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As an HIV positive health care worker do I have to disclose?

Apr 1, 2012

Hi. I'm a medical professional and newly diagnosed with HIV. I'm actually a resident. I'm wondering what the laws are in regard to whether I have to disclose my status to my residency program and to the state medical board? I do very few procedures that require needles. I'm scared of losing my career for which I've worked so hard to obtain. If you disclose your status to patients, you won't have any patients. It seems as if HIPAA, ADA, and the privacy laws apply to everyone except medical professionals.

Response from Ms. Douaihy

Thank you for asking whether, as a health care worker, you have a duty to disclose your status.

In general, according to case law and professional practice guidelines, health care workers have a duty to inform patients or employers that they are HIV positive if they perform invasive or "exposure-prone" procedures on patients. Specific guidelines are set out in the American Medical Association's "Guidance for HIV-Infected Physicians and other Health Care Workers", 2011. (H-20.912).

In pertinent part the guidelines say: "Patient Care Duties: A physician or other health care worker who performs exposure-prone procedures and becomes HIV-positive should disclose his/her serostatus to a state public health official or local review committee. An HIV- infected physician or other health care worker should refrain from conducting exposure-prone procedures or perform such procedures without permission from the local review committee and the informed consent of the patient."

Regarding confidentiality and discrimination, the guidelines go on to say: "AMA expresses its commitment to HIV -infected physicians concerning confidentiality of HIV serostatus, protection against discrimination, involvement in legislation affecting HIV- infected physicians, financial support through such means as insurance disability guidelines, and assistance with alternative careers through its Physician Health Program. Our AMA believes the confidentiality of the HIV- infected physician should be protected as with any HIV patient. Knowledge of the health care worker's HIV serostatus should be restricted to those few professionals who have a medical need to know. Except for those with a need to know, all information on the serostatus of the health care worker must be held in the strictest confidence."

So the answer to your question really turns on the nature of your work, i.e. whether you perform "exposure prone" procedures. There is no bright line rule on what qualifies as "exposure prone" or under what circumstances an employee constitutes a "direct threat" -- these inquiries are very fact specific.

As you suggest in your question, limiting the employment and civil rights of HIV positive health care workers has a stigmatizing effect. This can perpetuate unfounded fear and HIV animus especially considering the plethora of medical studies that show the actual risk of transmission in the heath care environment is remote.

If you choose to disclose your status to your employer, it may be wise to review the laws that protect you against discrimination and protect your confidentiality. I wish you all the best in your residency and thank you for writing with this important question.

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