E-LEARNING

TEST YOUR KNOWLEDGE ON HIV

INTRODUCTION 

This resource has been written by NAT (National AIDS Trust) in partnership with BHIVA (British HIV Association) for people working in the health and social care sector.

The reality of living with HIV has changed dramatically in the last thirty years. There are just over 100,000 people living with HIV in the UK today.1 With the huge improvements in treatment and care, many people with HIV can have a normal life expectancy, a career, relationships and children. As people living with HIV are living longer they need to access a range of services to meet their health and social care needs and this means you are more likely to come into contact with someone who is HIV positive.

This training resource is designed to enable you to feel confident about treating and caring for someone living with HIV and includes information on the routes of HIV transmission and levels of HIV risk in a health and social care setting.

The resource will also help ensure service users and colleagues living with HIV are treated appropriately and that your understanding and knowledge of HIV is accurate and up to date.

[1] Public Health England, HIV in the UK, 2016

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THE FACTS ABOUT HIV

HIV (Human Immunodeficiency Virus) is a virus that attacks and damages the body’s immune system.

HIV makes the body’s immune system less effective over time so that it can no longer protect itself against some opportunistic diseases which it would normally be able to fight off. People who are undiagnosed and have been living with HIV for a considerable time can develop a number of serious illnesses such as pneumonia, TB and certain types of cancer such as Non-Hodgkin Lymphoma. For more information on conditions associated with late stage undiagnosed HIV please see UK HIV testing guidelines.1

[1] UK National Guidelines for HIV Testing, 2008

HEALTH AND SAFETY

The Department of Health Guidance on occupational exposure to HIV in a healthcare setting notes that the risk of transmission is low, with a transmission risk of about 3 per 1,000 in percutaneous injuries such as needlestick injuries involving someone known to be HIV positive. There have been no reported cases of HIV transmission in a social care setting.

Notwithstanding the very low risk of HIV transmission in a health and social care setting, it is important that you have the correct information to protect yourself and others at work from HIV.

Routine procedures should involve using universal precautions such as wearing gloves when taking blood or when handling other bodily fluids and making sure any cuts or skin infections are properly covered. The General Medical Council’s (GMC) guidelines outline how universal precautions are all that are necessary to protect yourself from HIV transmission when you are in contact with someone living with HIV, even when conducting more invasive procedures or surgery.1 There is no need to use extra precautions.

It is vital that you do not overstate the risk of HIV transmission when someone known to be living with HIV is in your care, or act in a way that would be discriminatory by using ‘extra’ precautions that you would not use for an HIV negative person. Please see section four and five for more information on how to treat a service user living with HIV.

If someone’s HIV status is known, they are likely to present a low transmission risk. This is because people with diagnosed HIV are likely to be on effective treatment, which significantly reduces the amount of HIV in the bloodstream. People who have fewer than 50 copies/ml of HIV in their bloodstream are virally suppressed (also known as having an ‘undetectable viral load’), meaning that they cannot pass on the virus. Around 78% of people living with HIV in the UK are virally suppressed, so cannot pass HIV on.2

People living with HIV who take their HIV medication as prescribed and have achieved an undetectable viral load can feel confident that they do not present an HIV transmission risk to their sexual partners.

However, 1 in 7 people living with HIV are unaware of their status and are more likely to be infectious than a person who has an HIV diagnosis and is on treatment. It is therefore important that health workers use universal precautions at all times to protect themselves from undiagnosed HIV or any other blood-borne virus (BBV) that a person under their care may have.

[1] General Medical Council (GMC), Confidentiality: disclosing information about serious communicable diseases
[2] Public Health England, HIV in the UK, 2016

LIVING WITH HIV TODAY

Since the 1980s, treatment for HIV has improved substantially and the majority of people diagnosed today go on to have a normal life expectancy, lead active lives and do not develop AIDS.

Effective treatment means for example, there is no reason why someone living with HIV cannot have children and the transmission risk between mother to child when the mother is HIV positive and on treatment is now around 0.27%.

There is also no reason why someone living with HIV cannot expect to have a full working life. Research has shown that the majority of people living with HIV in work say that their HIV has no impact on their job.1

People living with HIV work in a wide range of professions. The only job they cannot do is working in frontline roles of the armed forces. This is due to concerns over access to HIV medication when in combat.

The ban on people living with HIV working as a dentist, midwife or surgeon (professions which involve ‘exposure prone procedures’ or EPPs), was removed in 2014, although someone living with HIV has to have a low viral load (<200 copies/ml) before they are able to perform EPPs. For more information on the requirements, please see NAT’s briefing on the changes to occupational restrictions for healthcare workers with HIV.2 There are no such requirements for people living with HIV working in any other health or social care profession.

[1] NAT (National AIDS Trust), Working with HIV, 2009
[2] NAT (National AIDS Trust) ‘Changes to employment restrictions for healthcare workers with HIV’, 2014

HOW TO TREAT A SERVICE USER WITH HIV

When caring for someone with HIV, it is important that you give them access to the same treatment and services as someone who is HIV negative. It is unlawful under the Equality Act 2010 to single out someone living with HIV for different treatment or decline to offer goods or services to them (for example health and social care).

In particular, you should NOT:

  • Give someone living with HIV an appointment at the end of the day because of a supposed infection risk. Universal precautions should be used at all times (around 13% of people living with HIV are undiagnosed). 
  • Dispose of something that has been in contact with someone living with HIV in a different way. There is no need to specially disinfect equipment just because it has been in contact with someone living with HIV. Usual disinfecting processes are sufficient. 
  • Use additional precautions when dealing with someone living with HIV as this can be stigmatising and discriminatory. For instance, you should not double glove when taking blood from someone who is HIV positive.
  • Operate a blanket policy of denying someone living with HIV surgery because of surgical or post-procedure complications. The health of someone living with HIV should be assessed individually on a case by case basis as with anyone else undergoing surgery. There is no evidence to suggest that someone living with HIV is more susceptible to surgical or post-surgical complications than an HIV negative patient. 
  • Ask someone living with HIV how they got the virus. This is an invasion of personal privacy and can make people feel uncomfortable. It is completely unnecessary outside of the sexual health clinic to know how someone acquired HIV when giving care and treatment to a patient. 

You should always:

  • Understand the rules around confidentiality and in what circumstances you should/should not share the HIV status of a service user. 
  • Ensure someone living with HIV has access to HIV treatment they are taking.
  • Ensure any drugs you prescribe do not interact with any HIV medication a patient is on.
  • Treat someone living with HIV with dignity and respect.

HOW TO TREAT A COLLEAGUE WITH HIV

It is important to remember that people living with HIV are able and entitled to work just like anyone else. There is no risk of HIV transmission through everyday work contact for either colleagues or the public (please refer to sections one and two).

People living with HIV in work are protected from discrimination under the Equality Act 20101 (HIV is defined as a disability from the point of diagnosis in this legislation). For more information about the different types of discrimination and how to avoid acting unlawfully please see HIV @ Work: Advice for Employers2 (please note, this guidance was written prior to the changes in occupational restrictions for people living with HIV in healthcare settings discussed in section three).

The Act also prohibits the use of pre-employment health questionnaires. This means it is unlawful to ask any questions about a candidate's health or disability prior to making a job offer. There are exceptions to this requirement if a job involves carrying out ‘exposure prone procedures’ in a healthcare setting, for example being a dentist, midwife or surgeon, where people will be asked to disclose their HIV status. All new healthcare workers employed or starting training (including students) in professions which involve exposure prone procedures will undergo standard health checks after they have been offered a position which will include being offered an HIV test.

Someone living with HIV who faces discrimination at work has the right to report this to their line manager and where appropriate disciplinary action should be taken. If the issue continues to be unresolved, they can take their case to an Employment Tribunal.

You should be aware of the Equality Act and how it applies to people living with HIV, including how to treat someone with HIV fairly and with respect.

[1] Equality Act 2010
[2] NAT (National AIDS Trust), HIV @ Work, Advice for Employers, 2012

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FUTHER READING

If you want to know more about HIV, you may find the following websites useful: