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Moreover, she backs the popular contention that the rule is obsolete.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.
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