Testing perpetrators of assault for diseases like HIV is pointless and harmful
A new Private Member’s Bill is attracting widespread attention and support, including a moving feature on BBC’s The One Show this week (29 January 2018). The Bill admirably aims to increase protection for emergency workers who suffer assaults at work, with a focus on tougher sentencing laws. But one part of the Bill is alarming to us at NAT, and other public health experts. This part will make it an offence, punishable by fine, for suspects to refuse to be tested for infectious diseases following spitting and biting incidents.
Voluntary testing is a cornerstone of an ethical, evidence based and effective response to infectious disease. The enforcement of an offence of refusal to provide a sample for testing amounts to coercion, undermining this long-standing approach. There are no other circumstances where it is legal to impel someone to test in this way.
We have heard the proposal justified on the grounds of the harm caused to emergency service workers who have been bitten or spat at. Victims report that they face agonising waits for their own test results, or that they have had to take post-exposure medication to prevent infection. But testing suspects won’t do anything to protect against this, as these procedures are entirely unnecessary in the first place.
Although no diseases are specifically mentioned in the Bill, the most feared in these circumstances are HIV and Hepatitis C. Despite common misconceptions, neither can be transmitted by spitting or biting. Risk from biting is sometimes described as ‘negligible’, which can be misunderstood to mean ‘very small risk’. But this isn’t really what this means. Rather, risk is considered negligible as, while there is no definitive proof it could never happen, there is not a known, quantifiable and scientifically verified risk. In plain English, HIV and Hepatis C are not risks for spitting or biting. There have been no cases of HIV transmission from spitting in the history of the global epidemic, and only a handful from biting (which occurred in extreme circumstances and in the days before treatment). For Hepatitis B, risk is so small as to be unquantifiable and in any event, is preventable by a vaccine recommended for emergency health workers.
National medical guidelines do not recommend prescribing prevention medication or testing for diseases following spitting or biting incidents. So, what should happen if a suspect did test positive? The answer is nothing, as there would be no risk from the incident. A positive diagnosis from the suspect would not benefit the victim of the assault and would likely only increase unnecessary anxiety.
Even if, hypothetically, there were a risk of transmission, testing wouldn’t help. It couldn’t rule out that someone had acquired a disease recently; most tests don’t pick up infections right away (you can only be totally sure of an HIV test result about a month after infection, by which time it would be too late for the victim to take a course of preventative drugs). Enforced testing also wouldn’t tell much about the level of risk of infection as many people living with a condition are not able to pass an infection on: there may still be no risk. For HIV, most people diagnosed are on treatment and are completely non-infectious.
We are working with allies in the medical profession, patient advocacy and rights groups, to make sure that this Bill fulfils its potential to protect those who serve us, without causing undue harm – something that rests on the removal of this concerning aspect of the Bill.
The testing component of this Bill is nothing but a distraction from an important conversation about the poor treatment of people in our emergency services. Putting it into law validates myths, fear and anxiety. Harm that could be much better avoided through the provision of basic information, which might allay these unnecessary fears. No one should face violence and degradation at work. But authenticating mythical fear of disease only increases this degradation whilst also doing insurmountable harm to public awareness.
 Assaults on Emergency Workers (Offences) Bill 2017-19