greene
Ferris State University

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

According to The Rights of HIV Infected Healthcare Workers, by Peter Erridge, a

decade ago, drugs and homosexuality were highly associated with Human Immunodeficiency
Virus, or HIV. Individuals infected with HIV were typically given a life sentence of about 4
years. The transmission in the healthcare setting was scarcely known. HIV and the knowledge
surrounding it has since then changed, but the attitudes have not. When it comes to HIV, the
battle for human rights is the basis of debate. The issue surrounding HIV in healthcare has often
sided in favor of patients and infected workers have received little support from the profession,
as well as the media (Erridge, 1996). Restrictions on Health Workers with HIV Lifted as
Outdated Ban Ends, by Sarah Boseley, states that in some countries, restrictions were imposed
on doctors, nurses and dentists with HIV in 1993. Anyone with HIV was banned from carrying
out treatments or surgery inside a patient's body where their fingertips or hands were at any point
not visible. This was because they would not be able to see if they had cut themselves and were
bleeding. The ban meant some surgeons had to change their practice, but dentists often had to
give up their careers (Boseley, 2013).
Notes from the Field: Occupationally Acquired HIV Infection Among Health Care
Workers, by Royce, Kuhar, and Brooks, also states that as of 1997, over 9 million healthcare
workers in the US were reported to be HIV positive. This included physicians, surgeons, nurses,
dental workers, dentists, technicians, therapists, and aids. Healthcare workers are at greater risk
of infection through needle-sticks, cuts from sharp instruments, contact with mucous membranes
(eye or mouth), contact with non-intact skin, or contact with blood or other infectious bodily
fluids. Transmission of HIV from worker to patient is low; during surgery the risk is less than
1%. It is more likely that somebody will be struck by lightning than be infected with HIV by
their doctor or dentist. HIV levels in the blood of those on modern combination drug therapy are

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

too low for the virus to be transmissible. There are only four known examples of a healthcare
worker infecting a patient, and in every case, the doctor or dentist was not on antiretroviral drug
treatment. Scientific advances in the treatment of HIV mean that healthcare staff controlling their
infection with medication pose little danger to the public (Royce, Kuhar, & Brooks, 2015).
Although the rate of transmission is low, public fear of acquiring HIV from a healthcare worker
is high. Laws and policies are changing and the push for a change in attitude towards these
individuals is growing.
There are many questions surrounding the topic of healthcare workers infected with HIV.
The rights of these healthcare personnel, the restrictions on practice, and the prevention of
transmission are all topics that should be addressed. But the biggest question regarding HIV
infected healthcare workers is as follows: Why is there discrimination against HIV infected
healthcare workers and how can this stigma be changed?
Theory Base
In association with the issue at hand, two theories relate to HIV infected healthcare
workers. In nursing, Peplaus Theory of Interpersonal Relations addresses the importance of
therapeutic communication between nurse and patient. This theory explains the purpose of
nursing is to help others identify their felt difficulties and that nurses should apply principles of
human relations to the problems that arise at all levels of experience. The assumptions of
Peplaus Interpersonal Relations Theory are that the nurse and patient can interact, that both the
patient and nurse mature as the result of the therapeutic interaction, communication and
interviewing skills remain fundamental nursing tools, and that nurses must clearly understand
themselves to promote their clients growth and to avoid limiting clients choices to those that

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

nurses value. When applying this theory to the problem, in order for quality and effective care of
a patient to occur, the nurse must be able to be aware of themselves. The patient must also be
aware of their biases. And effective interpersonal relations must occur between the in situations
regarding HIV exposure in order for the problem to be safely handled (Wayne, 2014).
Outside of the nursing realm and healthcare, the Theory of Implicit (or unconscious) bias
uncovers the automatic discrimination against individuals that are different. The theory refers to
a bias that happens automatically, is outside of ones control and is triggered by the brain making
quick judgments and assessments of people and situations, influenced by our background,
cultural environment and personal experiences. Although an employer, coworker, or patient,
may state that they are unprejudiced and unbiased, it is programmed into the human mind to
have these thoughts and beliefs unconsciously. By sharing with others a positive HIV status,
people may automatically jump to their preconceived notions about HIV and AIDS. In the
healthcare field, people need to be aware of their biases and stereotypes and try to avoid acting
upon them. This is such the case with an HIV positive healthcare worker (Understanding
Implicit Bias, 2015).
Assessment of the Healthcare Environment
Among the healthcare environment, policies and regulations, resources, and quality and
safety concerns shape the issue at hand. When breaking down the problem as to why healthcare
workers infected with HIV are discriminated against and how this can be changed, many factors
come into play. Through the poor use of universal precautions, the social stigma surrounding
HIV/AIDS, the deadly history of such a disease, the lack of knowledge about HIV and the
scientific advances that have been made regarding its treatment, as well as the fear of catching
HIV.

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

As stated in the Americans with Disabilities Act (ADA) and the Rehabilitation Act of
1973, no covered entity shall discriminate against a qualified individual with a disability
because of the disability of such individual in regard to job application procedures, the hiring,
advancement, or discharge of employees, employee compensation, job training, and other terms,
conditions, and privileges of employment. These regulations specifically prohibit any type of
discrimination in the workplace in the United States (Appendix Recommendations for
Prevention of HIV Transmission in Health-Care Settings, 1991). In Michigan,
recommendations are in place that follow the Michigan Department of Community Healths
policy protecting both patients and healthcare workers. These directly mirror the
recommendations laid out in the ADA. It is highly suggested that all healthcare facilities
incorporate these guidelines into their infection control programs (Michigan Recommendations
on HIV, Hepatitis B, and Hepatitis C-Infected Health Care Workers, 2004).
The Stigma of HIV Still Exists, by Paul Burston, states that the recent overturn of a
policy banning surgeons, dentists, midwives and other healthcare workers who have HIV in the
UK from performing patient procedures is just one step in the elimination of discrimination of
healthcare workers. The lifting of the ban reflects changes in social attitudes towards
homosexuality and towards HIV. In the 1980s gay friends with HIV were rejected by their
families. Thanks to medical breakthroughs, many people with HIV now live far longer, healthier
lives. The new drugs have fewer side effects. The visible signs of HIV are harder to detect. Even
the facial wasting often associated with the disease can be treated with dermal fillers. This
doesn't mean the stigma around the virus has been removed. Friends compare revealing their
HIV status to coming out as gay. It carries a similar fear of rejection (Burston, 2013).
Inferences, Implications and Consequences

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

If this problem is not addressed and handled, negative outcomes may ensue for many.
The healthcare field may take a hit and lose many competent professionals due to the
discrimination facing them. The loss of jobs may also cause a loss of vitality in these
individuals, as well as mental distress for themselves and their families.
The loss of a job can hit hard and make it almost impossible to live a quality life, especially
when so much of their lives surrounded their careers. A stigma attached to their name could also
ensure that other employers would turn them down. Often, the loss of the career was found to be
harder than the actual diagnosis. Even if a healthcare worker is allowed to continue practicing,
they may be advised to stop performing procedures that put others at risk of transmission; this
could in turn cause others to question the status of that individual and may even cause mistrust.
Individuals infected with HIV may be some of the best and brightest in the healthcare field. A
diagnosis shouldnt make them any less competent. As of today, there are only four known
countries that still impose restrictions on healthcare workers with HIV.
Recommendations for Quality and Safety Improvements
Education of not only healthcare workers, but also of the public on this topic is of immense
importance. Individuals working in healthcare should be properly educated on equipment, PPE,
the epidemiology and pathophysiology of HIV, policies and regulations associated with their line
of work, the importance of completing the treatment course and post-treatment testing in order to
prevent HIV transmission. The public should be educated and kept informed on the scientific
advances of HIV treatment and the immense decrease in transmission due to these advances.
Universal precautions should be used for all patients, regardless of HIV status. But close
attention should be paid to those with a positive HIV status. Universal precautions include

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

aseptic technique, hand washing, barrier precautions (gloves, masks, protective eyewear, gowns),
no recapping of needles, placement of used needles and sharps in appropriate containers, the use
of mouthpieces or resuscitation bags to avoid mouth to mouth saliva transmission, covering of
open sores, and proper disposal of contaminated materials.
Position Paper: The HIV-Infected Healthcare Worker, by David K. Henderson, MD,
discussed numerous recommendations to be applied to the healthcare environment. All blood
and hazardous body fluids should be regarded as potentially infectious, transfers of blood or
hazardous body fluids from healthcare workers to patients should be avoided, and HIV infected
healthcare workers should not be prohibited from participating in patient care activities.
Healthcare workers should, however, be advised to avoid procedures that have been found to
increase the likelihood of bloodborne pathogen transmission; this should be a voluntary choice
left up to the individual. Healthcare institutions should develop occupational health programs to
assist any impaired healthcare workers. This may include evaluation of competence, ability to
perform duties and compliance with established guidelines and procedures. HIV infected
workers should not be required to disclose their HIV infection status to any patient, nor should
they be required to disclose their status to their coworkers. Healthcare workers should not be
required to be routinely screened for HIV infection. Individuals that have been exposed to HIV,
whether it be within the community or occupationally, should be encouraged to seek follow-up
for these exposures (Henderson, 1990).
Management of the Healthcare Worker Infected with Human Immunodeficiency Virus:
Lessons from Nosocomial Transmission of Hepatitis B Virus agrees that if a healthcare
professional risks transmission through blood or other infected bodily fluids, the source patient
should be informed of the incident and tested for serologic evidence of HIV infection after

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

consent is obtained. Institution policies should be in place for testing source patients in instances
where consent is unable to be obtained. Research has also shown a large decrease in
transmission rates when correct usage of post-exposure prophylaxis treatment of HIV in the
healthcare setting. This is turn may be helpful in reducing the fear. Post-exposure treatment
includes counseling, risk assessment, relevant laboratory tests, first aid, and the delivery of short
term antiretroviral drugs, along with follow up and support. A designated physician or
occupational health practitioner should be available; they should be available for counseling and
provide support. Individuals should feel comfortable that they will receive the appropriate
advice and treatment, as well as continued encouragement to practice. The rights of healthcare
workers need to be addressed and preserved, regardless of the public fears surrounding HIV
(Weber, Hoffmann, & Rutala, 1991).
According to Cold Comfort for Healthcare Workers? Medico-Ethical Dilemmas Facing a
Healthcare Worker after Occupational Exposure to HIV, employers of healthcare workers
should ensure that policies exist for orientation, continuing education, and training of all
healthcare on the epidemiology, modes of transmission, and prevention of HIV, as well as the
importance of the use of universal precautions with all patients. Necessary equipment and
supplies in reducing the risk of transmission of HIV should be provided by all healthcare
institutions. Adherence to protective measures should be monitored by employers, and retraining
and education should be provided in the instance that these are not being properly followed.
Disciplinary action may also need to be considered (Madiba, Jack, & Vawda, 2011).
Both the American Nurses Association (ANA) and the Quality and Safety Education for
Nurses (QSEN), outline standards and competencies in nursing that can be pulled forward into
the analysis of this issue and how it should be improved upon. Although all ANA standards of

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

practice may apply, standard 7, 10, and 11 stand out. These standards cover ethics, quality of
practice, and communication. The registered nurse should practice ethically and care in a way
that protected the patients autonomy, dignity, rights, values and beliefs. They also maintain a
therapeutic relationship within the appropriate professional boundaries. These individuals will
also take the appropriate action to ensure that the best interests of the patient are upheld. The
registered nurse will also contribute to quality nursing practice and communicate effectively in
all areas of practice. Equal care for all consumers is upheld and the nursing process is properly
used. This nurse will implement activities to enhance quality care and evaluate policies,
procedures and guidelines to improve the quality of practice. This nurse will convey information
to consumers, families, and other team members to promote effective care. They will recognize
hazards and errors in care and communicate these findings, as well as communicate with other
providers to minimize the risks associated with transfers and transitions in care delivery
(Nursing: Scope and Standards of Practice. 2010). The QSEN competencies that can be used
towards this issue are evidence based practice, quality improvement, and patient-centered care.
Attitudes in society need to change. HIV used to always be considered lethal and
dangerous. Although, tremendous advances in medicine have greatly improved the quality and
length of life and the risk of transmission has fallen, this opinion has stuck. Society is unaware
of the advanced in the treatment and management of HIV. It is essential that society moves past
this and that the discrimination comes to an end.

HIV INFECTED HEALTHCARE WORKERS: AN ISSUE ANALYSIS

10

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