Nurses with HIV: fear and loathing on the frontline
A survey carried out by the National AIDS Trust has found that staff with HIV working in the health service face discrimination. Charlotte Santry looks at the findings and reports on the legal rights of nurses working with the virus, their colleagues and patients
Nurses living with HIV are being shunned by colleagues, told they should not be working in healthcare and suffering breaches of confidentiality.
These are the findings of a National AIDS Trust study, which showed a fifth of respondents who disclosed their HIV status at work felt they were discriminated against as a result.
Of 1,800 gay men and black Africans taking part, nearly one in 10 worked in healthcare and this included nurses working in a range of settings, from accident and emergency to mental health.
NAT assistant director of policy and campaigns Eleanor Briggs said: “Stigma remains a real issue, there’s still a lot of misunderstanding.
“You might expect people in a healthcare setting to be the most informed. We found that wasn’t the case and people faced a range of negative responses.”
Nurses involved in the research said they were treated differently from other colleagues, made to feel isolated at work and were not invited to social events.
Terence Higgins Trust head of policy Lisa Power said: “The NHS should be ensuring that anybody with HIV is supported to do their job. It should be setting an example but quite often it’s setting a bad example.”
Chris Morley, HIV policy, information and publications co-ordinator at voluntary organisation the George House Trust, told Nursing Times he knew of four paramedics, a doctor and several dentists in the north of England whose careers have been ended or adversely affected following their diagnosis.
But he said very few people were prepared to “go public” by taking cases to employment tribunals.
The odds are stacked against complainants, who often lack the money to bring cases against NHS trusts and have no right to publicly funded legal help or confidentiality, he explained.
Perhaps unsurprisingly, some choose to keep their HIV status a secret.
The NAT findings revealed 60 per cent of respondents had disclosed their HIV positive status at work, more than three quarters of whom recorded a generally positive reaction. But a third faced or feared a negative reaction.
Infected NHS workers applying for new posts have a duty to complete health questionnaires honestly and should inform occupational health doctors if they have HIV.
However, fears that managers are approaching occupational health workers for details of employees’ medical history may deter nurses from disclosing their condition.
In addition, Ms Power said she knew of a nurse who was told by her organisation’s occupational health doctor that she was not fit to work in the NHS because she had HIV.
A respondent to the NAT survey said a manager had sent an email to all his colleagues, informing them of his HIV status out of a misplaced sense of responsibility. Another was outed when he arrived at work to find “HIV” scrawled above his in-tray.
Department of Health guidance states that, while there is a general duty to preserve the confidentiality of healthcare workers’ medical information, the identity of infected individuals may legally be disclosed without their consent, for example to prevent the spread of infection.
Healthcare workers who know or have good reason to believe that an HIV infected worker is performing risky procedures, or has done so in the past, must inform an appropriate person or the relevant regulatory body.
There are restrictions preventing HIV positive staff from carrying out any “exposure prone procedures”. The DH guidance states this includes all invasive procedures where there is a risk that patients’ open tissues may be exposed to the blood of an injured worker.
This may include repairs to perineal tears, procedures carried out by operating theatre nurses but it does not include work with patients known to be “regular and predictable biters”.
There is no exhaustive list, meaning the guidance may be interpreted differently across NHS organisations.
However there are calls for the guidance, issued in 2005, to be updated, and the Terrence Higgins Trust plans to lobby for changes at the party political conferences this autumn.
It will present a document titled “25 things the government can do”, which includes reviewing healthcare employment restrictions for people with HIV.
The document says: “At a time when the NHS is facing significant workforce capacity issues, it seems only sensible that, wherever possible, people with an HIV diagnosis should be supported and enabled to continue working.”
Mr Morley called the restrictions “unjustifiably sweeping” and “probably illegal” under the Disability Discrimination Act.
He said current policies “seem to be based on the department’s fear of media hysteria and apparent HIV institutionalised discrimination”.
But Hempsons solicitors partner and head of employment Jean Sapeta said she could envisage no legal challenge to the restrictions.
She said: “The employer’s obligation is to make reasonable adjustments. Any adjustment involving taking risks to patients wouldn’t be reasonable.
“It’s the ‘my mother’ test. If it was my mother or child would I want them exposed to any level of risk?”
She added: “I don’t find NHS employers hostile to disabled employees at all because of the ethos [of the health service].”
Organisations should pay attention to the health and wellbeing of their staff but patients were “top of the tree in the hierarchy of need”, she said.
A DH spokesman said policies were kept under review but there were no plans to change the guidance.
Should nurses be concerned for their own safety and that of their patients if they discover a colleague is HIV positive?
Ms Power said medical advances meant staff were “likely to be uninfectious” most of the time. The risk of transmission from needlestick injuries appears to be very low indeed, judging by figures on the NHS Choices website.
The website says that, between 1997 and 2007 in England, Wales, and Northern Ireland, there were 3,773 reported incidents in which healthcare workers were exposed to blood-borne viruses – including HIV - while doing their job.
But before 1999, only five healthcare workers developed HIV following exposure via needle punctures. Since 1999, there have been no new cases.
There have only ever been four known cases worldwide of patients catching HIV from healthcare workers.
Only one, in 1996, involved a nurse, who worked in a French hospital and, despite not performing exposure prone procedures, is thought to have transmitted HIV to a 61-year-old patient.
Nurses may also be concerned that working with HIV positive colleagues also find themselves working harder to cover long periods of sickness absence and doctors’ appointments.
This is not necessarily the case, according to the NAT, which found 34 per cent of respondents had not taken any days off to attend HIV clinic appointments in the past year.
Ms Power said better medication meant there were few side-effects, meaning those with HIV status were better able to get on with their lives, and could perform normally at work. In the past, some people suffered nightmares and manic episodes.
She said: “The majority suffer no side effects where they shouldn’t be doing their jobs for long periods of time. We still know people sometimes will have to take a couple of months off but it does settle down.”
Procedures that may be considered exposure prone and should not be carried out by HIV positive nurses:
- Handling or physically examining acute trauma patients with open tissues
- Pre-hospital trauma care
- Inserting chest drains in patients with multiple rib fractures
- Some endoscopies
- Repairs following episiotomies and perineal tears
- Tasks undertaken by theatre scrub nurses acting as first assistant
Procedures that can normally be carried out by HIV infected NHS staff:
- Work that poses a “significant risk of biting”
- Minor gynaecological procedures eg fitting intrauterine contraceptive devices (coils)
- Intensive care
- Simple vaginal delivery by midwife
- General nursing procedures
- Resuscitation performed wearing pocket masks
National AIDS Trust report - key findings*
- A fifth of respondents who had disclosed their HIV status at work had experienced discrimination
- 40 per cent of respondents who experienced discrimination after telling employers they were HIV positive felt they had lost their job as a result
- 34 per cent had not taken any days off to attend HIV clinic appointments in the past year
- 60 per cent had disclosed their HIV status to someone at work
- *Based on focus groups with 1,800 gay men and black Africans, 9 per cent of which worked in healthcare