Stigma and discrimination against HIV-positive nurses in healthcare

HIV Positive Nurses

The most profound effects of HIV are the stigma, discrimination and the psychological aspects of the disease and hence efforts to relieve these negative psychosocial perceptions are the most wanted. Evidence suggests that occupational infection of HIV from the HCW to the patient is very negligible while the odds of the patient infecting a HCW are much higher. However, the extent of discrimination of a HIV positive HCW is much higher creating severe health, economic and psychosocial consequences for the person. Healthcare policy makers should carefully evaluate the implications for various stakeholders before framing regulations pertaining to practice restrictions of HIV sero positive HCWs.

Introduction

HIV is a global epidemic that is causing significant strain on our already stretched health care system. Almost three decades later the search for a cure to HIV still continues to elude us. However, the vast amount of research over the last decade has considerably changed our view of HIV from being an untreatable and fatal disease to a chronic treatable condition. While we are focused on the prevention, therapeutic progress and the discrimination of HIV patients a new debate has arisen. The widespread concern about HIV positive workforce in the healthcare sector, particularly the nurses who are the primary caregivers and the potential dangers of infecting patients under their care. The healthcare sector in particular has been identified as the area where discrimination against HIV positive people is more pronounced. [Mahendra et.al (2007)] Fear of discrimination puts off health care workers (HCW) from screening themselves for HIV and thereby delaying their own treatment. Tarwirevi & Majako (2003) report that 77% of HCW were unwilling to test themselves for HIV. [Sadoh et.al, 2009] the recently conducted UK National AIDS Trust Study also reported that one fifth of the HIV positive HCW who reported their status felt they were discriminated in the workplace. A discussion of the pros and cons of having HIV positive nurses in direct care delivery will provide better insight into this important healthcare topic.

HIV Positive Nurses in healthcare

The issue of a healthcare worker being infected with HIV is a very complex one to deal with. As per the Americans with Disability Law (ADA) nurses and other healthcare workers with HIV should be protected from discrimination and permitted to work unless their disability or the infection limits their ability to perform competently. The ADA also states that if by suitable changes the risk of contamination is removed then the worker shall continue to perform. While the ANA deems it obligatory for the nurses to disclose their HIV status it also advocates that nurses with HIV should be allowed to continue their work in such a manner that there is no medically known risk for the patients under their care, while at the same time ensuring that their privacy privileges are not compromised. Thus HIV status of a Nurse or any other healthcare worker should not be a factor that automatically excludes them from providing patient care. [Susan J. Westrick, 2009] However, it is incumbent upon the HIV positive nurse to adhere strictly to the recommended 'Universal Precautions', to stay away from high risk areas of care delivery such as in a surgical or emergency setting where exposure to patients' blood is more common. In other words, nurses who are identified to be HIV positive should stay away from areas of nursing that involve invasive procedures. The stance of the ANA on HIV positive nurses is clearly expressed in its support for "policies that will ensure equitable practice guidelines for nursing practice by HIV-positive nurses, without undue limitation on scope of practice, and based on scientific and epidemiological information, respecting the rights and confidentiality of both patients and HIV-positive nurses" [Shaw Kathy, 2003]

It is also to be understood that the outlook on HIV has changed significantly over the years. As Garcia Jones, a professor at the Florida International University School of Nursing states, "Instead of viewing HIV as a fatal disease, it's now thought of more as a chronic condition.. This means that people are living with HIV, and they need to continue to work - not only as a means of financial support but also as 'therapy.'" [Susan, 2004]

The fact is that the improvements in anti-retroviral therapies have reduced the viral loads to undetectable levels that greatly reduce the risk of transmission. So there appears no cause for undue concern or worry when there is no scientific reason that a nurse providing care is a danger for the patient. Some nursing advocates such Lucy BradleySpringer, PhD, research nurse and ANAC president go to the other extreme by suggesting that, "It is safe for nurses with HIV to practice, even in surgery, if they use the reasonable precautions required of all nurses." [Susan, 2004] While this is a valid argument it is not ethically acceptable to risk a patient by letting a HIV infected HCW participate in invasive routines.

However, a HIV positive nurse who has disclosed his/her status should be allowed to continue their care provision so long as they are not in invasive or emergency care settings where there is a definite risk for the patient to contract the virus. Also when we are experiencing a national shortage of nurses with an already overworked nursing force it is important to support the HIV positive nurses as much as possible so that they can continue to provide nursing care in settings that exclude 'exposure prone procedures'. In the UK the National Aids Trust conducted an extensive survey in the NHS network and recommended, "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." [Charlotte Santry]

Conclusion

The most profound effects of HIV are the stigma, discrimination and the psychological aspects of the disease and hence efforts to relieve these negative psychosocial perceptions are the most wanted. Evidence suggests that the occupational infection of HIV from the HCW to the patient is very negligible [Charlotte Santry], while the odds of the patient infecting a HCW are much higher. However, the extent of discrimination and stigma on a HIV infected HCW is much higher creating severe health, economic and psychosocial consequences for the person. The risk of HIV infection is 100 times lesser than HBV infection and by following 'Universal Procedures' it is possible to eliminate chances of an infected HCW from affecting a patient. HIV positive nurses should be permitted to work in safe settings without 'exposure prone procedures' so they can continue to participate in care giving while they are themselves coping with the burden of the disease. This is in line with the globally accepted GIPA principle of encouraging the active participation of HIV patients as an effective means to prevent, control and provide support services for people infected with HIV. While patients' safety should be the foremost issue in the field of health provision, care must be taken not to subject the HIV positive HCWs to undue discrimination. Healthcare policy makers should evaluate the implications for various stakeholders before framing regulations pertaining to practice restrictions of HIV sero positive HCWs.