HIV in Filipino HCWs 4 VOL. 49 NO. 4 2015 ACTA MEDICA PHILIPPINA ______________ Corresponding author: Edsel Maurice T. Salvana, MD, DTM&H, FIDSA Institute of Molecular Biology and Biotechnology National Institutes of Health University of the Philippines Manila 625 Pedro Gil St. Ermita, Manila 1000 Philippines Telephone: +632 5251062 Email: edsel.salvana@gmail.com HIV in the Filipino Healthcare Worker: A Way Forward Edsel Maurice Tanghal Salvana 1,2 and Rontgene M. Solante 3,4 1 Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila 2 Section of Infectious Diseases, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila 3 San Lazaro Hospital, Department of Health 4 Department of Medicine, Medical Center Manila A diagnosis of HIV infection is one of the most devastating events for a person in his lifetime. A diagnosis of HIV is doubly crushing for a health care worker. A healthcare worker (HCW) does not only have to worry about his own health, but needs to know whether he can continue practicing his chosen profession. As the HIV epidemic works its way through the Filipino population, an increasing number of doctors, nurses, and other HCWs find themselves infected with the virus. 1 The question then arises whether safety can be assured if these HCWs living with HIV continue to care for patients. Due to the severe stigma associated with HIV in the Philippines, an emotional and even hysterical response has historically predominated. 2 Reports of HIV-positive medical students being asked to leave medical school, or declare for a non-clinical specialty are common, and do not take into account the actual risk to patients and the inherent human rights of these HCWs to practice their profession. Advances in antiretroviral treatment and our understanding of viral transmission dynamics has shown a way forward. In 2010, the Society for Healthcare Epidemiology of America released a document for the HCW infected with a blood-borne pathogen. 3 It included guidance for hepatitis B, hepatitis C and HIV. For the purposes of this review, we will only tackle the applicability of these guidelines for HIV to the Philippine setting. In addition, the United Kingdom recently rescinded its ban on HIV-infected physicians performing exposure-prone procedures last April 2014 as a result of extensive consultations with experts and HCWs. 4 In response to this announcement, Australia has circulated a draft of an update to its guidelines seeking to lift their own ban and move forward with a framework for patient safety. 5 Rationale for the approach While most physicians and other HCWs are generally looked up to by society as highly ethical and beneficent human beings, the high stakes involved when an HCW is diagnosed with HIV can preclude adequate testing behavior despite the presence of risk factors. Moreover, even if a diagnosis is made, the strict confidentiality laws of the Philippines (Republic Act 8504) that are meant to protect the privacy of individuals can serve as a shield for the HCW to not disclose his or her status to hospital authorities due to fear of curtailment of privileges and outright expulsion. The privilege to practice medicine is a hard-won goal of a lifetime, and the fear of losing one's livelihood and vocation can lead to nondisclosure, which in the long run puts patients at a much higher risk for infection. The benefits of adequate HIV testing for HCWs are three-fold: it ensures early intervention with antiretrovirals which can restore life expectancy of the HCW if given early; it lowers the risk of transmitting HIV to a patient; and it allows the HCW to continue practicing medicine in a reasonably safe manner. 3,6-8 The argument to just mandatorily test all HCWs for HIV prior to allowing them practice is not only illegal, it is inherently discriminatory, and can lead to high-risk HCWs into going underground or deceiving the system, which in the end will compromise patient safety. Rather, with the assumption that HCWs are beneficent persons, the impetus should be that all HCWs who practice medicine and have risk factors for HIV, whether through sexual or occupational exposure, are ethically obligated to know their HIV status, since the crux of the privilege to practice medicine is to improve, and not to further compromise, a patient's health. 3 SPECIAL ARTICLE