Presidential Advisory Council on HIV/AIDS Supports Call for New CDC Infected Health Care Worker Guidelines
"The CDC policy [regarding health care workers infected with HIV] reflects a failure to provide clear leadership on this politically sensitive public health issue," Todd Summers of the Presidential Advisory Council on HIV and AIDS writes in a letter to the Journal of the American Medical Association (Summers, JAMA, 2/21). Summers is responding to an Oct. 18 JAMA article by
Lawrence Gostin of the Georgetown University Law Center that called for a revision of the 1991 CDC guidelines that "recommend that infected health care workers be reviewed by an expert panel and inform patients of their serologic status before engaging in exposure-probe procedures." Gostin wrote that data supports that the risk of HIV transmission in a health care setting is "exceedingly low" and that the CDC guidelines place "significant human rights burdens on HCWs" but do not improve patient safety. He championed a new policy that would focus on "management of the workplace environment and injury prevention" by using "standard (universal) precautions," such as the use of barrier protection like gloves, gowns and face protection; cleaning, disinfecting and sterilizing patient-care equipment and environmental surfaces; and infection control training in professional schools and health care environments. He also argued that it should not be "legally mandated" that health care workers disclose their HIV status, because "HIV is a highly personal and sometimes stigmatic health condition that usually has little relevance to patient safety" (Gostin, JAMA, 10/18). Summers writes that the "Presidential Advisory Council on HIV and AIDS has repeatedly called on the CDC, the secretary of Health and Human Services, and the president to use public health science as the basis for federal AIDS policy decisions" instead of "political exigencies." He concludes that Gostin's proposal "merits serious discussion" because "the outdated health care worker guidelines evidence a paralysis within the federal government that dramatically impinges on U.S. efforts to slow the spread of HIV" (JAMA, 2/21). In an accompanying response, Gostin writes that he "appreciate[s] the Presidential Advisory Council's strong stand for reform" of the guidelines and points out that Summers raises "an issue of general importance." He asks, "Why do public health agencies sometimes place political considerations above science?" Gostin writes that he is a "strong supporter of the CDC's work" and that the CDC should "urge policy based on science and leave it to the elected branches of government to make political judgements" (Gostin, JAMA, 2/21).
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