HIV-positive health staff barred from invasive work: Guidelines place onus on the individual to protect patients. Rosie Waterhouse reports

DOCTORS, nurses and other healthcare workers who are infected with the HIV virus that causes Aids must not perform any 'invasive' medical procedures that would carry a remote risk of exposing patients to the virus, under stringent guidelines set out by the Department of Health yesterday.

The new rules bar all HIV-infected dentists and surgeons from performing their normal duties. They must do only 'non-invasive' work and can seek advice on redeployment or retraining.

The announcement met a muted response from professional groups. The British Dental Association said: 'We have no alternative but to abide by the department's guidelines. We will have to live with them.' The Royal College of Surgeons said: 'The guidance reinforces our own statement that surgeons who are HIV- infected should not continue to carry out major surgery.'

The new guidelines also force GPs and occupational physicians to breach patient confidentiality in some circumstances. If they are treating an HIV-infected healthcare worker who they know is still performing 'exposure-prone invasive procedures', they must report the patient to his or her employer and to their regulatory authority. This is, in effect, instructing doctors to break the Hippocratic Oath.

Rejecting compulsory testing of all healthcare workers at risk of contracting HIV, the guidelines make clear the onus of responsibility for protecting the public lies with the worker.

In the light of a recent spate of publicity in which several infected doctors were named, the guidelines also attempt to keep confidential the identity of any infected worker. The health authorities will have a duty to notify patients and offer them HIV tests if it emerges that they have had invasive treatment from an infected worker. But the name of the infected individual must not be released to the public or media, without their consent, other than in 'very exceptional circumstances'. The fact that a person may have died or have already been named does not alter this rule. Anyone who reveals the name of an infected worker may have to justify that decision before the General Medical Council or other regulatory body.

The department also announced that a study would collate evidence from the United States and the Public Health Service Laboratory of patients who had had invasive treatment from an infected health worker. Dr Gwyneth Lewis, principal medical officer, said of 8,000 people tested in the UK after incidents came to light, none had been infected with the virus.

A spokesman for the Royal College of Nursing said: 'Employees with HIV will only co-operate if they know they will be supported by their employer and be protected from media hounding.'

The guidelines also state: 'Those who believe they may have been exposed to infection with HIV in their personal life or during the course of their work must seek medical advice and, if appropriate, diagnostic HIV testing.'

Government funding of the leading Aids charity, the Terrence Higgins Trust, is to be reduced by two- thirds. The charity said yesterday that it faced a cut in grant from pounds 450,000 to pounds 150,000 - equal to 10 per cent of its budget - over the next three years, yet it was assisting an increasing number of people.

Nick Partridge, chief executive of the trust, criticised the move. 'We now face the immensely difficult task of maintaining our vital services with progressively less support from the Government.

'This news comes just three days after the preliminary results of the AZT drug trial, which highlighted the absence of effective drugs for people who are currently well and living with HIV, sadly confirming the continued need for our services for many years to come,' he said.

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