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Mandatory testing of health care workers for hiv: is it a relic of the past?

Mandatory testing of health care workers for hiv: is it a relic of the past?

Currently the petition is under consideration by the Russian Supreme Court seeking invalidation of pre-employment and post-employment (once a year) mandatory HIV testing for health professionals working with patients in surgical wards.

The petition was filed by Andrey Starchenko, MD, the Director of the National Agency for the Safety of Patients and Independent Medical Examination. According to the expert, Rospotrebnadzor until now have not cited a single case of a patient contracting HIV from a healthcare provider. At the same time, significant budgets are spent on the regular testing of HCPs, whereas the "problems with HIV in Russia are of a different nature."

We have tried to look into the matter and find out whether mandatory HIV testing of health care workers is an outdated requirement, or if this extra precaution measure would never hurt?

Today, the mandatory HIV testing for certain categories of HCPs is stipulated by the Federal Law №38 "On the Prevention of HIV Spread in the Russian Federation" dated 30.03.1995 (revised on 06.04.2014). A list of these categories was approved by the Government Decree №877 dated 04.09.1995 and includes health professionals who deal with HIV-infected material or biomaterials derived from HIV-infected individuals.

In addition, in accordance with the Resolution of the Chief State Sanitary Physician №1 "On approval of the provision pertaining to prevention of HIV transmission" dated 11.01.2011, the HCPs working with patients in surgical units are subject to pre-employment and post-employment (once a year) testing. However, some lawyers argue that these sanitary regulations cannot be applied since the Federal Law №38 refers directly to the Resolution of the Russian Government but not any other legislative act.

"It should be borne in mind that those who work with HIV-infected patients are examined not to prevent virus transmission. This is done with a sole purpose to prove or disprove the fact of infection being contracted at the workplace, since this can lead to a number of legal consequences (e.g. damages suit, etc.)", explains professor Vadim Pokrovsky, MD the Head of the Federal Scientific and Methodology Center for AIDS Prevention.

According to expert, the idea of mandatory HIV testing emerged in the 90-s as sign of fear and, to a certain degree, as an evidence of stigmatization of HIV-positive people.

"It is easy to imagine, for example, that the blood of an HIV-positive surgeon who cut his hand can get into patient’s abdominal cavity. Although there have been no single case of a patient being infected during surgery so far, just thinking along these lines may cause fear and justify the need for testing. But the existing legislation does not provide for any employment restrictions for HIV-positive citizens", says Pokrovsky.

Another common argument in favor of mandatory testing is a formal expansion of the groups that need to undergo HIV testing. "Of course, the health care workers are always there and not going to run from you as opposed to the drug users", ironically adds the expert. This situation is possible due to the fact that the priority target for the Ministry of Health is not so much the prevention, but rather identifying and treating those who have already been infected with the virus.

"Therefore, the current law is against mandatory testing of health care workers (except those who work directly with HIV-positive patients). But the debate about the need to test other categories of HCPs will continue even after the positive court decision, and attempts will be made to revise it. As for me, I support voluntary HIV testing. And recommend that anybody would have it done ", sums up the expert.

The fact that these rules should have been revisited long ago is also evident to Elena Romanyak, a  member of the "ESVERO" non-profit partnership council, a member of the Regional Network of Legal Support for People Affected by HIV / AIDS.

"From the standpoint of effective prevention and human rights, the compulsory testing of the  medical staff across the board is really inefficient and quite expensive, and does not change the overall situation relating to HIV / AIDS epidemic in Russia, - said the lawyer. - Let me remind you, that the experience of many countries shows that mandatory testing does not motivate people, but instead, puts them at risk of discrimination if they test positive, provokes the fear of being fired, and so on. That is why surgeons committed to many years of training and professional growth, do not wish for their HIV-positive status to be known at work. "

At the same time, those who represent the groups listed in the Resolution who refused to be tested are subject to disciplinary action, that is, they may be dismissed by the administration.

"Certainly, our legislation provides for transfer to another position where the direct contact with HIV-infected  individuals would not occur, but in practice it may not be as smooth as it is written in the legal acts, - says Elena Romanyak. - I think that, compliance with the safety rules and regulations that exist for the operating room personnel makes the issue of HIV transmission virtually non-existent in the XXI century. In other words, we fully support this petition."

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