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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


 

 

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HIV disclosure rule comes under attack

Adam Katz-Stone

http://www.bizjournals.com/eastbay/stories/2001/01/22/focus7.html

Lawrence O. Gostin is having second thoughts. About a decade ago, he helped formulate a rule that the U.S. Centers for Disease Control then adopted to help control the spread of AIDS.

That rule, still in effect, requires health care workers infected with the HIV virus to inform patients of that fact.

"Since that time I have been watching and studying that data, and it turns out the risk to patients is virtually zero," says Gostin, a professor at Georgetown University Law Center in Washington, D.C. "At the same time, I have found that health care workers have been literally hounded out of the profession (because of disclosure). They have been subject to a lot of discrimination and invasion of privacy."

    

Now Gostin is pushing for a change. In an article published this fall in the Journal of the American Medical Association, he called for the CDC to drop the rule, and instead require health care workers only to report their HIV-positive status to their employers, rather than to patients.

The CDC says the rule is under review. "We are currently reevaluating worker guidelines based on the best and most up-to-date science," says CDC spokesman Tom Skinner.

Health care professionals, meanwhile, say the rule is a matter of some indifference. Because medical science has learned so much about AIDS in the past decade, they say, the rule goes largely unnoticed in the day-to-day work of caregiving.

Mary Wakefield, director of George Mason University's Center for Health Policy, Research and Ethics, says it is likely that the CDC rule is going unenforced in many area institutions.

In the first place, she says, the prospect of workers voluntarily disclosing their infection status simply strains credulity.

"It's just like providers choosing not to disclose a medical error that they have committed, either because of shame or guilt or fear of being isolated by their peers. Those same human reactions could certainly play out around something like the disclosure of HIV," she says.

Moreover, she backs the popular contention that the rule is obsolete. "From what we know of how HIV is transmitted, the risk here is so minimal. I would be a heck of a lot more concerned about being treated by a physician or a nurse who didn't wash their hands before they treated me, than I would be about getting treated by someone with HIV."

    

Wakefield supports efforts to get the rule changed, if only to bring regulation into line with existing practice. "We are at a different point in time in terms of our knowledge of HIV and AIDS than we were 10 years ago," she says.

Katz-Stone is a contributor to the Business Times.