Overview of the situation
The Department of Health revealed that from April 2014 HIV-positive healthcare workers on combination antiretroviral therapy who have an undetectable viral load will be able to carry out all dental and surgical procedures. The findings are based on up-to-date scientific evidence, which brings the UK in line with most Western countries.
A new confidential register run by Public Health England will monitor the treatment and viral load of HIV-infected doctors, dentists and nurses every 3 months to safeguard patients. The Department of Health emphasised that the decision allowing an HIV-positive healthcare worker to undertake certain procedures will be made on a case-by-case basis.
The new regulations will also allow people to buy self-testing HIV kits to use at home from April 2014. This will enable the testing kits to be regulated, ensuring people are buying kits that have been properly tested for accuracy.
If the home test shows a positive reaction the user will be advised that this is a reactive result and will need confirmation. The individual will need to access a healthcare setting for a confirmatory test to establish if they have HIV infection.
It is the position of the National HIV Nurses Association that:
All healthcare practitioners living with HIV should be able, and have support, to undertake a full range of medical and surgical procedures based on sound medical evidence.
Early diagnosis of HIV is vital to ensure that people can live well and manage their condition and we support any steps to extend testing. We will also continue to advocate for early HIV testing.
Whilst we recognise it is a step forward to have home testing kits available, it remains vital that home testing kits provide accurate information, and 'signpost' anyone who does have a reactive result to support services. There also needs to be a system in place to ensure people receiving a reactive result in this way are then linked into a healthcare setting.
Statement of concern
Many of the UK's policies in relation to HIV were designed to combat the perceived threat at the height of HIV concerns in the 80s. The new reforms are now in line with current up-to-date scientific evidence, which enables people to have more choices on how to get tested or treated early for HIV.
Early diagnosis of HIV is vital to ensure people live well and manage their condition and we support any steps to extend testing. The option to self test at a time and place of a person's choosing can create the potential to overcome some barriers of stigma, lack of confidentiality and access to testing centres that may otherwise prevent people from obtaining an HIV test.
As the self test places sole responsibility on the individual with a reactive result to seek a confirmatory HIV test, it is essential that testing kits provide accurate information and signposting, and for support services to be in place for those who test positive.
Allowing healthcare practitioners living with HIV to undertake a full range of medical and surgical procedures and continue to perform a job they have spent many years training to do, is the right decision. The decision is based on the new evidence regarding treatment and transmission, and challenges outdated notions of the risk of HIV. We believe that this is another step forward in enabling people living with HIV to take a full and active role in society.
Stigma is the main reason that prevents people testing for HIV and accessing services. NHIVNA welcomes any reforms which help to break down stigma.
We welcome these changes to the guidance on HIV-positive healthcare workers undertaking exposure-prone procedures and the removal of the ban on self-testing kits. NHIVNA believes it is vital that policies are not based on fear, stigma and outdated information but on up-to-date scientific evidence, information and knowledge.