Key Points
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Considers the position of HIV-infected dentists in the UK from a legal and philosophical viewpoint.
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Highlights the potential exposure to litigation of HIV-infected dentists if allowed to continue to work.
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Considers public awareness of HIV infection and the implications for consent to treatment by HIV-infected dentists.
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Confirms the professional difficulties of HIV-infected dentists in the UK.
Abstract
In 1991, the United Kingdom Advisory Panel (UKAP) was set up under the aegis of the Expert Advisory Group on AIDS (EAGA) to consider individual cases of HIV infected healthcare workers.1 Policy and guidance relating to HIV infected healthcare workers is set out in a Department of Health report.2 Although more recently the EAGA has advised that an HIV positive dentist may under certain conditions provide clinical treatment for patients who are also HIV positive,3 the advice from UKAP relating to exposure-prone procedures means, in effect, that dentists who become HIV positive must cease contemporary clinical dentistry. The plight of dentists who become HIV positive and face this situation has been poignantly described as '...the dental practice equivalent of clearing your desk and being escorted off the premises.'4
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References
Health Protection Agency. UK Advisory Panel for healthcare workers infected with blood-borne viruses (UKAP) Web page.
HIV infected Health Care Workers: Guidance on Management and Patient Notification. Department of Health Annual Report August 2005 (replacing 1998 version).
The report from the Expert Advisory Group on AIDS (EAGA) 1 January 2006 to 31 December 2006.
Hancocks S . Losing your livelihood just twenty minutes from now. Br Dent J 2006; 201: 485.
Ciesielski C A, Marianos D W, Schochetman G, White J J, Jaffe H W . The 1990 Florida Dental Investigation: the press and the science. Ann Intern Med 1994; 121: 886–888.
Ou C Y, Ciesielski C A, Myers G, Bandea C I, Luo C C et al. Molecular epidemiology of HIV transmission in a dental practice. Science 1992; 226: 1165–1171.
Centers for Disease Control. Possible transmission of human immunodeficiency virus to a patient during an invasive dental procedure. MMWR Morb Mortal Wkly Rep 1990; 39: 489–493.
Lot F, Séguier J C, Fégueux S, Astagneau P, Simon P et al. Probable transmission of HIV from an orthopaedic surgeon to a patient in France. Ann Intern Med 1999; 130: 1–6.
Mallolas J, Arnedo M, Pumarola T, Erice A, Blanco J et al. Transmision of HIV-1 from an obstetrician to a patient during a caesarean section. AIDS 2006; 20: 285–287.
Goujon C P, Schneider V M, Grofti J, Montigny J et al. Phylogenic analysis indicate an atypical nurse-to-patient transmission of human immunodeficiency virus type 1. J Virol 2000; 74: 2525–2532.
Yazdanpanah Y, Sisoko D, Egger M, Mouton Y, Zwahlen M . Clinical efficacy of antiretroviral combination therapy based on protease inhibitors or non-nucleoside analogue reverse transcriptase inhibitors: Indirect comparison of controlled trials. BMJ 2004; 328: 249.
Jocelyn Elder's foreword to Webber D W. AIDS and the Law (New York Aspen 1997). As reported in HIV/AIDS and European Human Rights Law. Bob Watt European Human Rights Law Review 2000.
HIV/AIDS and European Human Rights Law. Bob Watt European Human Rights Law Review 2000 p 54.
Watts v High Quality Lifestyles Ltd [2006] All ER (D) 216 Apr.
The Federal Rehabilitation Act of 1973.
Americans with Disabilities Act (ADA) 1990.
The legal protection of HIV+ve healthcare workers and the human rights jurisprudence of the European Court of Justice. Bob Watt. European Human Rights Law review 1998.
Scoles v Mercy Health Corporation of Southeastern Pennsylvania Civ. A. No 92-6712 Dec 8 1994.
Waddell v Valley Forge Dental Associates 276 F.3d 1275: 12 A D.Cas. (BNA) 1029 (11th Cir. 2001).
Scully C, Porter S R . Can HIV be transmitted from dental personnel to patients by dentistry? Br Dent J 1993; 175: 381–382.
Robinson P, Challacombe S . Transmission of HIV in a dental practice – the facts. Br Dent J 1993; 175: 383–384.
Robert L M, Chamberland M E, Cleveland J L, Ruthanne M, Goocg B F et al. Investigations of patients of healthcare workers infected with HIV: the centres for disease control and prevention database. Ann Intern Med 1995; 122: 653–657.
C Scully, Greenspan J S . Human Immunodeficiency Virus (HIV) in dentistry. J Dent Res 2006; 85: 794–800.
Irwin D J, Millership S . Description of an HIV patient notification exercise in Essex Involving a dental healthcare worker. Commun Dis Public Health 2002; 5: 276–281.
Jaffe H W, McCurdy J M, Kalish M L, Liberti T, Metellus G et al. Lack of HIV transmission in the practice of a dentist with AIDS. Ann Intern Med 1994; 121: 855–859.
Centers for Disease Control and Prevention. Investigation of patients treated by and HIV-infected cardiothoracic surgeon – Israel 2007. MMWR Morb Mortal Wkly Rep 2009; 57: 1413–1415.
Vernazza P, Hirschel B, Bernasconi E, Flepp M . Les personnes séropositives ne souffrant d'aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bull Med Suisses 2008; 89: 165–169 [in French].
Beijing Declaration 2009. The Mouth and AIDS. The Global Challenge. April 2009 Beijing.
Lewis K. Unacceptable treatment. Br Dent J 2006; 201: 687.
Martin M V . Illogical guidance. Br Dent J 2006; 201: 687.
HIV positive dentists permitted to practice in Europe. Br Dent J 2009; 206: 119.
Hancocks S . Blood-borne one year on. Br Dent J 2007; 203: 439.
R v Konzani [2007] CFLQ.
R V Dica [2004] EWCA Crim 1103 [2004] QB.
Dodds C, Weatherburn P, Hickson F, Keogh P, Nutland W . Grievous harm? Use of the Offences Against the Person Act 1861 for sexual transmission of HIV. Briefing paper. p 2.
COSHH regulations 2002 reg.2 (1)(a),(c).
Martin R . Public health and the scope of potential liability in tort. P N 2005; 21: 55.
Bennett D . Litigating hospital acquired MRSA as a disease. J P I Law 2004; 3: 197–208.
Plowden S, Volpe H . Fairchild and Barker in MRSA cases: do Fairchild and Barker provide an argument for a relaxation of causation principles in claims for hospital acquired MRSA? J P I Law 2006; 3: 259–265.
Junor G . Spreading MRSA – with liability? S L T 2008; 30: 201–204.
Miller v Greater Glasgow Health Board [2008] CSOH 2008 WL 203 3437.
Common law claims based on 'fear of AIDS' L. Camille Herbert Employee Privacy Law Database updated Nov 2008. Part V Medical screening in the Workplace. Ch 11 AIDS and HIV testing V. Common Law Challenges to Employer Use of HIV testing and Employer Discrimination Based on AIDS.
Brown v New York City Health & Hosps Corp., 225 A D.2d 36: 648 N Y S.2d 880 (1986).
Simms V Comprehensive Community Dev Corp., 40 A D.3d 256: 835 N Y S.2d [1st Dept. 2007].
Taormino v State of New York 286A D.2d 490: 729 N Y S. 2d 757 [2nd Dept. 2001].
Lombardo v New York University Medical Center 232 A D.2d 459: 648N Y.A D. 2 Dept 1996.
Damanti v Jamaica Community Adolescent program 12 A D.3d 341: 784 N Y.S 2d 570.
Ornstein v New York City Health and Hospitals Corp.10 N Y.3d, 881 N E.2nd 1187 N Y.2008.
Faya v Almarez 329 Md. 435: 620 A.2d 327 (1993).
Kerins v Hartley, 27 Cal.App. 4th1062: 33 Cal. Rptr.2d 172(2nd Dist 1994).
K A C. v Benson, 527 N W.2d 553: 59 A L R. 5th 853 (Minn. 1995).
Vanessa Grabauskas v Johnson & Wales University 2004 WL 5576602 Superior Court of Rhode Island.
Pamplona v Detmer 2004 WL 5539191.
DeMilio v Schrager, 666 A.2d 627: 636 N J. Super. L 1995, Pamplona v Detmer 2004 WL 5539191.
Dollar Inn, Inc v Stone 695 N E.2d 185 Ind.App., 1998.
Madrid V Lincoln County Med Ctr., 1996 NMSC 49: 923 P.2d 1154: 122 N M. 269 (N M. 1996).
Hartwig v Oregon Trail Eye Clinic et al., 254 Neb. 777: 580 N W.2d 86.
John & Jane Roes 1–100 v FHP Inc 91 Hawai'I 470: 985 P 2d 661.
Doe v Northwestern University 289 Ill. App.3d 682 N E. 2d 145.
Brzoska v Olsen, 668 A.2d 1355 (Del 1995).
Mason K, Laurie G . Mason & McCall Smith's law and medical ethics, 7th ed. p 307. Oxford University Press, 2006.
Mason K, Laurie G . Mason & McCall Smith's law and medical ethics, 7th ed. p 35. Oxford University Press, 2006.
Airdale NHS Trust v Bland [1993] AC 789.
Re T [1993] Fam 95,.
Sidaway v Board of Governors of the Bethlehem Royal Hospital [1984] QB 493.
Reid v Hughes (1980). 114 DLR (3d) 1.
Rogers v Whittacker (1992). 109.
Smith v Tunbridge Wells Health Authority [1994] 5 Med LR.
McAllister v Lewisham and North Southwark Health Authority, Newell v Goldenberg [1995] 6 Med LR 371.
Pearce v United Bristol Healthcare NHS Trust (1999).48BMLR 118.
Mason K, Laurie G . Mason & McCall Smith's law and medical ethics, 7th ed. p 407. Oxford University Press, 2006.
Smith v Salford Health Authority (1994). 23 BMLR 137.
Smith v Barking, Havering and Brentwood Health Authority [1994] 5 Med LR 285.
Schafer S . AIDS: the social dimension. In Overall C, Zion W P (eds). Perspectives on AIDS. Ethical and social issues. p 3. Oxford University Press, 1991.
Almond B . Personal issues and personal dilemmas. In: AIDS: a moral issue. The ethical, legal and social aspects. Vhps Distribution, 1990.
Bickenbach J E . AIDS and disability. In Overall C, Zion W P (eds). Perspectives on AIDS. Ethical and social issues. pp 13–14. Oxford University Press, 1991.
Fry D E . Occupational risks of blood exposure in the operating room. Am Surg 2007; 73: 637–646.
Zazzali M E . HIV infected health care workers who perform invasive, exposure-prone procedures: defining the risk and balancing the interests of health care workers and patients. Seton Hall Law Rev 1998; 28: 1000–1045.
Trends in misconceptions about HIV transmission. Kaiser public opinion spotlight. http://www.kff.org.
Terrence Higgins Trust. Survey highlights shocking ignorance about HIV, 25 years after death of Terry Higgins. [Press release]. London: Terrence Higgins Trust, 2007. http://www.tht.org.uk/mediacentre/pressreleases/2007/july/july4.htm.
National AIDS Trust. Our Thinking: Public Understanding.
Graham J . 'The Biases of Public Perception'. SRA-Europe Meeting, University of Surrey, Guildford.
Pell J, Gruer L, Christie P, Goldberg D . Management of HIV infected health care workers: lessons from three cases. BMJ 1996; 312: 1150–1152.
H (A Healthcare Worker) v Associated Newspapers Ltd, H (A Healthcare Worker) v N (A Health Authority) [2002] EWCA Civ 195.
H v. Associated Newspapers Limited and H v. N Health Authority. Confidentiality: publication of details relating to HIV affected healthcare workers identity. Med Law Rev 2003; 11: 124–128.
Napoli C, Tato D, De Benedittis M et al. A survey of preventive measures against infection risk in dental surgery. Ig Sanita Pubbl 2005; 61: 261–269.
Travaglini P, Shahaj L, Durante S, DeLuca A et al. Risk perception in a group of dentists from Abruzzo. G Ital Med Lav Ergon 2007; 29 (3 Suppl): 719–720.
Crossley M L . An investigation of dentists' knowledge, attitudes and practices towards HIV+ and patients with other blood-borne viruses in South Cheshire. Br Dent J 2004; 196: 749–754.
Crossley M L . A qualitative exploration of dental practitioners' knowledge, attitudes and practices towards HIV+ and patients with other high risk groups. Br Dent J 2004; 197: 21–26.
Worthington M G H, Ross J J, Bergeron E K . Post-traumatic stress disorder after occupational HIV exposure: two cases and a literature review. Infect Control Hosp Epidemiol 2006; 27: 215–217.
Kaye v Robertson [1991] F S R. 62.
X v Y [1988] 2 All E R. 648.
Re D unreported, CO/3369/97 November 17: 1997 as reported in; The legal protection of HIV positive healthcare workers and the human rights jurisprudence of the European Court of Justice. Bob Watt. European Human Rights Law review 1998 p 62.
HR/PUB/98/1 (Geneva; U N. 1998).
Tuboku-Metzger J, Chiarello L, Sinkowitz-Cochran R L, Casano-Dickerson A, Cardo D . Public attitudes and opinions toward physicians and dentists infected with blood-bourne viruses: results of a national survey. Am J Infect Control 2005; 33: 299–303.
Blatchford O, O'Brien S J, Blatchford M, Taylor A . Infectious healthcare workers: should patients be told. J Med Ethics 2000; 26: 27–33.
Hollingsworth T D, Anderson R M, Fraser C . HIV-1 transmission, by stage of infection. J Infect Dis 2008; 198: 687–693.
Quinn T C, Wawer M J, Sewankambo N, Serwadda D et al. Viral load and heterosexual transmission of human immunodefficiency virus type1 Rakai Project study group. N Engl J Med 2000; 342: 921–929.
Bailey J R, Sedaghat A R, Kieffer T, Brennan T et al. Residual human immunodeficiency virus type 1 viraemia in some patients on antiretroviral therapy is dominated by a small number of invariant clones rarely found in circulating CD4+ T cells. J Virol 2006; 80: 6441–6457.
Sahu G K, Paar D, Frost S D, Smith M M et al. Low-level plasma HIVs in patients on prolonged suppressive highly active antiretroviral therapy are produced mostly by cells other than CD4 T Cells. J Med Virol 2008; 81: 9–15 (Epub).
Scully C, Greenspan J S . Human Immunodeficiency Virus (HIV) transmission in dentistry. J Dent Res 2006; 85: 794–800.
Barber H D, Upton L G . Evaluation of surgical gloves for perforation following oral & maxillofacial surgery. Oral Surg Oral Diagn 1992; 3: 49–50.
Tanner J, Parkinson H . Double gloving to reduce surgical cross-infection. Cochrane Database Syst Rev 2006; 3: CD003087.
Florman S, Burgdorf M, Finigan K et al. Efficacy of double gloving with an intrinsic indicator system. Surg Infect (Larchmt) 2005; 6: 385–395.
Avery C M, Gallagher P, Birnbaum W . Double gloving and a glove perforation indication system during the dental treatment of HIV positive patients: are they necessary? Br Dent J 1999; 186: 27–29.
General Dental Council. Standards for dental professionals. May 2005. http://www.gdc-uk.org.
Tumin W, Bagg J . Achieving balance. Br Dent J 2006; 201: 740–741.
Weller I, Williams I . Clinical review ABC of AIDS Antiretroviral drugs. BMJ 2001; 322: 1410–1412.
Hall C . Dentist killed by AIDS may have infected patients. The Independent 1995 January 11.
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Williams, M. The HIV positive dentist in the United Kingdom - a legal perspective. Br Dent J 207, 77–81 (2009). https://doi.org/10.1038/sj.bdj.2009.608
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DOI: https://doi.org/10.1038/sj.bdj.2009.608
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