Modernisation of HIV rules to better protect public
Author: Department of Health
Date: Aug 2013
Protection against HIV will be strengthened under plans to help people get diagnosed earlier, the Chief Medical Officer has announced.
Chief Medical Officer Professor Dame Sally Davies announced that outdated rules designed to combat the threat of AIDS in the 1980s, when attitudes were very different and risks were less understood, will be modernised in line with the most recent science.
The changes mean that:
- people will be able to buy HIV self-testing kits once the kits comply with regulations
- doctors, nurses and other skilled healthcare workers with HIV who are undergoing treatment will be able to take part in certain medical procedures from which they are currently banned
Up to 100,000 people have HIV in the UK but around a quarter are living with it undiagnosed. These changes will give people more choice on how to get tested and therefore get treatment earlier, which will reduce the risk of new HIV infections.
Following independent scientific advice, the Department of Health will lift the ban on healthcare workers with HIV being able to carry out certain dental and surgical procedures. Strict rules on treatment, monitoring and testing will be in place to safeguard patients.
This change will bring the UK in line with most other Western countries. Under the new system, patients will have more chance – around one in five million – of being struck by lightning than being infected with HIV by a healthcare worker. There is no record of any patient ever being infected through this route in the UK. There have been just four cases of clinicians infecting patients reported worldwide and the last of these was more than a decade ago.
The changes announced today could reduce that risk even further because healthcare workers will be more likely to get tested themselves and therefore less likely to potentially put people at risk.
Because of the stigma attached to HIV, some people are reluctant to use existing testing services and as a result half of HIV infections are discovered late, meaning they are harder to treat.
Removing the ban on the sale of self-testing kits will make it easier for people to get tested as early as possible and get the best treatment available.
If a test indicates a positive result people are advised to get a follow-up confirmatory test at an NHS clinic. Clear information about how to interpret the result and what to do afterwards will be included with the kit.
Chief Medical Officer Professor Dame Sally Davies said:
Many of the UK’s HIV policies were designed to combat the perceived threat at the height of HIV concerns in the 1980s and have now been left behind by scientific advances and effective treatments. It is time we changed these outdated rules which are sometimes counter-productive and limit people’s choices on how to get tested or treated early for HIV.
What we need is a simpler system that continues to protect the public through encouraging people to get tested for HIV as early as possible and that does not hold back some of our best healthcare workers because of a risk that is more remote than being struck by lightning.
Public Health Minister Anna Soubry said:
HIV continues to be a serious health issue but we know that for a number of reasons some people are reluctant to come forward and get an HIV test in person.
By removing the ban on the sale of self-testing kits and cutting red tape that stops healthcare workers from treating patients we are bringing the UK in line with most other Western countries. We want to make it even easier for people to test themselves as early as possible and get the best treatment available.
Deborah Jack, Chief Executive of NAT (National AIDS Trust) said:
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 as we believe it is vitally important that policies are based on up-to-date scientific evidence and not on fear, stigma or outdated information.
Allowing healthcare workers living with HIV to undertake exposure-prone procedures corrects the current guidance which offers no more protection for the general public but keeps qualified and skilled people from working in the career they had spent many years training for. We know people are already buying poor quality self-testing kits online which is why NAT have campaigned for a change in the law. Legalisation is an important step to ensure they are regulated, accurate and safe.
The British Dental Association’s scientific adviser Professor Damien Walmsley, said:
Dentists in the UK comply with rigorous infection control procedures to protect both patients and the dental team against the risk of transmission of blood-borne infections.
Today’s announcement brings England into line with nations including Sweden, France, Canada and New Zealand, and is good news for patients and HIV-positive dentists alike. We look forward to seeing its implementation.
Decided on a case-by-case basis, HIV-infected healthcare workers may be allowed to undertake certain procedures, if they are:
- on effective combination antiretroviral drug therapy (cART)
- have an undetectable viral load
- are regularly monitored by their treating and occupational health physicians
Both policies will be in place from April 2014. Public Health England will now put in place a programme to register and monitor healthcare workers who have HIV and ensure they are able to perform certain procedures when appropriate.
For more information contact the Department of Health press office on 0207 210 5239.
There have been four cases worldwide of patients being infected with HIV by a healthcare worker. These are
- a case of a dentist in Florida (USA), who transmitted HIV to six patients (reported in 1992)
- an orthopaedic surgeon in France who transmitted HIV to one patient during a hip hemiarthroplasty (reported in 1999)
- an obstetrician and gynaecologist in Spain who transmitted HIV to one patient during a Caesarean section (reported in 2003)
- an additional case of HIV transmission by a nurse in France, where the route of transmission is still unclear (reported in 2000)
Current rules prevent companies from selling HIV self-testing kits in England. Once these rules are lifted, all kits will be subject to strict regulatory control by the Medicines and Healthcare Regulatory Authority before they are authorised for sale.
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